Highlights
- •There is a lack of best-practice models for delivering outpatient surgical care.
- •Improving timely access to outpatient surgical care likely decreases ED utilization.
- •A Same-Day Surgery Clinic model improves community access to surgical care.
- •For surgical problems, surgeon-led imaging is superior in diagnosis and efficiency.
Abstract
Background
Best-practice models delivering surgical care in the preoperative setting are unknown.
In April 2018, we established a Same-Day Clinic (SDC) to increase the access and efficiency
of general surgical care delivery.
Methods
This is a single-institution retrospective cohort study. We included patients who
underwent elective laparoscopic cholecystectomy, inguinal or umbilical hernia repair.
112 patients were seen in the year prior to clinic creation; 84 were seen in the year
following clinic creation.
Results
After clinic creation, the percentage of patients referred following an emergency
department encounter decreased from 33.4 to 17.9%. Patients referred from primary
care encounters increased from 28.6 to 44%. Patients who underwent pre-referral imaging
decreased from 58.9% to 44%. The SDC cohort was seen 11 days sooner (40 vs. 29d).
Conclusion
The SDC increases access and decreases wait times to surgical treatment. It strengthens
referral networks for traditionally underserved populations and reduces the burden
of non-necessary preoperative imaging.
Graphical abstract
Graphical Abstract
Keywords
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References
- Disparities in surgical access: a Systematic literature review, conceptual model, and evidence map.J Am Coll Surg. 2019 Mar; 228: 276-298https://doi.org/10.1016/j.jamcollsurg.2018.12.028
- Millman M. Committee on Monitoring Access to Personal Health Care Services. Access to Health Care in America. National Academies Press,
US1993 (Available at:)http://www.ncbi.nlm.nih.gov/books/NBK235882/Date accessed: June 6, 2022
- The price of acute care surgery.J Trauma Acute Care Surg. 2013 May; 74 (; discussion 1242-5): 1239-1242https://doi.org/10.1097/TA.0b013e31828da7af
- Incremental cost of emergency versus elective surgery.Ann Surg. 2015; 262: 260-266https://doi.org/10.1097/SLA.0000000000001080
- The cost of ignoring acute cholecystectomy.Ann R Coll Surg Engl. 2009; 91: 39-42https://doi.org/10.1308/003588409X359079
- Geographic diffusion and implementation of acute care surgery: an uneven solution to the national emergency general surgery crisis.JAMA Surg. 2018; 153: 150-159https://doi.org/10.1001/jamasurg.2017.3799
- Primary care physicians who treat blacks and whites.N Engl J Med. 2004; 351: 575-584
- Mirror, Mirror on the Wall, How the Performance of the US Health Care System Compares Internationally.CommonWealth Fund, New York2014
- Many emergency department visits could be managed at urgent care centers and retail clinics.Health Aff. 2010; 29: 1630-1636https://doi.org/10.1377/hlthaff.2009.0748
Article info
Publication history
Published online: August 23, 2022
Accepted:
August 19,
2022
Received in revised form:
August 11,
2022
Received:
July 18,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
