Ingraham Angela M, Chaffee Scott M, Ayturk M Didem, Heh Victor K, Kiefe Catarina I, Santry Heena P
Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI.
Department of Surgery, The Ohio State University, 395 W 12 Avenue, Columbus, OH.
Ann Surg Open. 2021 Mar;2(1):e043. doi: 10.1097/as9.0000000000000043. Epub 2021 Feb 18.
Despite three million adults in the United States (US) being admitted annually for emergency general surgery (EGS) conditions, which disproportionately affect vulnerable populations, we lack an understanding of the barriers to round-the-clock EGS care. Our objective was to measure gaps in round-the-clock EGS care.
From August 2015 to December 2015, we surveyed all US-based, adult acute care general hospitals that have an emergency room and ≥1 operating room and provide EGS care, utilizing paper and electronic methods. Surgeons or chief medical officers were queried regarding EGS practices.
Of 2,811 hospitals, 1,634 (58.1%) responded; 279 (17.1%) were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and non-teaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for lacking round-the-clock EGS care (n=162; 58.1%). However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care.
We found significant gaps in access to EGS care, often attributable to workforce deficiencies.
尽管美国每年有300万成年人因急诊普通外科（EGS）疾病入院，这些疾病对弱势群体的影响尤为严重，但我们对全天候EGS护理的障碍缺乏了解。我们的目标是衡量全天候EGS护理方面的差距。
2015年8月至2015年12月，我们采用纸质和电子方式，对美国所有设有急诊室且有≥1间手术室并提供EGS护理的成人急性护理综合医院进行了调查。就EGS实践向外科医生或首席医疗官进行了询问。
在2811家医院中，1634家（58.1%）做出了回应；279家（17.1%）无法始终提供全天候EGS护理。农村地区、床位规模较小以及非教学医院与无法提供全天候护理有关。外科医生覆盖不一致是缺乏全天候EGS护理的主要原因（n=162；58.1%）。然而，缺乏紧急病例分级预订系统、夜间无麻醉可用以及EGS值班无津贴也与无法提供全天候EGS护理有关。
我们发现EGS护理的可及性存在显著差距，这通常归因于劳动力不足。
