A qualitative analysis of acute care surgery in the United States: it's more than just "a competent surgeon with a sharp knife and a willing attitude".
BACKGROUND
Since acute care surgery (ACS) was conceptualized a decade ago, the specialty has been adopted widely; however, little is known about the structure and function of ACS teams.


METHODS
We conducted 18 open-ended interviews with ACS leaders (representing geographic [New England, Northeast, Mid-Atlantic, South, West, Midwest] and practice [Public/Charity, Community, University] diversity). Two independent reviewers analyzed transcribed interviews using an inductive approach (NVivo qualitative analysis software).


RESULTS
All respondents described ACS as a specialty treating "time-sensitive surgical disease" including trauma, emergency general surgery (EGS), and surgical critical care (SCC); 11 of 18 combined trauma and EGS into a single clinical team; 9 of 18 included elective general surgery. Emergency orthopedics, emergency neurosurgery, and surgical subspecialty triage were rare (1/18 each). Eight of 18 ACS teams had scheduled EGS operating room time. All had a core group of trauma and SCC surgeons; 13 of 18 shared EGS due to volume, human resources, or competition for revenue. Only 12 of 18 had formal signout rounds; only 2 of 18 had prospective EGS data registries. Streamlined access to EGS, evidence-based protocols, and improved education were considered strengths of ACS. ACS was described as the "last great surgical service" reinvigorated to provide "timely," cost-effective EGS by experts in "resuscitation and critical care" and to attract "young, talented, eager surgeons" to trauma/SCC; however, there was concern that ACS might become the "wastebasket for everything that happens at inconvenient times."


CONCLUSIONS
Despite rapid adoption of ACS, its implementation varies widely. Standardization of scope of practice, continuity of care, and registry development may improve EGS outcomes and allow the specialty to thrive.
Department of Surgery, University of Massachusetts Medical School, Boston, MA; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA. Electronic address: heena.santry@umassmemorial.org.
Heena P
HP
Santry
Department of Medicine, Massachusetts General Hospital, Boston, MA.
Patricia L
PL
Pringle
Department of Surgery, University of Massachusetts Medical School, Boston, MA.
Courtney E
CE
Collins
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA.
Catarina I
CI
Kiefe
D003266:Continuity of Patient Care; D004632:Emergency Medical Services / Q000592:standards*; D013502:General Surgery / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D011787:Quality of Health Care / Q000592:standards*; D012042:Registries; D013043:Specialties, Surgical / Q000592:standards; D013503:Surgery Department, Hospital / Q000592:standards*; D014193:Trauma Centers / Q000592:standards*; D014481:United States