title: What price for general surgery?
abstract: This study aims to determine the cost-benefit analysis of adding a full emergency general surgery (EGS) arm to a trauma/critical care (TCC) service with limited EGS activity in a Level I trauma center.
  
  
  
  Data on the composition, activity, and billings of a TCC were collected and compared before (January 1, 2002-June 30, 2003) and after (July 1, 2003-December 31, 2003) it assumed the care of all unassigned EGS patients. These included patient volume and demographics, service, procedures, on-call/service activity, and professional billings and collections. Data are means +/- SD or percentages. Intergroup comparisons were performed by using t test or chi2 as appropriate; significance was assumed for values of p < 0.05.
  
  
  
  Deploying an EGS arm increased coverage weeks (+52 weeks) and necessitated additional staffing (pre-EGS, n = 5; post-EGS, n = 6). Trauma operative volume remained constant (8.2 vs. 10.3 per month), EGS and elective case load increased (28.7 vs. 60 per month; p < 0.01), and the EGS case/consult ratio decreased from 0.81 to 0.64 (p < 0.01). This expanded activity was associated with reduced on-call nonclinical hours, from 3.2 +/- 0.9 to 1.1 +/- 0.8 (p < 0.01), and increased outpatient visits (68.6 vs. 91.1 per month; p < 0.01) and off-service time used for elective operations (22.3 vs. 76%; p < 0.01). Billings significantly increased in each arm compared with the pre-EGS study period (operating room, +44.8; intensive care unit, +12.5; outpatient, +48.7%; p < 0.01).
  
  
  
  Integrating a full EGS into a TCC service encumbers increased nontrauma unscheduled clinical activity in the operating room, clinic, and floors, which resulted in enhanced billings. These beneficial effects were accrued at the expense of individual time and investment in recruiting additional faculty.
authors.affiliation: Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut 06520, USA. lewis.kaplan@yale.edu
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Kaplan
authors.forename: Heidi Lee
authors.initials: HL
authors.lastname: Frankel
authors.forename: Horacio
authors.initials: H
authors.lastname: Hojman
authors.forename: Joseph
authors.initials: J
authors.lastname: Portereiko
authors.forename: Reuven
authors.initials: R
authors.lastname: Rabinovici
mesh_terms: D003237:Connecticut; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D004630:Emergencies; D013502:General Surgery / Q000191:economics / Q000458:organization & administration; D006801:Humans; D009873:Operating Rooms / Q000191:economics / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000191:economics; D011357:Product Line Management; D013503:Surgery Department, Hospital / Q000191:economics / Q000458:organization & administration*; D014193:Trauma Centers / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data