title: Acute care surgery: the impact of an acute care surgery service on assessment, flow, and disposition in the emergency department.
abstract: BACKGROUND
  Acute care surgery (ACS) services are becoming increasingly popular.
  
  
  METHODS
  Assessment, flow, and disposition of adult ACS patients (acute, nontrauma surgical conditions) through the emergency department (ED) in a large health care system (Calgary) were prospectively analyzed.
  
  
  RESULTS
  Among 447 ACS ED consultations over 3 centers (70% admitted to ACS), the median wait time from the consultation request to ACS arrival was 36 minutes, and from ACS arrival to the admission request it was 91 minutes. The total ACS-dependent time was 127 minutes compared with 261 minutes for initial ED activities and 104 minutes for transfer to a hospital ward (P < .05). Forty percent of patients underwent computed tomography (CT) imaging (76% before consultation). The time to ACS consultation was 305 minutes when a CT scan was performed first.
  
  
  CONCLUSIONS
  An ACS service results in rapid ED assessment of surgical emergencies. Patient waiting is dominated by the time before requesting ACS consultation and/or waiting for transfer to the ward.
authors.affiliation: Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9. Electronic address: ball.chad@gmail.com.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: MacLean
authors.affiliation: Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9.
authors.forename: May Lynn
authors.initials: ML
authors.lastname: Quan
authors.affiliation: Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9.
authors.forename: Lynn
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9.
authors.forename: Francis R
authors.initials: FR
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D000416:Alberta; D003422:Critical Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies