Surgeons report that 12-hour shifts improve patient outcomes, lower costs

For covering emergency and urgent operations, hospitals have traditionally assigned general surgeons to 24-hour on-call schedules, which often puts them in a situation where they need to operate and make complex medical decisions after being on duty for 18 or 20 hours or more. However, Texas Tech University Health Sciences Center, Lubbock, Tex., has used a model to cap surgeon shifts at 12 hours for covering surgical emergencies, and a study has shown that it led to shorter hospital stays and lower overall costs for patients with acute appendicitis, according to findings presented at the American College of Surgeons Clinical Congress 2019.

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"We found a decrease in perforation rates of appendicitis with the acute-care surgery (ACS) model. Although it wasn't the original intention of the model we created we also found a decreased hospital length of stay, which has a trickle-down effect of having a decreased cost," said Robyn Richmond, MD, associate program director for the general surgery residency program at TTUHSC. "With the ACS model, we are getting patients to the operating room faster, so therefore they're in the hospital a shorter amount of time, which overall results in decreased cost." The researchers claim this is the first study of patient outcomes comparing the ACS and traditional staffing models head-to-head.

Texas Tech University Health Sciences Center is an academic tertiary referral center. The study involved a retrospective review of patients admitted with acute appendicitis from September 2018 to June 2018, when the health center transitioned from the traditional 24-hour call model to ACS, which involves having an acute-care surgeon in the hospital for a 12-hour shift. Study coauthor Ariel P. Santos, MD, MPH, FRCS, FACS, assistant professor of surgery, explained that the researchers chose to study acute appendicitis because it is the most common urgent operation performed.

In presenting updated results from the podium, study coauthor Beatrice Caballero, MS, reported that patients treated by surgeons in the ACS model had an average length of stay of 0.73 days vs. 2 days for those treated under the traditional model (p=0.001), and had no reported cases of organ space infection vs. a rate of 7.1 percent in the traditional group (p=0.036). 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 (p=0.001). Per-patient costs with the ACS model were $1,452 vs. $9,834 per patient (p=0.001).