Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Am J Surg. 2018 Dec;216(6):1076-1081. doi: 10.1016/j.amjsurg.2018.08.023. Epub 2018 Sep 8.
Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals.
The American Hospital Association (AHA) Annual Survey of Hospitals database was queried to identify acute care general hospitals. A hybrid mail/electronic survey was sent to 2811 acute care hospitals that met the inclusion criteria of hospitals that care for adult patients (≥18 years old) with an emergency room (ER), ≥ 1 operating room (OR), and 24-h ER access. Hospitals were queried on whether they utilized an ACS model. The workforce composition among ACS and non-ACS hospitals was evaluated using X tests, t tests, and Wilcoxon rank-sum tests.
Survey response was 60% (N = 1690). ACS hospitals had a higher proportion of emergency surgeons who were female (20% vs. 14%, p < 0.0001), newly-trained (17% vs 10%, p < 0.0001), critical care trained (78% vs. 31%, p < 0.0001), and who had an additional degree (35% vs. 13%, p < 0.0001). More ACS hospitals had 24/7 in-house OR nursing staff (72% vs. 15%, p < 0.0001) and ancillary staff.
ACS and non-ACS hospitals differ in their surgical workforce. It is clear that ACS hospitals have more human capital, which suggests that ACS hospitals may require more dedicated resources compared to non-ACS hospitals.
急性护理外科（ACS）的提出是为了应对普通外科医生劳动力危机；然而，ACS 劳动力的构成情况尚不清楚。进行了一项全国性调查，以确定 ACS 和非 ACS 医院之间的急诊普通外科（EGS）劳动力之间的差异。
查询美国医院协会（AHA）年度医院调查数据库，以确定急性护理综合医院。向符合纳入标准的 2811 家急性护理医院发送了混合邮件/电子调查，这些医院收治成年患者（≥18 岁），有急诊室（ER）、≥1 个手术室（OR）和 24 小时 ER 通道。调查医院是否采用 ACS 模式。使用 X 检验、t 检验和 Wilcoxon 秩和检验评估 ACS 和非 ACS 医院之间的劳动力构成。
调查回应率为 60%（N=1690）。ACS 医院中女性急诊外科医生的比例更高（20%比 14%，p<0.0001），新培训（17%比 10%，p<0.0001）、重症监护培训（78%比 31%，p<0.0001）和拥有额外学位（35%比 13%，p<0.0001）的比例更高。更多的 ACS 医院拥有 24/7 内部 OR 护理人员（72%比 15%，p<0.0001）和辅助人员。
ACS 和非 ACS 医院的外科劳动力存在差异。很明显，ACS 医院拥有更多的人力资本，这表明与非 ACS 医院相比，ACS 医院可能需要更多的专用资源。
