Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA.
Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA.
J Crit Care. 2020 Dec;60:84-90. doi: 10.1016/j.jcrc.2020.04.002. Epub 2020 Jul 5.
We examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care.
2811 EGS-capable hospitals were surveyed to examine structures and processes including critical care domains and ACS implementation. Differences between ACS and GSOC hospitals were compared using appropriate tests of association and logistic regression models.
272/1497 hospitals eligible for analysis (18.2%) reported they use an ACS model. EGS patients at ACS hospitals were more likely to be admitted to a combined trauma/surgical ICU or a dedicated surgical ICU. GSOC hospitals had lower adjusted odds of having 24-h ICU coverage, in-house intensivists or respiratory therapists, and 4/6 critical-care protocols.
Critical care delivery is a key component of EGS care. While harnessing of critical care structures and processes varies across hospitals that have implemented ACS, overall ACS models of care appear to have more robust critical care practices.
我们研究了在急诊普通外科（EGS）治疗中采用急性外科手术（ACS）与普通外科随叫随到（GSOC）模式的医院之间，在重症监护结构和流程方面的差异。
对 2811 家有 EGS 能力的医院进行了调查，以检查包括重症监护领域和 ACS 实施情况在内的结构和流程。使用适当的关联检验和逻辑回归模型比较 ACS 和 GSOC 医院之间的差异。
在可分析的 1497 家医院中有 272 家（18.2%）报告称他们采用了 ACS 模式。ACS 医院的 EGS 患者更有可能被收治到联合创伤/外科重症监护病房或专门的外科重症监护病房。GSOC 医院在调整后的 24 小时 ICU 覆盖、内部重症监护医生或呼吸治疗师以及 4/6 项关键护理方案方面的可能性较低。
重症监护的实施是 EGS 治疗的一个关键组成部分。尽管采用 ACS 的医院在重症监护结构和流程的利用方面存在差异，但 ACS 整体护理模式似乎具有更完善的重症监护实践。
