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Assessing Quality in Acute Care Surgery

Assessing Quality in Acute Care Surgery

Emergency and trauma surgeries are increasingly being performed by the same providers, often using the same resources. It has been implied that improvements in care for one of these populations could enhance the care of the other, but few analyses have compared the quality of care provided to each type of surgery group. New Research In the Archives of Surgery, my colleagues and I had a study published that evaluated the relationship between trauma and elective general surgery (ELGS) and emergency general surgery (EMGS) care. Our hypothesis was that there would be similarities in mortality and serious morbidity outcomes because of the crossover in providers and resources used. We compared performance among 46 hospitals to determine how well these institutions performed across populations with regard to outcomes. Our findings indicated that there were no significant relationships between trauma and EMGS mortality or between trauma and ELGS mortality. We also didn’t observe any significant relationships between trauma and EMGS morbidity or between trauma and ELGS morbidity. Furthermore, no hospital had consistently good or poor outcomes across the surgical populations assessed in the analysis. Examining Implications Based on our findings, research and quality improvement efforts should focus on how to improve EMGS care. Many performance improvement measures have been devoted to trauma surgery, but few have focused on EMGS patients. The National Trauma Databank contains records on more than 2 million patients. The American College of Surgeons has established the Trauma Quality Improvement Program for benchmarking trauma centers. Similar data banks and benchmarking efforts that focus on quality of care provided to EMGS patients are in the early stages of development...
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