Outsourcing surgery relieves burdens on staff physicians and even improves key metrics like costs, length of stay complications, one new study finds.
When Sacramento, Calif.-based Sutter Medical Center's general surgery department was regularly overwhelmed by patient capacity, it quickly became a problem. The hospital started having trouble covering surgical call weekends and evenings at their emergency department. "We had to transfer patients away, and that was not good for the patients or for our facility," says Richard SooHoo, CFO of the hospital.
With patient transfers undesirable, Mr. SooHoo and Sutter's assistant administrator Tim Daley sat down to create a plan for approaching coverage solutions, taking stock of available models and thinking about medical groups in the area. Then, they settled on an unusual strategy: they contacted the group helping their hospital competitor, Surgical Affiliates.
Surgical Affiliates is a surgical hospitalist group that employs the acute-care surgery model — an integrated team approach to serve the type of acutely ill surgery patient that often presents to the ED. The group installs teams of providers to handle the kind of 24-hour call coverage that can overextend the hospital's employed surgeons, leaving the hospital's surgeons to focus exclusively on elective surgeries.
"We were approached by Mr. SooHoo about a model that would help Sutter, a very busy tertiary hospital, with call challenges. We separated the issues of emergency and elective surgery, a task that can be quite challenging," says Leon Owens, MD, founder of the company. For the ED physicians at Sutter, the support was welcome.
"This had a huge impact on the ED, having this coverage. Without it patients would have to sit in ED longer. It also decreased inpatient length of stay and improved ED throughput," said Mr. SooHoo. These developments, however, were not necessarily at the forefront of Sutter's problem-solving process, according to Mr. SooHoo, who says he and Mr. Daley were mostly focused on how to fill the coverage gap as quickly as possible.
All told, the extra coverage decreased length of stay by one day, cost per case by between $3,000 and $4,000 and lowered surgical complications nearly 10 percent.
A study detailing the surprisingly far-reaching improvements of the collaboration has just been published in the July issue of Journal of the American College of Surgeons. According to Dr. Owens, the study is the first of its kind, filling in the gaps between some of the core concepts involved in splitting elective and emergency surgery. "No one had done a prolonged study that investigated all aspects of [this approach] in general surgery," he says.
The model seems to work in other places and at other scales, as well. Surgical Affiliates is now in nearly 20 facilities, including rural hospitals, which can often have a difficult time covering emergency surgery. The "halo effect" of improvement, as Dr. Owens calls it, is present every time. Improved capacity leads to shorter stays, lower costs, more successful surgeries and happier patients. Surgical Affiliates has also expanded the model to other service lines, including orthopedics, trauma and neurosurgery.
Of the model, Dr. Owens notes the importance of collaboration to its success. "Teaming up physicians with executives and C-suites who see the problem and can work hand-in glove has been one of the main keys to success, but you have to choose the right kind of practitioners," he says. "We use physicians who are oriented to working on a team. Often the great pride of surgeons is eccentricity, which is not a good fit with our model."
He also admits that the model is in a constant state of improvement. "We know what we do is not the best practice — it's the best we've done so far. We try to do things the same way each time with lists and algorithms that, when used appropriately, have produced these same results," he adds.
Mr. SooHoo notes another reason he believes the model was so successful within Sutter's culture is because it dovetails well with the hospital's strategic roadmap of 3C’s: collaboration, creativity and compassion. "The model we put together embodies the three Cs, thinking creatively on how to solve problem our call coverage, working collaboratively with a community partner and that third C, compassion, which ties to quality and outcomes," he says.
Dr. Owens is proud of the results of the collaboration: "At the end of the day the purpose was to get call coverage at a busy urban hospital and do it 24-7. We can do it at decreased costs, improved outcomes and higher patient satisfaction, all of which mean better results for the patients."