Adapting an emergency general surgery service in response to the COVID-19 pandemic

Urgent surgical patient classification: Development and validation of a novel instrument using the Delphi approach

BACKGROUND

The lack of a triage system for urgent surgical patients leads to non-standardized decision-making. Developing an instrument to objectively identify the complexity of care required for each case is challenging. The aim of this report is to develop and validate an urgent surgical patient classification instrument using the Delphi technique.

MATERIALS AND METHODS

The study was conducted in several stages: (1) definition of the construct; (2) item elaboration; (3) expert analysis; (4) item selection; (5) pretest. In the first study, scale items were designed and content validity was confirmed. In the second study, the factorial structure was analyzed. In the third study, alternative measurement models were tested. In the fourth study, criterion validity was analyzed.

RESULTS

Experts validated 14 items (31.81%) from Domain 1 with 75% agreement and specific items from Domain 2 with 100% agreement. Factor analysis indicated a two-factor solution explaining 58.4% of the variance. The bifactor model presented the best fit (χ2/df = 1.51; CFI = 0.95; TLI = 0.94; RMSEA = 0.051; SRMR = 0.043). Factors showed excellent internal consistency (α > 0.88; CR > 0.90; ω > 0.92).

CONCLUSION

This pioneering study developed and validated the content of the first specific instrument for classifying urgent surgical patients regarding their priority for care. The instrument was deemed valid in terms of content, based on expert consensus. Further studies are recommended to evaluate its practical application and perform additional psychometric measures. This instrument has the potential to enhance the organization of emergency services and operating theaters, promoting patient safety and efficient resource management in healthcare institutions. Its implementation should align with current health guidelines and policies to optimize the triage and prioritization process for urgent surgical patients.

Emergencies do not shut down during a pandemic: COVID pandemic impact on Acute Care Surgery volume and mortality at a level I trauma center

BACKGROUND

The aim of this study was to evaluate the impact of the COVID-19 pandemic on volume and outcomes of Acute Care Surgery patients, and we hypothesized that inpatient mortality would increase due to COVID+ and resource constraints.

METHODS

An American College of Surgeons verified Level I Trauma Center's trauma and operative emergency general surgery (EGS) registries were queried for all patients from Jan. 2019 to Dec. 2020. April 1st, 2020, was the demarcation date for pre- and during COVID pandemic. Primary outcome was inpatient mortality.

RESULTS

There were 14,460 trauma and 3091 EGS patients, and month-over-month volumes of both remained similar (p > 0.05). Blunt trauma decreased by 7.4% and penetrating increased by 31%, with a concomitant 25% increase in initial operative management (p < 0.001). Despite this, trauma (3.7%) and EGS (2.9-3.0%) mortality rates remained stable which was confirmed on multivariate analysis; p > 0.05. COVID + mortality was 8.8% and 3.7% in trauma and EGS patients, respectively.

CONCLUSION

Acute Care Surgeons provided high quality care to trauma and EGS patients during the pandemic without allowing excess mortality despite many hardships and resource constraints.