RS29 - Implementation and One-Year Interim Analysis of an Acute Care Vascular Surgery Model

Objectives: Acute care vascular surgery (ACVS) comprises a significant proportion of the modern vascular surgery practice. Given the volume of ACVS at our institution, we have transitioned from a traditional “on call” model to a “Doc of the Week” (DOW) model, in which a single surgeon covers all daytime inpatient consults and associated operations over the course of a week. The DOW surgeon has no overnight call or outpatient clinic, and minimizes elective operations during this week, enabling dedicated care to inpatient responsibilities. (Figure 1) In this study, we report our one-year experience with the DOW model for ACVS.

Methods: Institutional medical records were retrospectively queried for all operations performed by the DOW service at a single academic medical center from 2023-2024. The one-year DOW period was then compared with the antecedent five-year period from 2018-2023 (pre-DOW), in order to evaluate care delivery metrics.

Results: A total of six vascular surgeons covered 51 weeks as the DOW over the study period. The DOW surgeon performed a total of 598 cases, averaging a median of 11.5 (interquartile range [IQR] 9-14) cases per week. The median weekly operative time was 28.6 hrs (IQR 21.0-33.5). (Table 1) 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 cases comprised 21.7% of all operations. An additional 61 intraoperative consultations were requested from 14 other surgical services over the study period. The sum of these DOW operations generated $17.5 million in charges. Compared to the pre-DOW period, preoperative length of stay for inpatient operations was shorter in the DOW period (2 days [IQR 0-7] vs 3 days [IQR 1-8], p< 0.0001). Elective case cancellations (4.0% vs 3.7%, p=0.55) and the proportion of weekend operations (8.3% vs 8.1%, p=0.75) were similar between periods.

Conclusions: In this study, we report our experience following implementation of the DOW model at a tertiary academic medical center. This alternative model for ACVS coverage enabled the DOW to perform a wide breadth of primary vascular operations and provide intraoperative assistance to other surgical services, without being encumbered by competing responsibilities. Furthermore, the DOW model was associated with improved continuity of care, while offering more efficient delivery of inpatient care. Other medical centers with similar, high-volume ACVS responsibilities may also benefit from implementing a DOW model.