Leichtle Stefan, Murphy Patrick, Nahmias Jeffry, Bruns Brandon, Agapian John, Smith Sawyer, Kim Phillip, Dowzicky Phillip, Haddad Diane, Adams Raeanna C, Hu Parker, Ayung Chee Patricia, Crandall Marie, Martin R Shayn, Staudenmayer Kristan
From the Division of Trauma and Acute Care Surgery (S.L.), University of Virginia School of Medicine, Inova Fairfax Medical Campus, Falls Church, VA; Division of Trauma and Acute Care Surgery (P.M.), Medical College of Wisconsin, Milwaukee, WI; Division of Trauma, Burns, Critical Care and Acute Care Surgery (J.N.), University of California Irvine, Orange, CA; Division of Trauma and Acute Care Surgery (B.B.), University of Texas Southwestern Medical Center, Dallas, TX; Division of Acute Care Surgery (J.A.), Loma Linda University, Loma Linda, CA; Division of Trauma, Acute Care Surgery and Surgical Critical Care (S.S.), University of California Davis, Sacramento, CA; Department of Surgery (P.K.), Emory University School of Medicine, Atlanta, GA; Division of Trauma and Acute Care Surgery (P.D.), University of Chicago; Department of Surgery (D.H.), University of Pennsylvania Health System, Philadelphia, PA; Division of Acute Care Surgery (R.C.A.), Vanderbilt University Medical Center, Nashville, TN; Department of Surgery (P.H.), Chippenham Hospital, Richmond, VA; Department of Surgery (P.A.C.), Morehouse School of Medicine, Atlanta, GA; Department of Surgery (M.C.), MetroHealth, Cleveland, OH; Department of Surgery (R.S.M.), Wake Forest School of Medicine, Wake Forest, NC; and Division of General Surgery (K.S.), Stanford University School of Medicine, Stanford, CA.
J Trauma Acute Care Surg. 2025 Apr 1;98(4):667-672. doi: 10.1097/TA.0000000000004470. Epub 2024 Nov 13.
The Healthcare Economics Committee of the American Association for the Surgery of Trauma has published a series of three articles on the topic of value in acute care surgery (ACS). In this series, the key elements of value, cost and outcomes, and the impact of stakeholder perspective on what constitutes high-value care are discussed. The fourth article in this series continues the discussion by focusing on the unique economic value that an ACS service brings to a hospital system and its patients. Characterized by the immediate 24-hour availability of surgeons trained in trauma management, emergency general surgery, and surgical critical care, acute care surgeons extend the benefits of surgical rescue and critical care to all hospitalized patients. As such, an ACS service acts as a vital part of a hospital's infrastructure to successfully care for complex and seriously ill patients, in addition to enabling the establishment of other, high revenue-generating services such as vascular, transplant, and complex oncologic surgery programs. The trauma service acts as intake for patients that lead to downstream revenue creation by other disciplines such as orthopedic and neurological surgery, while trauma center designation itself results in dedicated state funding to ensure trauma readiness in many states in the United States. The traditional "value equation" in health care of outcomes achieved per dollar spent is ill-suited to capture many of these unique aspects and benefits of ACS. This article provides the background to understand the economic value of an ACS service and future directions toward improving overall value of care.
美国创伤外科协会医疗保健经济委员会发表了一系列共三篇关于急性护理手术（ACS）价值主题的文章。在这个系列中，讨论了价值、成本和结果的关键要素，以及利益相关者视角对构成高价值护理的影响。本系列的第四篇文章通过关注ACS服务给医院系统及其患者带来的独特经济价值继续进行讨论。急性护理外科医生的特点是随时有接受过创伤管理、急诊普通外科和外科重症监护培训的外科医生，他们将手术救援和重症监护的益处扩展到所有住院患者。因此，ACS服务是医院基础设施的重要组成部分，除了能够建立其他高收入的服务项目，如血管、移植和复杂肿瘤外科项目外，还能成功护理复杂和重症患者。创伤服务为患者提供了入口，这些患者会带来其他学科（如骨科和神经外科）的下游收入创造，而创伤中心的指定本身会带来专门的州资金，以确保美国许多州的创伤准备就绪。医疗保健中传统的“价值等式”，即每花费一美元所取得的结果，并不适合捕捉ACS的许多这些独特方面和益处。本文提供了理解ACS服务经济价值的背景以及提高整体护理价值的未来方向。
