Concepts and Considerations for Regionalization of Emergency General Surgery

As our healthcare system evolves, outcomes are becoming more important and the delivery of quick, effective, and quality care is paramount. Emergency general surgery (EGS) procedures have traditionally had higher rates of morbidity and mortality compared to those undergoing elective surgical procedures. Given that every human is susceptible to EGS disease, the goal of this review was to highlight the ideas, concepts, and data behind EGS regionalization. Regionalization at its basis is to provide the appropriate care to the appropriate hospital as close to home as possible. In doing so, we show an overview of different regionalization concepts, how they have worked in our geographic region, and specifically the data driven outcomes that have led to improved quality, consistency, and timeliness of EGS related care and how that impacts EGS regionalization as a whole.

Not all healthcare systems are created equal. Different hospital systems even within our own region have access to differing levels of resources. Initial findings within our own system highlight that appropriate triage and transfer of low risk-surgical patients to nearby community hospital increased operating room and hospital bed availability at our tertiary hospital. Implementation of an ACS service at one of our regional Level 3 trauma centers led to increased procedures on critical patients without increased mortality. Finally, evaluation of geocodes (utilizing zipcodes) of patients showed the need for expansion of our acute care surgical practice to other regional hospitals in our area. While this led to an increase in urgent/emergent procedures at these centers, elective surgical volume was preserved and transfers to tertiary our tertiary care center was decreased.

EGS procedures remain time-sensitive, and overall have higher morbidity and mortality. While different methods and implementation of EGS regionalization will work for different healthcare systems and regions, we outline the work that our health care system has done as our population rapidly grows and adds increasing constraints to an already stressed hospital system in terms of patient capacity and volume. Our work includes establishment of an Acute Care Surgery Network, expansion of an ACS model of care, introduction of different regionalization models, expansion of resources as well as meticulously tracking our EGS data to drive quality and resource assessment.