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Texas Tech University Health Sciences Center (TTUHSC), in 2018, transitioned from a traditional 24-hour surgeon on-call shift to a 12-hour one, in part to help promote physician well-being and reduce burnout. Researchers have now looked at some patient and fiscal outcomes that occurred after this transition (Caballero 2019). They chose to look at patients admitted with acute appendicitis, because that is the most frequent condition for which the on-call surgeon would provide urgent surgery.
Patients treated by surgeons in the 12-hour shift model had an average length of stay of 0.73 days vs. 2 days for those treated under the traditional 24-hour model and had no reported cases of organ space infection vs. a rate of 7.1 percent in the traditional group. On average, ACS patients were seen by a surgeon more than an hour sooner after they arrived at the hospital: 2 hours, 9 minutes vs. 3 hours, 14 minutes. Per-patient costs with the 12-hour model were $1,452 vs. $9,834 per patient. They also found a decrease in perforation rates of appendicitis with the shorter surgeon on-call shift (ACS 2019).
Subjectively, faculty satisfaction was better with the new model. They also felt that continuity of care was improved, mainly because when the attending surgeon is working 12-hour shifts on consecutive days, he/she is more likely to be in the hospital and follow-up with the patient on the day after surgery than he/she would be doing 24-hour call. Also, the handoff between surgeons and surgical teams is more efficient with the 12-hour shift.
We’ve discussed some of the logistical and personnel issues that may lead to worse outcomes for surgery done “after hours” (see list below). The 12-hour surgeon on-call shift does improve upon several of those factors. It would also be interesting to know how other members of the surgical team (nurses, OR techs, anesthetists, etc.) were deployed when urgent cases were done under the new protocol. Additionally, we suspect factors pertinent to the rest of the team might be less impacted for general surgery cases, like acute appendicitis. It would be very interesting to see whether the 12-hour surgeon on-call shift also improves outcomes for other surgical specialties, where composition of the surgical team is more complicated.
This is a very interesting finding and merits consideration for other surgical specialties.
Some of our previous columns on “after-hours” surgery:
· September 2009 “After-Hours Surgery – Is There a Downside?”
· October 2014 “What Time of Day Do You Want Your Surgery?”
· January 2015 “Emergency Surgery Also Very Costly”
· September 2015 “Surgery Previous Night Does Not Impact Attending Surgeon Next Day”
· October 4, 2016 “More on After-Hours Surgery”
· August 15, 2017 “Delayed Emergency Surgery and Mortality Risk”
· October 24, 2017 “Neurosurgery and Time of Day”
Caballero B, Puckett Y, Chung C, et al. Improved Patient Outcomes and Reduced Cost in Treating Acute Appendicitis with a Shift-Based Acute Care Surgery Model Compared with Traditional General Surgery Call. Scientific Forum Abstracts. J Am Coll Surg 2019; 229(4 Supplement 1): S99
ACS (American College of Surgeons) Press Release. Surgeons report that 12-hour shifts improve patient outcomes, lower costs vs. 24-hour call shifts. American College of Surgeons October 30, 2019
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