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The evolution of emergency general surgery: its time for a dedicated program manager.

Barbara Eaton1, Lindsay O'Meara2, Carla Aresco2

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Implementing a dedicated Emergency General Surgery (EGS) program manager is crucial for improving surgical quality. This role ensures accurate data collection and timely review, vital for the EGS specialty's advancement.

Keywords:
Advanced practice providerEmergency general surgeryProgram manager

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Area of Science:

  • Surgical Quality Improvement
  • Health Services Research
  • Acute Care Surgery

Background:

  • Emergency General Surgery (EGS) is an emerging sub-specialty lacking structured quality processes common in trauma care.
  • A formal EGS quality program was established with Service-Based Advanced Practice Provider (SB APP) oversight.
  • The need for a dedicated EGS program manager (PM) was identified to drive quality initiatives.

Purpose of the Study:

  • To evaluate the effectiveness of a formalized quality structure in Emergency General Surgery.
  • To assess the accuracy of data collection and identify discrepancies between EMR and manual registry data.
  • To underscore the importance of dedicated personnel for EGS quality improvement.

Main Methods:

  • Formalized a quality structure including scheduled meetings, peer review, and outcomes review starting in 2017.
  • Service-Based Advanced Practice Providers (SB APPs) manually audited admission, dashboard, and readmission data.
  • Compared Electronic Medical Record (EMR) data with a novel manually compiled EGS registry for accuracy.

Main Results:

  • Manual review revealed significant under-representation of EGS admissions in EMR data (e.g., 625 vs. 130 in 2016).
  • Discrepancies in readmission data were identified, with errors of 14 patients in 2017 and 11 in 2018.
  • The EGS registry demonstrated higher accuracy in capturing patient volume and outcomes.

Conclusions:

  • High-quality, accurate data is essential for improving Emergency General Surgery patient care.
  • Dedicated, trained personnel, such as an EGS Program Manager, are vital for effective quality review and specialty evolution.
  • The established quality program highlighted the critical role of an EGS PM in advancing the specialty.