Length of Stay and Operating Schedule Efficiency are Not Impacted with Implementation of an Acute Care Service Model
Daniel Lehane, Joshua Geiger, Baqir Kedwai, Karina Newhall, Michael Stoner, Roan Glocker
University of Rochester Medical Center, Rochester, NY
INTRODUCTION:As interest and efforts focus on the reduction of burnout among vascular surgery staff and trainees, the models of delivering care have come under examination. To that end, this institution implemented a so called “acute care service” model (ACS) where the elective and consult services are split. This service model intends to improve the schedule and quality of life of the vascular surgeon on the elective service. The hypothesis of this study was that this change would not impact time to operating room from admission, length of stay, or in-hospital mortality. METHODS: A retrospective cohort analysis of prospectively collected institutional Vascular Quality Initiative (VQI) data from August 2017-December 2019 and January 2022-March 2023 was performed. Patients who underwent surgery captured in the VQI (open and endovascular aortic aneurysm repair, open and endovascular lower extremity intervention, and amputation) during those time periods were included. The washout period between the dates of analysis accounted for practice abnormalities during the COVID pandemic. Patients were grouped by acuity of surgery - urgent versus a composite of emergent and elective surgery as a control. The primary outcomes were time from admission to operating room and length of stay and were compared in the pre- and post- acute care service model periods. In-hospital mortality was also analyzed. Statistical analysis was performed using Student’s t-test, Mann-Whitney U test, Pearson’s chi-squared test, and Fisher’s exact test, as appropriate. RESULTS:1,662 patients met inclusion criteria, with 845 undergoing surgery pre-ACS and 817 post-ACS. Patients in the pre-ACS group were slightly younger (69.1 ± 11.4 versus 70.6 ± 11.5 years, p=0.02) and more likely to have coronary artery disease (36.8% versus 20.0%, p<0.01) and hypertension (88.0% and 84.0%, p=0.02). Post-ACS implementation, there was no difference in length of stay (11 ± 12 pre-ACS versus 12 ± 20 days post-ACS [median ± inter-quartile range], p=0.59) or time from admission to operating room (2 ± 3 versus 3 ± 5 days, p=0.24). In-hospital mortality among patients undergoing urgent surgery was higher post-ACS (2.0% versus 7.6%, p=0.04). The control emergent/elective group showed no differences between pre- and post-ACS. CONCLUSIONS: The implementation of an acute care service model did not impact patient care measured as time from admission until surgery or length of hospital stay. In-hospital mortality was higher after the implementation of ACS among patients undergoing urgent surgery. However, this appeared to be a higher-risk surgery cohort than during the pre-ACS period. Research into the impact of this service model on faculty and trainee wellness is ongoing. Anecdotally, the changes have been well-received at our institution. Future research should also study the financial implications of implementing this service model.
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