Acute Care Surgery Services Can Improve Emergency Ward Overcrowding

Researchers at the University of Toronto (Canada) conducted a study involving 2,510 patients between January 1, 2007, and June 30, 2009. The participants included 1,448 patients before ACCESS implementation in the ED on July 1, 2008, and 1,062 patients after ACCESS implementation. In order to better understand the key factors contributing to overcrowding, the authors developed a conceptual model that partitioned ED overcrowding into three interdependent components; input, which refers to factors that contribute to the volume of care delivered in the ED; throughput, which refers to factors that contribute to the amount of time a patient spends in the ED; and output, which refers to either admission to a hospital bed or discharge. The primary study outcome was surgical decision time, and the secondary outcome was a measure of overall ED overcrowding.

The study found that implementation of ACCESS was associated with a 15% reduction in surgical decision time (12.6 hours versus 10.8 hours) and a 20% decrease in the average “time-to-stretcher” for all ED patients. The researchers also found that in an isolated group of appendicitis cases, ACCESS service reduced surgical decision time by 30%. The inability to move patients from the ED to an inpatient bed was found to be one of the major contributing factors to ED overcrowding. The study was published in the August 2011 issue of the Journal of the American College of Surgeons.

“The establishment of an acute care surgery service can improve overall ED overcrowding by decreasing surgical decision time for all general surgery patients,” said senior author Homer Tien, MD, MSc. “In the past five years, there has been a groundswell of support in both Canada and in the US for establishment of these services for various reasons, such as the growing difficulty of treating acute surgical conditions and a decrease in operative trauma surgical cases.”

EDs are a crucial point of access to the health care system for patients with a broad spectrum of injuries and illnesses, and overcrowding has been identified as a widespread and serious problem with adverse consequences. ACCESS is defined as the urgent assessment and treatment of nontrauma general surgical emergencies, such as appendicitis, diverticulitis, bowel obstruction, biliary disease, and postoperative complications.

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