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Effect of a Dedicated Acute Care OR on Hospital Efficiency
*Cecilia K Trydestam, James Whiting, *Steven Prato, Brad Cushing
Maine Medical Center, Portland, ME

1.Objective. Creating models for the care of patients with urgent surgical problems has been a challenge. We developed a system where an OR was set aside for urgent general surgery during daytime hours and general surgeons from different practice groups were reimbursed opportunity costs for staffing the room. Our objective was to examine the effect of this intervention on efficiencies of care for three separate diagnoses.
2.Design. Retrospective database review of 1289 patients surgically treated for appendicitis, cholecystitis, or small bowel obstruction (SBO).
3.Setting. 606 bed tertiary referral center.
4.Patients. 1289 patients admitted via emergency department from 1/1/2007 through 10/31/2010 who underwent surgical treatment for appendicitis, cholecystitis, or small bowel obstruction as determined by ICD-9 procedure codes.
5.Interventions. Institution of a dedicated acute care surgery OR and coordinating "surgeon of the day".
6.Main Outcome Measure. Time from ED to OR, time of day patient entered OR, and length of stay.
7.Results. 18 different surgeons performed at least one operation. For appendicitis, LOS decreased post intervention (p<0.05), while there was no significant change in the time to get to the OR, or the time of day of the operation. For cholecystitis, there was no difference in LOS or the time to get to the OR, but the time of day that the surgery occured was significantly different occurring earlier in the day. For SBO there was no significant change in any parameter.
8.Conclusions. The effect of an acute care surgery OR and designated surgeon of the day has varied effects on the efficiency of patient care depending upon the diagnosis, likely related to the perceived urgency of the case.

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