title: A county hospital surgical practice: a model for acute care surgery.
abstract: BACKGROUND
  Trauma surgery has changed significantly over the past decade. Nonoperative evidence-based algorithms have become common and surgical trauma volume has become increasingly difficult to maintain. The acute care surgery (ACS) model, which integrates trauma, critical care, and emergency surgery, has been proposed as a future model of trauma practice.
  
  
  METHODS
  Database information from an academic, county-based, trauma center was reviewed. A performance improvement surgical procedure database and level I trauma registry from 2005 were used to evaluate one center's ACS practice.
  
  
  RESULTS
  There were 2,276 cases performed by 7 full-time and 5 part-time surgeons. Elective cases accounted for 64% (1,480) of caseload, emergency/urgent general surgery accounted for 32% (719) of cases, and emergency trauma surgeries accounted for 4% (96 procedures in 77 patients). In all, 23% were performed after hours. The ACS model supported controllable hours, adequate surgical volume, excellent patient care, and an appealing clinical practice.
  
  
  CONCLUSIONS
  Surgical practice in a county-run trauma hospital can be similar to the ACS model, with positive results in terms of clinical volume and physician satisfaction. As clinical practices shift to the ACS model, there are lessons to be learned from currently existing, thriving, long-standing similar prototypes.
authors.affiliation: Department of Surgery, Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA 95125, USA.
authors.forename: Adella M
authors.initials: AM
authors.lastname: Garland
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Riskin
authors.forename: Susan I
authors.initials: SI
authors.lastname: Brundage
authors.forename: Friedrich
authors.initials: F
authors.lastname: Moritz
authors.forename: David A
authors.initials: DA
authors.lastname: Spain
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Purtill
authors.forename: John P
authors.initials: JP
authors.lastname: Sherck
mesh_terms: D000208:Acute Disease; D002140:California; D004638:Emergency Treatment / Q000592:standards / Q000706:statistics & numerical data; D006766:Hospitals, County / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D017146:Models, Organizational; D012042:Registries; D013503:Surgery Department, Hospital / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000592:standards / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D014194:Traumatology / Q000458:organization & administration / Q000592:standards; D014600:Utilization Review; D016526:Workload / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality