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Impact of Acute Care Surgery to Departmental Productivity

Barnes, Stephen L. MD, FACS; Cooper, Christopher J. MD; Coughenour, Jeffrey P. MD, FACS; MacIntyre, Allan D. DO; Kessel, James W. MD, FACS

The Journal of Trauma: Injury, Infection, and Critical Care: October 2011 - Volume 71 - Issue 4 - p 1027-1034
doi: 10.1097/TA.0b013e3182307146
Original Article

Background: The face of trauma surgery is rapidly evolving with a paradigm shift toward acute care surgery (ACS). The formal development of ACS has been viewed by some general surgeons as a threat to their practice. We sought to evaluate the impact of a new division of ACS to both departmental productivity and provider satisfaction at a University Level I Trauma Center.

Methods: Two-year retrospective analysis of annual work relative value unit (wRVU) productivity, operative volume, and FTEs before and after establishment of an ACS division at a University Level I trauma center. Provider satisfaction was measured using a 10-point scale. Analysis completed using Microsoft Excel with a p value less than 0.05 significant.

Results: The change to an ACS model resulted in a 94% increase in total wRVU production (78% evaluation and management, 122% operative; p < 0.05) for ACS, whereas general surgery wRVU production increased 8% (-15% evaluation and management, 14% operative; p < 0.05). Operative productivity was substantial after transition to ACS, with 129% and 44% increases (p < 0.05) in operative and elective case load, respectively. Decline in overall general surgery operative volume was attributed to reduction in emergent cases. Establishment of the ACS model necessitated one additional FTE. Job satisfaction substantially improved with the ACS model while allowing general surgery a more focused practice.

Conclusions: The ACS practice model significantly enhances provider productivity and job satisfaction when compared with trauma alone. Fears of a productivity impact to the nontrauma general surgeon were not realized.

From the Division of Acute Care Surgery, Department of Surgery, University of Missouri, Columbia, Missouri.

Submitted for publication November 30, 2010.

Accepted for publication July 29, 2011.

Presented at the 24th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 25–29, 2011, Naples, Florida.

Address for reprints: Stephen L. Barnes, MD, FACS, Division of Acute Care Surgery, University of Missouri, One Hospital Drive M144, Columbia, MO 65203; email:

© 2011 Lippincott Williams & Wilkins, Inc.