Table 3 Distribution of SB-715992 elective cancer operations performed by subspecialty surgical oncologists (non-general
surgeons) at Victoria Hospital, before and after the implementation of ACCESS (pre- and post-ACCESS, respectively) Variable Pre-ACCESS, n (%) Post-ACCESS, n (%) Change, n (%) P value Number of cases, n 1685 1624 -61 (-4) – Number of cases by priority level, n (%) <0.0001 P2 187 (11) 95 (6) -92 (-49) P3 1027 (61) 768 (47) -259 (-25) P4 471 (28) 761 (47) +290 (+62) No. of cases exceeding wait-time targets by priority, n (%) 0.39 P2 120 (64) 61 (64) -59 (-49) P3 485 (47) 297 (39) -188 (-39) P4 122 (26) 118 (16) -4 (-3) Median wait-times by priority, days (range) 0.52 P2 19 (1–215) 17 (1–55) -2 (-10) P3 27 (0–274) 23 (0–108) -4 (-14) P4 66 (0–246) 41 (0–207) -25 (-37) Type of cancer, n (%) < 0.0001 Gastric 21 (1) 10 (0.6) -11 (-52) Endocrine 238 (14) 172
(11) -66 (-28) Genitourinary (excluding prostate) 228 (14) 230 (14) +2 (+1) Gynecological 350 (21) 284 (17) -66 (-19) Head and neck (excluding thyroid) 154 (9) 276 (17) +122 (+79) Lung 168 (10) 194 (12) +26 (+15) Lymph 2 (0.1) 3 (0.2) +1 (+50) SAR302503 Peripheral nervous system 1 (0.1) 3 (0.2) +2 (+200) Prostate 132 (8) 105 (6) -27 (-20) Skin carcinoma1 8 (0.5) 7 (0.4) -1 (-13) Skin melanoma 49 (3) 30 (2) -19 (-39) 1Includes basal and squamous cell carcinoma. Discussion As ACS continues to flourish around the world, an increasing number of studies have emphasized the benefits of this care model for patients with general surgical emergencies [2, 5, 8, 15–18]. Surgical departments, however, have historically been expensive to run because of the costly equipment, support staff, as well as the specialized nursing and medical staff required [19]. The operating
room, therefore, is viewed as a necessary but expensive liability in the financially-constrained Monoiodotyrosine Canadian healthcare system. Consequently, funding for the implementation of surgical programs such as ACS services often requires the reallocation of pre-existing operating room resources. Prior to the implementation of ACCESS at our institution, there was no structured system for performing emergency general surgery cases during the daytime. Emergency patients would usually have their operation in the evening or night, after the completion of the daytime elective caseload, or they would have their operation during the daytime at the expense of cancelling one or more elective cases. Alternatively, patients would stay in the hospital—sometimes for days— before a surgeon was able to perform an operation during his elective schedule. The goal of ACCESS, therefore, was to provide more timely access to the OR for emergency general surgery, while decreasing the amount of expensive “after-hours” surgeries, all the while without increasing the overall general surgery operating volume.