title: Impact of acute care surgery to departmental productivity.
abstract: BACKGROUND
  The face of trauma surgery is rapidly evolving with a paradigm shift toward acute care surgery (ACS). The formal development of ACS has been viewed by some general surgeons as a threat to their practice. We sought to evaluate the impact of a new division of ACS to both departmental productivity and provider satisfaction at a University Level I Trauma Center.
  
  
  METHODS
  Two-year retrospective analysis of annual work relative value unit (wRVU) productivity, operative volume, and FTEs before and after establishment of an ACS division at a University Level I trauma center. Provider satisfaction was measured using a 10-point scale. Analysis completed using Microsoft Excel with a p value less than 0.05 significant.
  
  
  RESULTS
  The change to an ACS model resulted in a 94% increase in total wRVU production (78% evaluation and management, 122% operative; p<0.05) for ACS, whereas general surgery wRVU production increased 8% (-15% evaluation and management, 14% operative; p<0.05). Operative productivity was substantial after transition to ACS, with 129% and 44% increases (p<0.05) in operative and elective case load, respectively. Decline in overall general surgery operative volume was attributed to reduction in emergent cases. Establishment of the ACS model necessitated one additional FTE. Job satisfaction substantially improved with the ACS model while allowing general surgery a more focused practice.
  
  
  CONCLUSIONS
  The ACS practice model significantly enhances provider productivity and job satisfaction when compared with trauma alone. Fears of a productivity impact to the nontrauma general surgeon were not realized.
authors: Division of Acute Care Surgery, Department of Surgery, University of Missouri, Columbia, Missouri 65203, USA. barnesste@health.missouri.edu
authors: Stephen L
authors: SL
authors: Barnes
authors: Christopher J
authors: CJ
authors: Cooper
authors: Jeffrey P
authors: JP
authors: Coughenour
authors: Allan D
authors: AD
authors: MacIntyre
authors: James W
authors: JW
authors: Kessel
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D006801:Humans; D007588:Job Satisfaction; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014194:Traumatology / Q000458:organization & administration / Q000706:statistics & numerical data*