Shorter Surgeon On-Call Shifts May Mean Better Outcomes of Acute Surgery

By Megan Brooks

November 08, 2019

NEW YORK (Reuters Health) - Limiting surgeon shifts to 12 hours for covering surgical emergencies has led to shorter hospital stays, fewer infections and lower overall costs for patients presenting with acute appendicitis at Texas Tech University Health Sciences Center (TTUHSC) in Lubbock, according to new research.

Moreover, "in the era of surgeon/physician burnout," the 12-hour model is a "very viable model to adopt to help with surgeon well-being hopefully to avoid burnout," Dr. Ariel Santos, assistant professor of surgery at TTUHSC, who worked on the study, told Reuters Health by email. The 12-hour shift policy has also resulted in better "continuity of care for surgical patients," he noted.

The findings were presented October 30 at the American College of Surgeons (ACS) Clinical Congress in San Francisco.

Dr. Santos and his colleagues took a look back at patients admitted to their center with acute appendicitis from September 2017 to June 2018, when the health center transitioned from traditional 24-hour on-call shifts to 12-hour shifts for acute-care surgeons. They chose to study acute appendicitis because it is the most common urgent operation.

Patients treated by surgeons in the 12-hour model had an average length of stay of 0.7 days versus 2 days for those treated under the traditional 24-hour on-call model (P=0.001), with no cases of organ-space infection versus a rate of 7.1% in the 24-hour model (P=0.036), study co-author Beatrice Caballero noted in her conference presentation.

With the 12-hour on-call policy, patients were seen by a surgeon more than an hour sooner on average after they arrived at the hospital (2 hours, 9 minutes versus 3 hours, 14 minutes; P=0.001). Per-patient costs were also significantly lower with the 12-hour policy ($1,452 versus $9,834).

"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," Dr. Robyn Richmond, associate program director for the general-surgery residency program at TTUHSC, commented in a conference news release. "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."

Improving wellness and working conditions for surgeons was the impetus for developing the 12-hour model, although the measure of surgeon well-being was not a specific outcome of the study.

"We have not studied this factor, but subjectively our faculty is more satisfied that there is a continuity of care that we didn't have with a 24-hour call schedule," Dr. Santos said in the news release.

"We believe that it is improving morale not only for the ACS surgeons but also for the general surgeons who now no longer have to take general surgery call," Dr. Richmond added. "They can concentrate on building their elective practices, without being interrupted by the demands of being on call."

The 12-hour policy is now standard policy at the two teaching hospitals affiliated with TTUHSC: UMC and Covenant Medical Center in Lubbock, Dr. Santos said.


American College of Surgeons 2019 Clinical Congress.