Implementation of an acute care vascular surgery "Surgeon of the Week" model improves efficiency of inpatient care delivery.

OBJECTIVE: Acute care vascular surgery (ACVS) comprises a significant proportion of modern vascular surgery practice. Given the burden of ACVS at our institution, we have transitioned from a traditional "on call" model to a "Surgeon of the Week" (SOW) model, in which a single surgeon covers all daytime inpatient consults and resultant operations over the course of a week. The SOW surgeon has no overnight call, outpatient clinic, and minimizes elective operations during this week, enabling dedicated care to inpatient responsibilities. In this study, we report our 2-year experience with the SOW model for ACVS. METHODS: Institutional medical records were retrospectively queried for all operations performed by the SOW surgeon at a single academic medical center from 2023 to 2024. The 1-year SOW period was then compared with the antecedent 5-year period from 2018 to 2023 (pre-SOW) to evaluate care delivery metrics. RESULTS: A total of six vascular surgeons covered 51 weeks as the SOW over the study period. The SOW surgeon performed a total of 598 cases, averaging a median of 11.5 cases per week (interquartile range [IQR], 9-14 cases per week). The median weekly operative time was 28.6 hours (IQR, 21.0-33.5 hours). The most common indications for primary vascular operations included acute limb ischemia (n = 31), aortic disease (n = 44), carotid disease (n = 32), hemodialysis access (n = 71), major amputations (n = 112), mesenteric ischemia (n = 23), peripheral artery disease (n = 105), and wound complications (n = 87). Urgent and emergent procedures comprised 21.7% of all operations. An additional 61 intraoperative consultations were requested from 14 other surgical services over the study period. Compared with the pre-SOW period, preoperative length of stay for inpatient operations was shorter in the SOW period (2 days [IQR, 0-7 days] vs 3 days [IQR, 1-8 days]; P < .0001). Elective case cancellations (4.0% vs 3.7%; P = .55) and the proportion of weekend operations (8.3% vs 8.1%; P = .75) were similar between periods. CONCLUSIONS: In this study, we report our experience following implementation of the SOW model at a tertiary academic medical center. This alternative model for ACVS coverage enabled the SOW to perform a wide breadth of primary vascular operations and provide intraoperative assistance to many other surgical services, without being encumbered by competing responsibilities. Furthermore, the SOW model was associated with more efficient delivery of inpatient care, as reflected in a reduced time-to-operating room. Other medical centers with similar, high-volume ACVS responsibilities may also benefit from implementing a SOW model.

Duke Scholars

Author Young Kim Surgery, Vascular and Endovascular Surgery

Author Chandler Alexander Long Surgery, Vascular and Endovascular Surgery

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