Transforming Emergency General Surgery
Lessons from South Korea’s Acute Care Surgery Model
Emergency general surgery has always been a challenging field, defined by urgency, unpredictability, and the need for swift decision-making. Yet, traditional models of surgical care often fall short when it comes to addressing these demands efficiently. In South Korea, a revolutionary shift has taken place with the implementation of the Acute Care Surgery (ACS) model, which has transformed emergency surgical care. This system offers a compelling blueprint for improving outcomes and redefining emergency surgery globally.
The ACS model, originally developed in the United States, focuses on having dedicated surgical teams available 24/7 to handle emergency cases. South Korea adopted this system across multiple tertiary hospitals, aiming to streamline processes, reduce delays, and improve outcomes. A recent study published in the ANZ Journal of Surgery1 by Yi and colleagues provides an in-depth analysis of the model’s impact. The results are a testament to how structural changes can dramatically enhance the quality of emergency surgical care.
A New Approach to Emergency Surgery
The traditional system for handling emergency surgical cases often relied on general surgeons juggling multiple responsibilities. Elective surgeries, outpatient visits, and emergency cases were all managed by the same individuals, leading to inefficiencies and delays. Under the ACS model, this fragmented approach has been replaced with a dedicated team of surgeons focused solely on emergency cases. This shift ensures that patients in need of urgent surgical intervention are prioritized and receive timely care.
Yi’s study highlights the transformative power of this model. Across three South Korean hospitals, the implementation of ACS significantly reduced the time from a patient’s arrival in the emergency room to the operating room. This improvement alone has had profound implications for patient outcomes, especially for those with conditions like perforations or bowel ischemia, where every minute counts.
The Measurable Impact of ACS
The study’s findings demonstrate that implementing the ACS system isn’t just about improving efficiency—it’s about saving lives and reducing complications. For example, patients treated under the ACS model experienced fewer postoperative complications compared to those treated before its implementation. This underscores the importance of having surgeons dedicated to emergency cases, ensuring that critical decisions are made promptly and care pathways are optimized.
What stands out in the research is not only the reduction in surgical delays but also the broader implications for patient care. With the ACS model, hospitals were able to perform more surgeries during weekends and off-hours, ensuring that emergencies didn’t have to wait until standard operating times. This improvement reflects a commitment to treating emergencies as true priorities, regardless of the time or day.
Challenges in Implementation
While the ACS model has brought undeniable benefits, it has not been without challenges. The study notes that while surgical delays and complications have been reduced, hospital length of stay and mortality rates saw less dramatic changes. This points to the need for further structural enhancements, such as increasing access to dedicated emergency operating rooms and improving coordination among surgical, anesthesiology, and nursing teams.
Another limitation highlighted by Yi and colleagues is the focus on conditions like appendicitis and cholecystitis, which are relatively less severe compared to high-acuity cases such as severe trauma or ischemic bowel disease. Future research could expand the scope to understand the model’s full potential across a broader spectrum of surgical emergencies.
Global Relevance of the ACS Model
South Korea’s experience with the ACS system offers valuable lessons for other countries grappling with the demands of emergency general surgery. The success of this model lies in its ability to prioritize emergency cases while maintaining a high standard of care. For countries with similar healthcare challenges, adopting an ACS framework could be a game-changer.
The study’s findings also suggest that while the ACS model improves efficiency and outcomes, its impact could be amplified through additional reforms. For instance, integrating dedicated emergency operating rooms and fostering stronger multidisciplinary collaboration could further enhance the system’s effectiveness.
A Vision for the Future
The ACS model represents more than a change in logistics—it’s a cultural shift in how emergency surgical care is delivered. By recognizing the unique demands of emergency cases and dedicating resources to meet those needs, healthcare systems can dramatically improve patient outcomes. The results from South Korea are clear: when emergency cases are prioritized, and care is streamlined, everyone benefits—from the patients whose lives are saved to the healthcare teams that can work more effectively.
As Yi and colleagues conclude, the ACS system isn’t just a better way to handle emergencies—it’s an essential evolution in surgical care. For surgeons and healthcare leaders, this model provides a compelling vision for how emergency surgery can be reimagined and improved.
Related Research and References
To understand more about the ACS system and its impact, here are additional studies that provide further insights:
Vergis, A., et al. (2019). "Impact of acute care surgery on timeliness of care and patient outcomes: A systematic review." Canadian Journal of Surgery. DOI: 10.1503/cjs.003819
Murphy, P. B., et al. (2017). "Impact of the ACS model on disease-specific outcomes in appendicitis and biliary disease: A meta-analysis." Journal of the American College of Surgeons. DOI: 10.1016/j.jamcollsurg.2017.08.027
Lau, B., et al. (2011). "An ACS model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis." American Surgeon. DOI: 10.1177/000313481107701014
Nelson, B. V., & Talboy, G. E. (2010). "Acute care surgery: Redefining the general surgeon." Missouri Medicine.
Yi, G.-H., Hong, S.-K., Jun, Y.-H., Yoo, S., Bae, J.-M., Yoo, K., Jung, Y. T., Kim, E., Lee, N., Ko, M. J., Shin, H., & Lee, H.-J. (2024). Clinical outcomes of the implementation of acute care surgery system in South Korea: a multi‐centre, retrospective cohort study. ANZ Journal of Surgery. https://doi.org/10.1111/ans.19366