Development of an Acute Care Plastic Surgery Service in the Saskatoon Health Region: Effects on flexor tendon management
Notice bibliographique
Résumé
T he Acute Care Plastic Surgery (ACS) service is a new and inno- vative practice model implemented in the Saskatoon Health Region (SHR), Saskatoon, Saskatchewan, in 2011.In this model, two surgeons are 'on call' weekly, each with distinct and complementary responsibilities in the care of patients with traumatic plastic surgery injuries (Table 1).The first surgeon (ACS surgeon) serves as the 'quarterback' of the team, and is on call for all urgent plastic surgery referrals received through the Region's Acute Care Access Line from 06:00 to 17:00 Monday through Thursday, and from 06:00 Friday until 06:00 Saturday.The ACS surgeon is stationed at a hospital-based ambulatory care clinic with two dedicated minor procedure rooms, allowing them to see urgent referrals as well as perform minor procedures that can be accomplished under local anesthesia.Patients seen in referral who require operative care are prepared for the second member of the team, the plastic surgery trauma surgeon, designated the 'E3' surgeon.The E3 surgeon has dedicated trauma time in the operating room Monday, Wednesday and Friday (on Tuesday and Thursday, the E3 surgeon may pursue their elective practice).A more standard call arrangement remains for evening call (Monday to Thursday) as well as weekend call, in which there is single on-call surgeon to complete consultations and emergent operative cases as required.Despite Saskatoon's relatively small population, its place as the province's tertiary referral centre for plastic surgery make it a very busy trauma centre.Before implementation of ACS, surgeons struggled while on call to balance the responsibility of caring for patients in their elective practice while attending to urgent referrals, many of whom required timely operative intervention.This could result in delays in tending to urgent referrals, the cancelling of elective cases and/or the completion of trauma cases after hours.This system was believed to compromise safe and timely care for patients with urgent needs, as well as lead to decreased physician satisfaction and increased surgeon fatigue.CS Wilgenbusch, PW Dust, IR Sunderland.Development of an Acute Care Plastic Surgery Service in the Saskatoon Health Region: Effects on flexor tendon management.Plast Surg 2015;23(3):195-198.BACkgROUND: The acute care surgery model has gained favour in general surgery, but has yet to be widely adopted in other specialties.An Acute Care Plastic Surgery (ACS) Service was recently implemented in the Saskatoon Health Region in an effort to improve trauma care.OBjECTIVE: To evaluate the impact of ACS on the management of flexor tendon lacerations.The authors hypothesize that ACS has resulted in more timely intervention, improved outcomes and decreased 'after hours' surgery.METHODS: A retrospective review of patients treated for flexor tendon lacerations from 2007 to 2013 was performed.Patients were stratified into two groups based on whether they received treatment before (group A) or after (group B) ACS implementation.Variables included dates and times of patient referral, consultation and tendon repair; postoperative complications; and admissions.A surgeon survey was administered on the perceived impact of ACS.RESULTS: Group A was more likely to have surgery performed after hours (P=0.0019) and be admitted to hospital (P=0.0211)compared with group B. Time from referral to consultation and injury-to-surgery interval were slightly increased post-ACS (Group B).Surgeons were highly satisfied with the new system, citing benefits to patients and surgeons.CONCLUSION: ACS was designed to improve trauma care, while favourably impacting surgeon workload.Surprisingly, the injury-to-surgery interval was slightly increased.However, this was not clinically significant and did not lead to increased postoperative complications.This finding was likely due to a favourable change in practice patterns observed after ACS implementation.ACS has resulted in fewer hospital admissions, decreased after-hours surgeries and improved surgeon satisfaction.
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