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Adherence to 20 Emergency General Surgery Best Practices

Results of a National Survey

Ingraham, Angela M. MD, MS*; Ayturk, M. Didem MS; Kiefe, Catarina I. MD, PhD; Santry, Heena P. MD, MS§

doi: 10.1097/SLA.0000000000002746

Objective: To examine national adherence to emergency general surgery (EGS) best practices.

Background: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adherence to clinical guidelines. We previously established best practices for EGS using RAND Appropriateness Methodology and pilot data.

Method: A hybrid (postal/electronic) questionnaire measuring adherence to 20 EGS best practices was administered to respondents overseeing EGS at all eligible adult acute care general hospitals across the US (N = 2811). Questionnaire responses were analyzed using bivariate methods and multiple logistic regression.

Results: The response rate was 60.1%. Adherence ranged from 8.5% for having an EGS registry to 86.2% for auditing 30-day postoperative readmissions. Adherence was higher for practices not restricted to EGS (eg, auditing readmissions) compared to EGS-specific practices (eg, registry, activation system). Adopting an ACS model of care increased adherence to practices for deferring elective cases; tiering urgent operations; following National Comprehensive Cancer Network guidelines; reversing anticoagulants; auditing returns to intensive care, time to evaluation, time to operation, and time to source control; and having transfer agreements to receive patients, ICU admission protocols, as well as EGS-specific activation systems, outpatient clinics, morbidity and mortality conferences, and registries.

Conclusions: There is substantial room for performance improvement, and adopting an ACS model predicts better performance. This novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.

*Department of Surgery, University of Wisconsin, Madison, WI

Department of Surgery, University of Massachusetts Medical School, Worcester, MA

Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA

§Department of Surgery, The Ohio State University, Columbus, OH.

Reprints: Angela M. Ingraham, MD, MS, Trauma and Acute Care Surgery, University of Wisconsin, G5/342-CSC, 600 Highland Ave, Madison, WI 53792-3236. E-mail:

Sources of Support: This research is supported by grants from the Agency for Healthcare Research Quality (R01HS022694) to HPS, National Institutes of Health/National Institute of Mental Health to CIK (R01MH112138), National Institutes of Health/National Center for Advancing Translational Sciences to CIK (U54 RR 026088), and Patient-Centered Outcomes Research Institute to CIK (ME-1310-07682). The content represents the thoughts and opinions of the authors and not the funding agencies.

Dr. Heena Santry had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The authors report no conflicts of interest.

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