Are emergency general surgery patients more work than trauma patients? Characterizing surgeon work in an acute care surgery practice.

Abstract

Many trauma surgery groups have embraced emergency general surgery (EGS) as part of their practice. This practice pattern takes advantage of the trauma surgeon's 24-hour presence in the hospital. However, differences in quantity and timing of work between EGS and trauma patients affect demands on resources and staff. Hospital trauma, financial, pharmacy, and medical records of 100 successive trauma and 50 successive EGS patients were reviewed. Work performed by our service was quantified using relative value units, operations, complications, and laboratory tests/imaging/medications ordered, and the events organized by time intervals after contact by the acute care surgery service. Our estimators of surgeon work per patient, totaled over all studied time intervals, showed EGS exceeding trauma patients by 59% (laboratory tests) to 470% (operations) (all but one p < 0.01). The exception was that trauma patients required more imaging studies per patient (4.25 vs. 2.48, p < 0.01). Trauma patients had a mean time to primary diagnosis of 0.9 hours, compared to 4.3 hours in EGS patients. In this pilot effort, we found that EGS patients required more diagnostic effort initially and generated more relative value units, operations, laboratory tests, and new medication orders and had more complications during the course of their care. Addition of EGS patients to a trauma service consumes more per-patient resources than trauma patients. Epidemiologic study, level III.