title: Innovation or rebranding, acute care surgery diffusion will continue.
abstract: BACKGROUND
  Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown.
  
  
  METHODS
  We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public or charity, and university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, and West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents' views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation.
  
  
  RESULTS
  We found a paradox between ACS viewed as a health care delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS because of increased desirability for trauma and critical care careers as well as improved EGS outcomes was tempered by fear over lack of continuity, poor institutional resources, and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true health care delivery innovation or an innovative rebranding, fits into the Rogers' diffusion of innovation theory.
  
  
  CONCLUSIONS
  Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters.
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Collins
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Pringle
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: heena@santry.org.
authors.forename: Heena P
authors.initials: HP
authors.lastname: Santry
mesh_terms: D001291:Attitude of Health Personnel; D003422:Critical Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004059:Diffusion of Innovation; D004638:Emergency Treatment; D013502:General Surgery / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D009936:Organizational Innovation; D036301:Qualitative Research; D013043:Specialties, Surgical / Q000458:organization & administration*; D014481:United States
keywords: Acute care surgery; Diffusion of innovation; Health care delivery; Health care innovation; Resource allocation; Surgery