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Pitfalls of implementing acute care surgery.

Lewis J Kaplan¹, Heidi Frankel, Kimberly A Davis

¹Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA. Lewis.Kaplan@yale.edu

The Journal of Trauma

|May 15, 2007

Summary

Integrating emergency general surgery (EGS) into trauma and critical care requires careful planning. Key considerations for EGS implementation and the emerging acute care surgery model need further examination to avoid pitfalls.

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Area of Science:

Surgical Practice Evolution
Trauma and Critical Care
Emergency General Surgery (EGS)

Background:

The integration of emergency general surgery into trauma and critical care surgery presents significant implications for future surgical practice and training.
Current trauma and critical care services face challenges in adapting to the evolving landscape of emergency surgical care.

Purpose of the Study:

To examine the benefits of emergency general surgery (EGS) practice.
To contrast EGS with the emerging paradigm of acute care surgery (ACS).
To identify pitfalls encountered during the integration of EGS into traditional trauma/critical care surgery services.

Main Methods:

A comprehensive MEDLINE literature search was conducted.
Findings were supplemented with local institutional experience.
Data from national presentations at major surgical meetings were incorporated.

Main Results:

Critical aspects such as faculty numbers, service organization, resident staffing, and the role of physician extenders require further exploration.
The diminishing role of community hospitals in providing trauma and EGS care impacts integration strategies.
Current recommendations inadequately address the incorporation of EGS to satisfy both academic and community practice needs.

Conclusions:

The future likely involves an expanded training and clinical care program known as acute care surgery (ACS).
Essential elements for a critical analysis of EGS and ACS applicability, advisability, and structure remain unexamined.
Potential training, education, and implementation pitfalls must be addressed before ACS adoption as a national standard.