title: Implementation of an acute care emergency surgical service: a cost analysis from the surgeon's perspective.
abstract: BACKGROUND
  Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings.
  
  
  METHODS
  This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ(2) test.
  
  
  RESULTS
  Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p < 0.001). Total surgeon billings for operations pre- and post-ACCESS were $281 066 and $287 075, respectively: remuneration was $6008 higher post-ACCESS for an additional 97 cases (p = 0.003). Using cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Acute care surgical services have dramatically shifted EGS from nighttime to daytime. Cost-modelling analysis demonstrates that these services have cost-savings potential for the health care system without reducing overall surgeon billing.
authors.affiliation: The Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont..
authors.forename: Ram Venkatesh
authors.initials: RV
authors.lastname: Anantha
authors.affiliation: The Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont., and The Division of Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont..
authors.forename: Neil
authors.initials: N
authors.lastname: Parry
authors.affiliation: The Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, Calif.
authors.forename: Kelly
authors.initials: K
authors.lastname: Vogt
authors.affiliation: Strathroy Middlesex General Hospital, Strathroy, Ont.
authors.forename: Vipan
authors.initials: V
authors.lastname: Jain
authors.affiliation: The Division of General Surgery, University of Western Ontario, London, Ont.
authors.forename: Silvie
authors.initials: S
authors.lastname: Crawford
authors.affiliation: The Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont..
authors.forename: Ken
authors.initials: K
authors.lastname: Leslie
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003365:Costs and Cost Analysis; D004632:Emergency Medical Services / Q000191:economics*; D013502:General Surgery / Q000191:economics*; D006801:Humans; D009864:Ontario; D015397:Program Evaluation; D060926:Remuneration; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000191:economics*