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. 2018 Jun 20:12:17.
doi: 10.1186/s13037-018-0167-z. eCollection 2018.

Development of an emergency general surgery process improvement program

Matthew J Bradley  1   2 , Angela T Kindvall  1 , Ashley E Humphries  1   2 , Elliot M Jessie  1   2 , John S Oh  1   2 , Debra M Malone  1   2 , Jeffrey A Bailey  1   2 , Philip W Perdue  1   2 , Eric A Elster  1   2 , Carlos J Rodriguez  1   2
Affiliations

Development of an emergency general surgery process improvement program

Matthew J Bradley et al. Patient Saf Surg. .

Abstract

Background: The Joint Trauma System has demonstrated improved outcomes through coordinated research and process improvement programs. With fewer combat trauma patients, our military American College of Surgeons level 2 trauma center's ability to maintain a strong trauma Process Improvement (PI) program has become difficult. As emergency general surgery (EGS) patients are similar to trauma patients, our Trauma and Acute Care Surgery (TACS) service developed an EGS PI program analogous to what is done in trauma. We describe the implementation of our novel EGS PI program and its effect on institutional PI proficiency.

Methods: An EGS registry was developed in 2013. Inclusion criteria were based on AAST published literature. In 2015, EGS registrar and PI coordinator positions were developed and filled with existing trauma staff. A formal EGS PI program began January 1, 2016. Pre- and post-program data was compared to determine the effect including EGS PI events had on increasing yield into our trauma PI program.

Results: In 2016, TACS saw 1001 EGS consults. Four hundred forty-four met criteria for registry inclusion. Eighty-two patients had 131 PI events; re-admission within 30 days, unplanned therapeutic intervention, and unplanned ICU admission were the most common events. Capture of EGS PI events yielded a 49% increase compared with 2015.

Conclusion: Overall patient volume and PI events post EGS PI program initiation exceeded those prior to implementation. These data suggest that extending trauma PI principles to EGS may be beneficial in maintaining inter-war military and/or lower volume trauma center readiness.

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Conflict of interest statement

This study was approved as a Process Improvement initiative, and not research, by the Walter Reed National Military Medical Center’s Institutional Review Board.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trauma Admissions: Trend of trauma patient admissions and distribution of Battle versus Non-Battle Injuries since 2010
Fig. 2
Fig. 2
Admissions and PI events over time: Comparison of yearly trauma versus trauma plus acute care surgery patient admissions and trends of PI events. Orange line indicates PI volume contributed by trauma patients in 2016. (PI- Process Improvement)
Fig. 3
Fig. 3
ACS and trauma PI events in 2016: 665 total trauma patients and 298 total PI events. Top four combined PI events are displayed. (ACS- Acute Care Surgery, PI- Process Improvement)
See this image and copyright information in PMC

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