Ann Surg Treat Res.  2023 Jan;104(1):43-50. 10.4174/astr.2023.104.1.43.

Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients

• Yoon KW
• Choi K
• Yoo K
• Gil E
• Park CM

• KMID: 2537629
• DOI: http://doi.org/10.4174/astr.2023.104.1.43

Abstract

Purpose
Acute care surgery (ACS) has been practiced in several tertiary hospitals in South Korea since the late 2000s. The medical emergency team (MET) has improved the management of patients with clinical deterioration during hospitalization. This study aimed to identify the clinical effectiveness of collaboration between ACS and MET in hospitalized patients.
Methods
This was an observational before-and-after study. Emergency surgical cases of hospitalized patients were included in this study. Patients hospitalized in the Department of Emergency Medicine or Department of Surgery, directly comanaged by ACS were excluded. The primary outcome was in-hospital mortality rate. The secondary outcome was the alarm-to-operation interval, as recorded by a Modified Early Warning Score (MEWS) of >4.
Results
In total, 240 patients were included in the analysis (131 in the pre-ACS group and 109 in the post-ACS group). The in-hospital mortality rates in the pre- and post-ACS groups were 17.6% and 22.9%, respectively (P = 0.300). MEWS of >4 within 72 hours was recorded in 62 cases (31 in each group), and the median alarm-to-operation intervals of each group were 11 hours 16 minutes and 6 hours 41 minutes, respectively (P = 0.040).
Conclusion
Implementation of the ACS system resulted in faster surgical intervention in hospitalized patients, the need for which was detected early by the MET. The in-hospital mortality rates before and after ACS implementation were not significantly different.

Keyword

Acute care surgery; Early warning score; Hospital rapid response team; Operative surgical procedures

Figure

• 

  Fig. 1 Patient classification for inclusion according to the patient’s location. ICU, intensive care unit; GS, general surgery; MEWS, Modified Early Warning Score; ACS, acute care surgery.

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  Fig. 2 Patient’s flowchart including Modified Early Warning Score (MEWS) alarm. BT, body temperature; RR, respiratory rate; HR, heart rate; BP, blood pressure; RN, registered nurse; MET, medical emergency team; ACS, acute care surgery; OR, operation room; MEWS, Modified Early Warning Score; SBP, systolic blood pressure; DBP, diastolic blood pressure; MBP, mean blood pressure; SpO2, oxygen saturation.

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  Fig. 3 Box plot of the secondary outcome (alarm-to-operation interval). ACS, acute care surgery.

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