Impact of an Acute Care Surgery Service on Timeliness of
Care at Ramathibodi Hospital
Chonlada Krutsri MD1, Tharin Thampongsa MD1, Preeda Sumritpradit MD1, Pongsasit Singhatat MD1
Affiliation :
1 Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : An Acute Care Surgery [ACSx] service is composed of trauma, general surgical emergency cases, and surgical critical
care patients, all of which has been introduced at Ramathibodi Hospital since August 1, 2015.
Objective : To evaluate the outcome after one-year of services on the general surgical emergency patients’ (cid:976)low from the emergency
room [ER]. We collected data of pre-ACSx and post-ACSx periods to compared time to consultation, waiting time to OR, and resident
satisfaction.
Materials and Methods : A retrospective cohort was studied by collecting data to compare outcome of pre-ACSx and post-ACSx
periods. Subgroup analysis was done by using Chi-square test and t-test. The resident satisfaction was evaluated by 12 residents
using a double-blind questionnaire on http://www.surveycan.com/survey175782.
Results : An ACSx service could improve (cid:976)low of surgical emergency patients from the ER. From the present study, there were
signi(cid:976)icant decreases in consultation time from 74.23 to 23.40 minutes (p-value <0.05) and in waiting time to operating room [OR]
from 299.25 to 213.88 minutes (p-value <0.05). However, there was no statistical difference in the decrease of length of hospital
stay (p-value 0.91). On subgroup analysis, there were signi(cid:976)icant decrease in consultation time in acute appendicitis, gut obstruction,
acute cholecystitis, hollow viscus organ perforation, and hernia with complication (p-value <0.05). There was reduction in the
acute appendicitis referral cases from 95 to 39 cases, and a reduction of ruptured rate from 45 to 13 cases. Resident satisfaction
was more than 80% for ACSx service. Total complication and death were 18 cases (2.45%).
Conclusion : Introduction of an ACSx service in the medical academic center, Ramathibodi Hospital had a good outcome in decrease
of consultation time and waiting time to OR, signi(cid:976)icant in acute appendicitis cases. There were improved time of care and improved
surgical emergency patients (cid:976)low from ER with low complication and death rate (2.45%), with good satisfaction of more than 80%
from residents.
Keywords : Acute care surgery, ACS, Surgical emergency, Consultation time
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