American College of Surgeons (ACS) – Quick Facts

About the College:

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient.  The College is dedicated to the ethical and competent practice of surgery.  Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients.  The College has more than 70,000 members, making it the largest organization of surgeons in the world.

Surgical Care in the Emergency Department (ED):

• According to the National Center for Health Statistics, there were about 114 million ED visits in 2003, or nearly 39 visits per 100 people.   This represents an increase of 26 percent since 1993.¹
• Nearly half of all hospitals reported that they were at or over capacity in their EDs in 2005, forced to divert ambulances to other facilities. ² 
• The overcrowding is attributed to many factors—including problems with inpatient capacity and patient flow management—but frequently cited issues are the federal mandate to screen and stabilize all patients and a scarcity of on-call physicians and surgeons to provide specialty care.²
• There are a variety of patient emergencies that may require surgical care.  Common surgical admissions involve gallbladder disease, gastrointestinal bleeding, appendicitis, heart disease, aneurysms, stroke, and complications associated with procedures, devices, implants, or grafts.  Patients suffering from externally caused injuries, or trauma, most often require emergency surgical intervention.³
• Trauma accounts for about 11.4 percent of non-pediatric and non-maternity hospital admissions that occur through the ED, according to the Agency for Healthcare Research and Quality.⁴
• Formally designated trauma centers that function as part of a state- or regionally-focused trauma care system are known to provide the highest quality care to severely injured patients.  Contrary to general assumptions, relatively few trauma center patients are victims of violence. ⁵ 
• According to the College’s own National Trauma Data Bank, the largest percentage of the patients who are treated in our nation’s trauma centers are victims of motor vehicle traffic injuries.  Falls are the second most common cause of severe injury, and are the most likely cause of trauma in the elderly.⁶

A Looming Workforce Crisis:

An analysis conducted by the Lewin Group of the American Hospital Association’s “ED and Hospital Capacity Survey of 2002” showed that neurosurgeons, orthopedic surgeons, general surgeons, and plastic surgeons were among the specialties in short supply for ED on-call panels.⁷

A similar survey conducted by the American College of Emergency Physicians in 2005 showed that nearly three-quarters of emergency department medical directors reported inadequate on-call specialist coverage, compared to two-thirds in 2004.  In that survey, the specialties of orthopedic surgery, plastic surgery, neurosurgery, otolaryngology, and hand surgery were reported as most often in short supply.⁸

Craig, LF, et al., “National Hospital Ambulatory Medical Care Survey:  2003 Emergency Department Summary.”  National Centers for Health Statistics, Centers for Disease Control and Prevention, Department of Health and Human Services.  Available on-line at: http://www.cdc.gov/nchs/data/ad/ad358.pdf.
Craig, LF, et al., “National Hospital Ambulatory Medical Care Survey:  2003 Emergency Department Summary.”  National Centers for Health Statistics, Centers for Disease Control and Prevention, Department of Health and Human Services.  Available on-line at:  http://www.cdc.gov/nchs/data/ad/ad358.pdf.
Agency for Healthcare Research and Quality.  “Reasons for being admitted to the hospital through the emergency department, 2003.”  Statistical brief #2.  February 2006.  Available on-line at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb2.jsp.
Agency for Healthcare Research and Quality.  “Reasons for being admitted to the hospital through the emergency department, 2003.”  Statistical brief #2.  February 2006.  Available on-line at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb2.jsp.
MacKenzie, EJ, et al.,  “A national evaluation of the effect of trauma-center care on mortality.”  NEJM 354:4.  January 26, 2006, p. 366.
Fildes, JD, ed., “National trauma data bank annual report 2005.”  American College of Surgeons, 2005.  Available on-line at http://www.facs.org/trauma/ntdb/ntdbannualreport2005.pdf.
"The Lewin Group Analysis of AHA ED Hospital Capacity Survey, 2002”. (April 2002) 7-18. Available at: http://www.aha.org/ahapolicyforum/resources/EDdiversionsurvey0404.html. Accessed April 4, 2006.
“On-Call Specialist Coverage in U.S. Emergency Departments, American College of Emergency Physicians Survey of Emergency Department Directors” (April 2006). Available on-line at: http://www.acep.org/NR/rdonlyres/DF81A858-FD39-46F6-B46A-15DF99A45806/0/RWJ_OncallReport2006.pdf.

Online June 15 , 2006

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