Expanding General Surgical Care at Rural Hospitals

In the event of a traumatic medical emergency, millions of Americans—especially in rural areas, home for more than 14% of Americans –don’t have access to qualified general surgeons. 当事故发生时, they have to travel miles and hours to find the care they need, 将他们的健康置于危险之中. Often ambulances will pass right by a community hospital to get patients to a qualified trauma care facility. It’s a loss for patients, families, hospitals and the community.

为什么会有这样一个 外科医生短缺 在美国乡村? 原因有很多. The American College of Surgeons notes that more than half of surgeons practicing in rural areas are nearing retirement. 除了, substantial numbers of new general surgeons choose to specialize, and because of the small number of patients in rural areas, there is not enough demand to support these specialty practices. Surgeons often choose to work in or near urban areas, where there are a wealth of professional opportunities for them and amenities, 学校和他们家庭的资源. Medical students who might consider rural surgery attend university-based surgical residencies in urban environments. Without exposure to and mentorship from rural practitioners, 他们通常选择住在城市设施里.

This situation creates many challenges for hospitals and communities. Frequently elective surgeries are scheduled out of the area, while community residents often choose to simply travel to other locales for health care. Even in emergencies, patients are often diverted 50 miles or more to other facilities.

萨特Amador医院, 就像许多农村地区的人一样, faced the challenges of 1) recruiting top-notch surgeons, 2) serving and retaining patients in it’s demographic and 3) achieving long-term clinical and efficiency outcomes.

While providing a range of much needed and high-quality health care 服务 to its patients, the hospital sought to find a way to give its patients and community access to high quality, 24/7/365 急症护理手术 服务. To that end, hospital leaders began an intensive effort to address their need for qualified surgeons.

They had a strong and successful model to follow. In 2007, 他们在萨特系统的附属医院, 萨特医学中心, Sacramento (SMCS) launched a surgicalist程序 with Surgical Affiliates. A five-year study of the program published in the Journal of American College of Surgeons showed it had generated significant improvements, 包括:

  • Length of stay for general surgery cases decreased by as much as 12% – from 6.5天至5天.7天.
  • Complications were reduced 43% – from 21% to 12%.
  • 发生率有所下降. 然而, the key fact is that while the length of stay decreased significantly, 再入院率没有增加.
  • 医院费用下降31%, 从12美元,009 to $8,306, indicating potential savings of $2 million or more in a single year for a facility of this type and size.

这个例子说明了 surgicalist程序, also referred to as a surgical hospitalist program, had transformed hospital performance and addressed the surgeon shortage, Sutter Amador and Surgical Affiliates made a commitment to replicate this success with 24/7 surgical teams and a collaborative and programmatic approach that would consistently improve both patient outcomes and hospital efficiency metrics.

已经三年了, Sutter Amador is already seeing significant outcome improvements and results.

  • Inpatient, outpatient and total cases increased 250%
  • Volumes of laparoscopic procedures doubled and tripled
  • 平均住院时间(ALOS)减少
  • 医院病例混合指数(CMI)上升 .0853%

The increase in volumes and improved metrics generated a positive ROI for the program. Additional benefits include the ability to ensure 24/7/365 call coverage; a cap on skyrocketing payments to surgeons and locum tenens companies, thus ensuring greater predictability of expenses; and improvements in the overall responsiveness and timeliness of care. All that and patient satisfaction increased as well.

The success of 萨特Amador医院 has achieved is an outstanding example of how to bring quality surgical care to rural areas. It proves that the surgicalist model works in a rural hospital environment by delivering 急症护理手术 based on evidence-based guidelines. The result of the model is improved quality of care, patient safety, and hospital performance.

If you’re interested in learning more, check out our case study “Off the Beaten Track: A Road Map for Expanding Surgical Care at Rural Hospitals”

i 农村卫生信息:http://www.ruralhealthinfo.org/states/united-states
ii 新英格兰医学杂志, “Physician Shortages in the Specialties Taking a Toll, 2011年3月(http://www).nejmcareercenter.org/article/physician-shortages-in-the-specialties-taking-a-toll/)
3 美国外科医生学会杂志, “Sustainability and Success of the 急症护理手术 Model in the Nontrauma Setting,“2014年7月, 卷219, 问题1, 90 - 98页

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