Emergency General Surgery: The Vanderbilt Model

  • José J. DiazJr.
  • Oscar D. Guillamondegui
  • John A. MorrisJr.


With the evolution of trauma systems in the United States, morbidity and mortality rates from trauma have decreased over the past 30 years.1, 2, 3 Trauma centers are highly organized systems that administer care to the most critically injured patients. This provides a concentrated setting for multispecialty professionals to dedicate themselves to the care of these individuals promptly and efficiently.


Trauma Center Chief Resident House Staff Percutaneous Cholecystostomy Major Trauma Patient 
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  1. 1.
    Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure. JAMA 1995; 14;273(22):1778–1780.CrossRefPubMedGoogle Scholar
  2. 2.
    Cornwell EE 3rd, Chang DC, Phillips J, et al. Enhanced trauma program commitment at a level I trauma center: effect on the process and outcome of care. Arch Surg 2003; 138(8):838–843.CrossRefPubMedGoogle Scholar
  3. 3.
    Mullins RJ, Veum-Stone J, Helfand M, et al. Outcome of hospitalized injured patients after institution of a trauma system in an urban area. JAMA 1994; 271(24):1919–1924.CrossRefPubMedGoogle Scholar
  4. 4.
    Rathore SS, Epstein AJ, Volpp KG, et al. Hospital coronary artery bypass graft surgery volume and patient mortality, 1998—2000. Ann Surg 2004; 239(1):110–117.CrossRefPubMedGoogle Scholar
  5. 5.
    Begg CB, Cramer LD, Hoskins WJ, et al. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998; 280(20):1747–1751.CrossRefPubMedGoogle Scholar
  6. 6.
    Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346(15):1128–1137.CrossRefPubMedGoogle Scholar
  7. 7.
    Sampalis JS, Denis R, Frechette P, et al. Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. J Trauma 1997; 43(2):288–296.CrossRefPubMedGoogle Scholar
  8. 8.
    Sampalis JS, Denis R, Lavoie A, et al. Trauma care regionalization: a process-outcome evaluation. J Trauma 1999; 46(4):565–581.CrossRefPubMedGoogle Scholar
  9. 9.
    Cherry D, Annest JL, Mercy JA, et al. Trends in nonfatal and fatal firearm-related injury rates in the United States, 1985–1995. Ann Emerg Med 1998; 32(1):51–59.CrossRefPubMedGoogle Scholar
  10. 10.
    Engelhardt S, Hoyt D, Coimbra R, et al. The 15-year evolution of an urban trauma center: what does the future hold for the trauma surgeon? J Trauma 2001; 51(4):633–638.CrossRefPubMedGoogle Scholar
  11. 11.
    Scherer LA, Battistella FD. Trauma and emergency surgery: an evolutionary direction for trauma surgeons. J Trauma 2004; 56(1):7–12.CrossRefPubMedGoogle Scholar
  12. 12.
    Spain DA, Richardson JD, Carrillo EH, et al. Should trauma surgeons do general surgery? J Trauma 2000; 48(3):433–438.CrossRefPubMedGoogle Scholar
  13. 13.
    Bulinski P, Bachulis B, Naylor DF Jr, et al. The changing face of trauma management and its impact on surgical resident training. J Trauma 2003; 54(1):161–163.CrossRefPubMedGoogle Scholar
  14. 14.
    Dutton RP, Cooper C, Jones A, et al. Daily multidisciplinary rounds shorten length of stay for trauma patients. J Trauma 2003; 55(5):913–919.CrossRefPubMedGoogle Scholar
  15. 15.
    Nguyen HB, Rivers EP, Havstad S, et al. Critical care in the emergency department: a physiologic assessment and outcome evaluation. Acad Emerg Med 2000; 7(12):1354–1361.CrossRefPubMedGoogle Scholar
  16. 16.
    Scaglione M, Grassi R, Pinto A, et al. Positive predictive value and negative predictive value of spiral CT in the diagnosis of closed loop obstruction complicated by intestinal ischemia. Radiol Med (Torino) 2004; 107(1–2):69–77.Google Scholar
  17. 17.
    Wilson EB, Cole JC, Nipper ML, et al. Computed tomography and ultrasonography in the diagnosis of appendicitis: when are they indicated? Arch Surg 2001; 136(6):670–675.CrossRefPubMedGoogle Scholar
  18. 18.
    Rosen MP, Sands DZ, Longmaid HE 3rd, et al. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR Am J Roentgenol 2000; 174(5):1391–1396.PubMedGoogle Scholar
  19. 19.
    Patel M, Miedema BW, James MA, et al. Percutaneous cholecystostomy is an effective treatment for high-risk patients with acute cholecystitis. Am Surg 2000; 66(1):33–37.PubMedGoogle Scholar
  20. 20.
    Menu Y, Vuillerme MP. Non-traumatic abdominal emergencies: imaging and intervention in acute biliary conditions. Eur Radiol 2002; 12(10):2397–2406.PubMedGoogle Scholar
  21. 21.
    Pronovost PJ, Angus DC, Dorman T, et al. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002; 288(17):2151–2162.CrossRefPubMedGoogle Scholar
  22. 22.
    Dimick JB, Pronovost PJ, Heitmiller RF, et al. Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection. Crit Care Med 2001; 29(4):753–758.CrossRefPubMedGoogle Scholar
  23. 23.
    Biffl WL, Moore EE, Offner PJ, et al. The Outreach Trauma Program: a model for survival of the academic trauma center. J Trauma 2002; 52(5):840–846.CrossRefPubMedGoogle Scholar
  24. 24.
    Warren J, Fromm RE Jr, Orr RA, et al. Guidelines for the inter-and intrahospital transport of critically ill patients. Crit Care Med 2004; 32(1):256–262.CrossRefPubMedGoogle Scholar
  25. 25.
    Lovell MA, Mudaliar MY, Klineberg PL. Intrahospital transport of critically ill patients: complications and difficulties. Anaesth Intensive Care 2001; 29(4):400–405.PubMedGoogle Scholar
  26. 26.
    Rhee KJ, Baxt WG, Mackenzie JR, et al. Differences in air ambulance patient mix demonstrated by physiologic scoring. Ann Emerg Med 1990; 19(5):552–556.CrossRefPubMedGoogle Scholar
  27. 27.
    Boyd CR, Corse KM, Campbell RC. Emergency interhospital transport of the major trauma patient: air versus ground. J Trauma 1989; 29(6):789–793.CrossRefPubMedGoogle Scholar
  28. 28.
    Kerr WA, Kerns TJ, Bissell RA. Differences in mortality rates among trauma patients transported by helicopter and ambulance in Maryland. Prehosp Disaster Med 1999; 14(3):159–164.PubMedGoogle Scholar
  29. 29.
    Farnell MB, Sachs JL. Mayo Clinic’s hospital-based emergency air medical transport service. Mayo Clin Proc 1989; 64(10):1213–1225.PubMedGoogle Scholar
  30. 30.
    Selevan JS, Fields WW, Chen W, et al. Critical care transport: outcome evaluation after interfacility transfer and hospitalization. Ann Emerg Med 1999; 33(1):33–43.CrossRefPubMedGoogle Scholar
  31. 31.
    Thomas F, Wisham J, Clemmer TP, et al. Outcome, transport times, and costs of patients evacuated by helicopter versus fixed-wing aircraft. West J Med 1990; 153(1):40–43.PubMedGoogle Scholar
  32. 32.
    Arbabi S, Jurkovich GJ, Rivara FP, et al. Patient outcomes in academic medical centers: influence of fellowship programs and in-house on-call attending surgeon. Arch Surg 2003; 138(1):47–51.CrossRefPubMedGoogle Scholar
  33. 33.
    Hoyt DB, Shackford SR, McGill T, et al. The impact of in-house surgeons and operating room resuscitation on outcome of traumatic injuries. Arch Surg 1989; 124(8):906–910.PubMedGoogle Scholar
  34. 34.
    DeNicola L, et al. Use of pediatric extenders in pediatric and neonatal intensive care units. Crit Care Med 1994; 22:1856–1964.CrossRefPubMedGoogle Scholar
  35. 35.
    Spisso J, O’Callaghan C, McKennan M, et al. Improved quality of care and reduction of housestaff workload using trauma nurse practitioners. J Trauma 1990; 30(6):660–663.CrossRefGoogle Scholar
  36. 36.
    Victorino G, Organ C. Physician assistant influence on surgery residents. Arch Surg 2003; 138:971–976.CrossRefPubMedGoogle Scholar
  37. 37.
    Mundinger M, Kane R, Lenz E, et al. Primary care outcomes in patients treated by nurse practitioners or physicians in a randomized trial. JAMA 2000; 283(1):59–68.CrossRefPubMedGoogle Scholar
  38. 38.
    Schaeffer H, Hardy D, Jewett P, et al. The role of the nurse practitioner and physician assistant in the care of hospitalized children. Pediatrics 1999; 103(5):1050–1052.CrossRefGoogle Scholar
  39. 39.
    Cooper R. The growing independence of nonphysician clinicians in clinical practice. JAMA 1997; 277(13):1092–1094.CrossRefPubMedGoogle Scholar
  40. 40.
    Riportella-Muller R, Libby D, Kindig D. The substitution of physician assistants and nurse practitioners for physician residents in teaching hospitals. Health Affairs 1995; 14:181–191.CrossRefPubMedGoogle Scholar
  41. 41.
    Polk H. The declining interest in surgical careers, the primary care mirage, and concerns about contemporary undergraduate surgical education. Am J Surg 1999; 178(3): 177–179.CrossRefPubMedGoogle Scholar
  42. 42.
    Abrass C, Ballweg R, Gilshannon M, et al. Process for reducing workload and enhancing residents’ education at an academic medical center. Acad Med 2001; 76(8):798–805.CrossRefPubMedGoogle Scholar
  43. 43.
    Bijttebier P, Vanoost S, Delva D, et al. Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses. Intensive Care Med 2001; 27(1):160–165.CrossRefPubMedGoogle Scholar
  44. 44.
    DeSanti L, Lincoln L, Egan F, et al. Development of a burn rehabilitation unit: impact on burn center length of stay and functional outcome. J Burn Care Rehabil 1998; 19(5):414–419.CrossRefPubMedGoogle Scholar
  45. 45.
    Sheridan R, Weber J, Prelack K, et al. Early burn center transfer shortens the length of hospitalization and reduces complications in children with serious burn injuries. J Burn Care Rehabil 1999; 20(5):347–350.CrossRefPubMedGoogle Scholar
  46. 46.
    Mosenthal AC, Livingston DH, Lavery RF, et al. The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma 2004; 56(5):1042–1048.CrossRefPubMedGoogle Scholar
  47. 47.
    Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M, et al. Post-ICU mechanical ventilation: treatment of 1, 123 patients at a regional weaning center. Chest 1997; 111(6): 1654–1659.CrossRefPubMedGoogle Scholar
  48. 48.
    Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M. Approach to patients with long-term weaning failure. Respir Care Clin North Am 2000; 6(3):437–461, vi.CrossRefGoogle Scholar
  49. 49.
    Dennis C, Houston-Miller N, Schwartz RG, et al. Early return to work after uncomplicated myocardial infarction. Results of a randomized trial. JAMA 1988; 260(2):214–220.CrossRefPubMedGoogle Scholar
  50. 50.
    Stohr IM, Albes JM, Franke U, et al. Outcome of patients after cardiac surgery transferred to other hospitals following prolonged intensive care stay. Thorac Cardiovasc Surg 2002; 50(6):329–332.CrossRefPubMedGoogle Scholar
  51. 51.
    Hutchinson L, Marks T, Pittilo M. The physician assistant: would the US model meet the needs of the NHS? BMJ 2001; 323:1244–1247.CrossRefPubMedGoogle Scholar
  52. 52.
    Hampton J. Evidence-based medicine, practice variations and clinical freedom. J Eval Clin Pract 1997; 3(2):123–131.CrossRefPubMedGoogle Scholar
  53. 53.
    Performance Improvement Subcommittee of the American College of Surgeons Committee on Trauma. Trauma Performance Improvement Reference Manual. Chicago: American College of Surgeons, 2002.Google Scholar
  54. 54.
    Miles A, Bentley P, Polychronis A, Grey J. Evidence-based medicine: why all the fuss? This is why. J Eval Clin Pract 1997; 3(2):83–86.CrossRefPubMedGoogle Scholar
  55. 55.
    Sox H. Independent primary care practice by nurse practitioners. JAMA 2000; 283(1):106–108.CrossRefPubMedGoogle Scholar
  56. 56.
    Chassin M. Practice guidelines: best hope for quality improvement in the 1990s. J Occup Med 1990; 32(12):1199–1206.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • José J. DiazJr.
    • 1
  • Oscar D. Guillamondegui
    • 1
  • John A. MorrisJr.
    • 1
  1. 1.Department of Surgery, Division of Trauma and Surgical Critical CareVanderbilt University Medical Center, Vanderbilt University HospitalNashvilleUSA

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