title: An acute care surgery model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis.
abstract: In October 2009, an acute care surgery (ACS) model was implemented to facilitate urgent surgical consults. This study examines the impact of ACS on the timeliness of care and length of hospitalization for patients with acute cholecystitis. A retrospective cohort study was performed  of patients presenting to the emergency department (ED) with acute cholecystitis who underwent early cholecystectomy. Patients with choledocholithiasis, pancreatitis, biliary colic, or cholelithiasis without cholecystitis were excluded. There were two study cohorts: ACS (October 2009 to July  2010) and pre-ACS (October 2008 to September 2009). Primary outcome measures were length of stay (LOS) and time from the ED to the operating room (OR). One hundred fifty-two cases were identified: 71 in the ACS group and 81 in the pre-ACS group. Patient demographics were similar. The ACS group  had a significantly shorter average time from the ED to the OR (24.6 vs 35.0 hours, P = 0.0276). Overall LOS was reduced by a mean of 14.7 hours in the ACS group (mean 3.23 vs 2.63 days, P = 0.11). There was no significant difference in OR time (2.45 vs 2.38  hours, P = 0.562). There was a significant decrease in after-hours cases in the ACS group (5.6 vs 21%, P = 0.004) and a decrease in complication rates (18.5 vs 7.0%, P = 0.032). In conclusion, the ACS model decreased time from the ED to the OR, decreased  after-hours cases, decreased length of hospitalization, and decreased complications for patients with acute cholecystitis.
authors: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
authors: Briana
authors: B
authors: Lau
authors: L Andrew
authors: LA
authors: Difronzo
mesh_terms: D002763:Cholecystectomy / Q000379:methods / Q000592:standards*; D041881:Cholecystitis, Acute / Q000601:surgery*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome