title: Impact of an acute care surgery model with a dedicated daytime operating room on outcomes and timeliness of care in patients with biliary tract disease.
abstract: BACKGROUND
  Although many acute care surgery (ACS) formats exist, the model established in 2006 at our academic, level 1 trauma center includes a dedicated daytime operating room. The goal of the present study was to evaluate the effect that an ACS model with a dedicated daytime operating suite would have on outcomes and timeliness of care in patients with biliary tract disease.
  
  
  METHODS
  A retrospective cohort study was performed on all patients with biliary tract disease admitted to the University of Alberta Hospital pre- and post-ACS. Data collected included demographic information, medical diagnoses, procedures performed, and complications. Time points included the time from admission to operation, operative time, and length of hospital stay. Pre- and post-ACS groups were compared with the Pearson Chi square test and Student's t test (α = 0.05).
  
  
  RESULTS
  There were 72 patients pre-ACS and 172 post-ACS. The two groups had similar demographics and co-morbidities. The post-ACS group had a shorter time from admission to operation (34.1 vs 24.8 h; p < 0.05). There was a decrease in the number of patients awaiting daytime operating room availability (95.8 vs 60.7 %; p < 0.05), with most surgeries being done within a 24 h period versus patients waiting upwards of 3 days pre-ACS.
  
  
  CONCLUSIONS
  We observed a significant decrease in preoperative time by 10 h with increased access to a readily available operating room. Having a dedicated ACS team is important, but it is equally important to have a dedicated operating room with disposable time to care for unpredictable, emergent cases to realize the full potential benefit of the ACS model.
authors.affiliation: Division of General Surgery, Department of Surgery, University of Alberta, 2D Walter C. Mackenzie Health Sciences Centre, 8440-112th Street, Edmonton, AB, T6G 2B7, Canada.
authors.forename: David W
authors.initials: DW
authors.lastname: Lim
authors.forename: Dejan
authors.initials: D
authors.lastname: Ozegovic
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Khadaroo
authors.forename: Sandy
authors.initials: S
authors.lastname: Widder
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000208:Acute Disease; D000416:Alberta; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000601:surgery*; D002763:Cholecystectomy; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D015397:Program Evaluation; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*