title: Development of an Acute Care Plastic Surgery Service in the Saskatoon Health Region: Effects on flexor tendon management.
abstract: BACKGROUND
  The acute care surgery model has gained favour in general surgery, but has yet to be widely adopted in other specialties. An Acute Care Plastic Surgery (ACS) Service was recently implemented in the Saskatoon Health Region in an effort to improve trauma care.
  
  
  OBJECTIVE
  To evaluate the impact of ACS on the management of flexor tendon lacerations. The authors hypothesize that ACS has resulted in more timely intervention, improved outcomes and decreased 'after hours' surgery.
  
  
  METHODS
  A retrospective review of patients treated for flexor tendon lacerations from 2007 to 2013 was performed. Patients were stratified into two groups based on whether they received treatment before (group A) or after (group B) ACS implementation. Variables included dates and times of patient referral, consultation and tendon repair; postoperative complications; and admissions. A surgeon survey was administered on the perceived impact of ACS.
  
  
  RESULTS
  Group A was more likely to have surgery performed after hours (P=0.0019) and be admitted to hospital (P=0.0211) compared with group B. Time from referral to consultation and injury-to-surgery interval were slightly increased post-ACS (Group B). Surgeons were highly satisfied with the new system, citing benefits to patients and surgeons.
  
  
  CONCLUSIONS
  ACS was designed to improve trauma care, while favourably impacting surgeon workload. Surprisingly, the injury-to-surgery interval was slightly increased. However, this was not clinically significant and did not lead to increased postoperative complications. This finding was likely due to a favourable change in practice patterns observed after ACS implementation. ACS has resulted in fewer hospital admissions, decreased after-hours surgeries and improved surgeon satisfaction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Saskatchewan, Saskatoon, Saskatchewan.
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Wilgenbusch
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Saskatchewan, Saskatoon, Saskatchewan.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dust
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Saskatchewan, Saskatoon, Saskatchewan.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Sunderland
keywords: Acute care surgery; Flexor tendon injury; Health care delivery; Surgeon satisfaction; Trauma care