Consideration of the Work System for Acute Care Surgery in Urban Emergency Medical Centers

Abstract

[Introduction] Considering the work style reforms that have been implemented, we reviewed emergency surgery cases at our hospital to examine the role of acute care surgeons in fulfilling the needs of the community and society. [Methods] We conducted a retrospective review of the medical records of patients who underwent emergency surgery at our hospital between January 1, 2016, and December 31, 2019, focusing on the admission routes and arrival times of the patients. [Results] There were 13 cases of esophageal rupture requiring emergency surgery, 85% of which were transfer cases. Of these, 67% occurred outside regular working hours, and 54% on weekends and holidays. There were 55 cases of colon perforation, 89% of which were transfer cases. Of these, 70% occurred outside regular working hours, and 69% on weekends and holidays. [Conclusion] At our hospital in the central area of Tokyo, there was a higher percentage of transfer cases, including of cases with esophageal rupture and colon perforation, as compared with the percentage of cases that were transported directly to our hospital. Additionally, a high number of the transfer cases were transferred to our hospital outside of the regular working hours. Therefore, it seems necessary to adjust the staffing ratios of acute care surgeons to better meet the regional needs, particularly by increasing the number of surgeons available outside of the regular working hours.