title: Sustainability and success of the acute care surgery model in the nontrauma setting.
abstract: BACKGROUND
  The use of an acute care surgical model has been shown to improve patient care and efficiency. We propose that it is possible to apply this model to emergency general surgery patients at a nontrauma hospital. With this acute care surgery service, no change in the quality of care will occur, and improvements in quality, cost, and outcomes may be achieved and sustained.
  
  
  METHODS
  A retrospective review was performed of all emergency surgery operations performed at a tertiary referral community hospital without a trauma service. Data were collected from 1 year before and each year up to 4 years after the implementation of an acute care surgical (ACS) service.
  
  
  RESULTS
  There were fewer overall complications with ACS (21% to 12%, p < 0.0001), and a shorter length of stay (6.5 days to 5.7 days, p = 0.0016). Hospital costs fell from $12,009 to $8,306 (p < 0.0001). Post-appendectomy complications decreased (13% to 3.7%, p < 0.0001), length of stay was shorter (3.0 to 2.3 days, p < 0.0001), and hospital costs decreased from $9,392 to $5,872 (p < 0.0001). Post-cholecystectomy complications decreased (21% to 9%, p = 0.012), length of stay was shorter (5.3 to 3.8 days, p = 0.0004), and hospital costs decreased from $12,526 to $9,348 (p < 0.0001).
  
  
  CONCLUSIONS
  An acute care surgery service can be successfully implemented at a nontrauma hospital. The improvements seen in outcomes and finances are sustainable over time. This sort of coordinated, consistent care is successful and allows alignment of the goals of surgeons, hospitals, and patients.
authors.affiliation: Department of Surgery, Grant Medical Center, Columbus, OH. Electronic address: shay.omara@ohiohealth.com.
authors.forename: Michael Shay
authors.initials: MS
authors.lastname: O'Mara
authors.affiliation: Department of Surgery, Mercy San Juan Medical Center, Carmichael, CA.
authors.forename: Lynette
authors.initials: L
authors.lastname: Scherer
authors.affiliation: Department of Surgery, The University of California Davis Medical Center, Sacramento, CA.
authors.forename: David
authors.initials: D
authors.lastname: Wisner
authors.affiliation: Department of Surgery, Sutter Medical Center Sacramento, Sacramento, CA.
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Owens
mesh_terms: D002140:California; D003422:Critical Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D004630:Emergencies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics / Q000592:standards; D062606:Tertiary Care Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards