Allocation of emergency general surgery resources by hospital category*
| Resource | No. (%) of hospitals | |||||||
|---|---|---|---|---|---|---|---|---|
| Large academic n = 18 | Large nonacademic n = 47 | Small nonacademic n = 44 | Overall n = 109 | |||||
| EGS n = 15 | Non-EGS n = 3 | EGS n = 19 | Non-EGS n = 28 | EGS n = 3 | Non-EGS n = 41 | EGS n = 37 | Non-EGS n = 72 | |
| Organizational structure and staffing | ||||||||
| All surgeons in on-call schedule | 6/15 (40.0) | 0/2 (0) | 14/18 (77.8) | 10/20 (50.0) | 3/3 (100.0) | 7/14 (50.0) | 23/36 (63.9) | 17/36 (47.2) |
| Other clinical responsibilities | 7/15 (46.7) | 0/1 (0) | 5/17 (29.4) | 11/19 (57.9) | 3/3 (100.0) | 9/18 (50.0) | 15/35 (42.9) | 20/38 (52.6) |
| Clinical associates | 4/15 (26.7) | 0/1 (0) | 3/17 (17.6) | 2/20 (10.0) | 0/3 (0) | 0/20 (0) | 7/35 (20.0) | 2/41 (4.9) |
| Residents or fellows | 15/15 (100.0) | 0/1 (0) | 11/17 (64.7) | 9/21 (42.9) | 0/3 (0) | 1/22 (4.5) | 26/35 (74.3) | 10/44 (22.7) |
| Nurse practitioners or physician assistants | 8/15 (53.3) | 0/1 (0) | 5/18 (27.8) | 3/21 (14.3) | 0/3 (0) | 0/22 (0) | 13/36 (36.1) | 3/44 (6.8) |
| Outpatient clinic | 8/15 (53.3) | 0/1 (0) | 6/18 (33.3) | 0/21 (0) | 0/3 (0) | 1/22 (4.5) | 14/36 (38.9) | 1/44 (2.3) |
| Operating room availability | ||||||||
| Operating room 24/7 | 14/15 (93.3) | 2/3 (66.7) | 18/18 (100.0) | 22/26 (84.6) | 2/3 (66.7) | 19/37 (51.4) | 34/36 (94.4) | 43/66 (65.1) |
| Dedicated operating room time | 10/15 (66.7) | 0/2 (0) | 13/18 (72.2) | 0/25 (0) | 0/3 (0) | 0/35 (0) | 23/36 (63.9) | 0/62 (0) |
| ASA ≥ 3 | 15/15 (100.0) | 2/3 (66.7) | 17/18 (94.4) | 22/25 (88.0) | 2/3 (66.7) | 13/36 (36.1) | 34/36 (94.4) | 37/64 (57.8) |
| Interventional radiology and interventional endoscopy availability | ||||||||
| Emergency department 24/7 | 15/15 (100.0) | 3/3 (100.0) | 18/18 (100.0) | 25/26 (96.2) | 3/3 (100.0) | 36/38 (94.7) | 36/36 (100.0) | 64/67 (95.5) |
| Computed tomography 24/7 | 15/15 (100.0) | 2/3 (66.7) | 16/17 (94.1) | 18/26 (69.2) | 2/3 (66.7) | 12/37 (32.4) | 33/35 (94.3) | 32/66 (48.5) |
| Interventional radiology | 15/15 (100.0) | 1/3 (33.3) | 16/18 (88.9) | 11/26 (42.3) | 0/3 (0) | 4/37 (10.8) | 31/36 (86.1) | 16/66 (24.2) |
| Endoscopy | 15/15 (100.0) | 2/3 (66.7) | 18/18 (100.0) | 18/26 (69.2) | 2/3 (66.7) | 17/37 (45.9) | 35/36 (97.2) | 37/66 (56.1) |
| ERCP | 15/15 (100.0) | 0/3 (0) | 14/18 (77.8) | 11/26 (42.3) | 1/3 (33.3) | 2/37 (5.4) | 30/36 (83.3) | 13/66 (19.7) |
| Intensive care unit availability and staffing | ||||||||
| Intensive care unit | 15/15 (100.0) | 3/3 (100.0) | 17/17 (100.0) | 22/25 (88.0) | 1/3 (33.3) | 17/37 (45.9) | 33/35 (94.3) | 42/63 (66.7) |
| Intensive care unit step-down | 9/15 (60.0) | 2/3 (66.7) | 8/17 (47.1) | 8/25 (32.0) | 2/3 (66.7) | 7/37 (18.9) | 19/35 (54.3) | 17/63 (27.0) |
| Intensive care unit outreach team | 15/15 (100.0) | 3/3 (100.0) | 16/17 (94.1) | 19/25 (76.0) | 1/3 (33.3) | 11/37 (29.7) | 32/35 (91.4) | 33/63 (52.4) |
| Regional participation | ||||||||
| Transfers to receiving hospital | 2/15 (13.3) | 1/3 (33.3) | 7/17 (41.2) | 15/26 (57.6) | 2/3 (66.7) | 32/37 (86.5) | 11/35 (31.4) | 48/64 (75.0) |
| Accepts transfers | 15/15 (100.0) | 1/3 (33.3) | 16/17 (94.1) | 17/26 (65.4) | 1/3 (33.3) | 12/37 (32.4) | 32/35 (91.4) | 30/64 (46.9) |
Note: ASA = American Society of Anesthesiologists physical classification,30 EGS = emergency general surgery, ERCP = endoscopic retrograde cholangiopancreatography.
↵* Hospitals are broken down into 3 categories: large academic hospitals with more than 100 beds that the Ministry of Health classifies as teaching hospitals, large nonacademic hospitals with more than 100 beds that the Ministry does not classify as teaching hospitals, or small nonacademic hospitals with fewer than 100 beds that the Ministry does not classify as teaching hospitals.