The acute care surgery (ACS) model, which is consultant-led,
provides a safe surgical environment for patients and is associated with a
reduced complication rate, according to an article in the Medical Journal of
Dr Robert Gandy, Surgical Registrar at the Prince of Wales
Hospital, Sydney, and co-authors conducted a retrospective historical control
study, comparing appendicectomy outcomes for the ACS model with the traditional
on-call (Trad) model.
Dr Gandy said that the ACS model, when compared with the
Trad model, resulted in reduced complication rates and fewer operations after
The complication rate was lower in the ACS model than the
Trad model (9.3 per cent versus 17.0 per cent).
After the intervention, there was no significant change
between the ACS and Trad model in the time from presentation to arrival in
theatre or length of stay, but the proportion of operations performed at night
was reduced from 22.7 per cent (Trad model) to 17.3 per cent (ACS model).
The ACS model is consultant-led. This means that a higher
proportion of patients are reviewed by a consultant before surgery than in the
Trad model (54.9 per cent versus 38.1 per cent).
The consultant supervision reduces adverse outcomes without
compromising registrar training opportunities, and is likely to reinforce
patients' confidence in their care.
"By implementing a consultant-led system and a culture in
which emergency surgery is prioritised and separated from the elective surgical
stream, complications and unnecessary operations after midnight can be
reduced", said Dr Gandy.
The Medical Journal of Australia
publication of the Australian Medical Association.