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The data on the financial and operational impact of an Acute Care Surgery (ACS) service is equivocal. Multiple stakeholders, mostly surgeons and anesthesia health care providers, envision themselves as caretakers of a precious, expensive service line. Although previous studies have examined the impact of an ACS service model on the time to theater metric, there are no studies examining the impact of an ACS service on the operating room (OR) from the perspective of an OR manager. In this study, we examine the impact of an ACS service on operating room utilization and general surgery services using several OR management metrics: elective in-block utilization, after-hours utilization, and opportunity-unused time. Using these metrics to study one year pre- and one year post-ACS service implementation at our institution we were able to demonstrate more effective use of an OR (fixed cost) and a decrease in after-hours operating time for the non-ACS general surgeons (variable cost). We propose the use of such OR management metrics as an integral component of service line implementation analysis.

BACKGROUND: The Acute Care Surgery (ACS) model has been widely adopted by hospitals across the United States, with ACS services managing emergency general surgery (EGS) patients previously treated by general surgery (GS) services. We evaluated the operational and financial impact of an ACS service model on general surgeons at an academic medical center. METHODS: Using WiseOR® (Palo Alto, CA), we compared surgical case volumes for the GS service two years before (October, 2013 - September, 2015) and two years after (October, 2015 - September, 2017) implementation of an ACS service at the University of Vermont Medical Center. From financial reports, we obtained monthly wRVUs, clinical FTEs, net patient revenue, and payer mix for the GS service and compared the two years before and after ACS model implementation. RESULTS: There was a significant reduction in the average number of cases performed by the GS service following ACS service implementation (monthly mean ± SD, 139.1 ± 16.0 vs. 116.7 ± 14.0, p < 0.001). The normal-hours caseload remained stable, while a significant decrease in after-hours cases accounted for the reduction in overall volume. Despite the reduction in operative volume, the decrease in mean monthly wRVU/FTE for the GS service when comparing the pre- and post- ACS periods did not reach statistical significance (614.9 ± 82.9 vs. 576.3 ± 62.1, p = 0.08). There was a significant increase in average monthly clinic-derived wRVU/FTE for the GS service (106.3 ± 13.5 vs. 120.5 ± 16.4, p = 0.007). CONCLUSIONS: Shifting EGS patient management from the GS to ACS service did not negatively impact the productivity of the GS service. BACKGROUND