B.N. Halimeh1, S. Myers1, S. Theodore1, O. Beresneva1, S. Sanchez1, J.S. Davids1 1Boston University, Department Of Surgery, Boston, MA, USA
Introduction: Both acute care (ACS) and colorectal (CRS) surgeons commonly manage patients presenting to the emergency department (ED) with acute lower gastrointestinal surgical conditions. No consensus guidelines exist regarding which service is best suited to manage specific conditions nor what other factors impact these decisions. The goal of this work was to investigate practice patterns and views on which service (ACS vs. CRS) should manage specific clinical cases with acute ED presentations.
Methods: An online, anonymous, secure, validated survey was created and distributed via email to all ACS and CRS surgeons practicing at teaching hospitals in New England. Respondents were asked to rate 20 conditions, using a Likert scale, on which service should manage the condition. They were also asked about basic demographic information, factors that influence service allocation decision-making, and additional open-ended questions. For each condition, the average of each service’s responses was calculated and compared between the two specialties. Open ended responses were evaluated using qualitative thematic analysis.
Results: The survey was emailed to 233 surgeons (87 CRS, 146 ACS) and 96 respondents completed the survey (41% response rate, RR), 41 from CRS (47% RR) and 55 from ACS (38% RR). The mean age of respondents was 48±10 years, 67% (N=64) were male, and 50% (N=48) were assistant professors. Most of the conditions (70%, N=14) had a consensus agreement between ACS and CRS on who should primarily manage them. In cases where there was disagreement (p<0.0001), each service responded by indicating that they should manage the condition, rather than the other service. Fifty-eight percent of surgeons were at institutions with established guidelines for which specialty should be consulted for which conditions, and 38% of surgeons reported that these were written guidelines. Themes extracted from open-ended responses showed that both specialties agreed the greatest factor impacting which service is consulted was CRS surgeon availability depending on time of day and day of week.
Conclusion: While there were some disagreements on who should manage specific conditions, ACS and CRS surgeons in New England mostly agree on which specialty should manage most acute presentations of lower gastrointestinal surgical conditions as well as the key factors impacting these decisions. These results suggest that it may be possible to create consensus guidelines on which service should be consulted for specific presentations to be used as a blueprint in hospitals with both CRS and ACS services. For conditions where specialties disagree, further investigation to obtain clarity on which service is better suited to manage the condition is warranted.