title: Pitfalls of implementing acute care surgery.
abstract: BACKGROUND
  Incorporating emergency general surgery into the current practice of the trauma and critical care surgeon carries sweeping implications for future practice and training.
  
  
  METHODS
  Herein, we examine the known benefits of the practice of emergency general surgery, contrast it with the emerging paradigm of acute care surgery, and examine pitfalls already encountered in integration of emergency general surgery into a traditional trauma/critical care surgery service. A MEDLINE literature search was supplemented with local experience and national presentations at major meetings to provide data for this review.
  
  
  RESULTS
  Considerations including faculty complement, service structure, resident staffing, physician extenders, the decreased role of community hospitals in providing trauma and emergency general surgery care, and the effects on an elective operative schedule are inadequately explored at present. There are no firm recommendations as to how to incorporate emergency general surgery into a trauma/critical care practice that will satisfy both academic and community practice paradigms.
  
  
  CONCLUSIONS
  The near future seems likely to embrace the expanded training and clinical care program termed acute care surgery. A host of essential elements have yet to be examined to undertake a critical analysis of the applicability, advisability, and appropriate structure of both emergency general surgery and acute care surgery in the United States. Proceeding along this pathway may be fraught with training, education, and implementation pitfalls that are ideally addressed before deploying acute care surgery as a national standard.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA. Lewis.Kaplan@yale.edu
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Kaplan
authors.forename: Heidi
authors.initials: H
authors.lastname: Frankel
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Davis
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D010819:Physician's Role; D013043:Specialties, Surgical / Q000193:education / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000601:surgery*