The Trauma Center at Froedtert & the Medical College of Wisconsin Froedtert Hospital is a highly active one, admitting some 3,400 patients a year. As the only adult Level I Trauma Center in eastern Wisconsin, it assures that skilled trauma surgeons and many other vital clinical specialists are available in-house, 24 hours a day to treat the most serious injuries.
Trauma surgeons also extend their expertise to another group of patients at Froedtert Hospital — those who arrive in the Emergency Department and need acute care surgery, known by some as emergency surgery.
“We focus on critically ill patients who are usually more complex, with diagnoses that range from inter-abdominal obstruction, ischemia and soft tissue infection to appendicitis and acute cholecystitis,” said Marc de Moya, MD, trauma surgeon and MCW faculty member. “Many diagnoses that fall under this auspice.”
The practice of trauma surgeons performing general surgery in emergencies is a longstanding and pragmatic one because they are in the hospital around the clock. As general surgeons become increasingly specialized and fewer are available for emergency cases, this trend is accelerating.
“There is a growing need in the community for complex surgery care because not as many doctors are being trained in general surgery and surgical critical care to provide such specialized care across the continuum,” Dr. de Moya said.
Formalized programs recognizing acute care surgery as a specialty combining trauma surgery with surgical critical care began in 2007, and Froedtert Hospital was among the first in the country to adopt the model in 2009. Recently, Froedtert Hospital was approved to be one of 20 hospitals in the country offering a two-year acute care surgery fellowship.
“Our goal is to provide complex emergency general surgical support and education for the region,” Dr. de Moya said.
A Community Operation
Acute care surgery plays an increasingly important role in the community. “We have more opportunities to take care of patients who really need our help,” said trauma surgeon Jeremy S. Juern, MD, FACS, director of the Acute Care Surgery Program. “Factors such as poverty, joblessness and changes in the health care system mean that many people in our region lack a primary care doctor or have limited access to health care.”
Acute care surgeons do more than operate and can take on broader responsibilities. “We follow patients beyond surgery into recovery at home and see them as outpatients,” Dr. de Moya said. “We provide the full spectrum of care from the time they enter the Emergency Department until the resolution of the disease process.”
During the course of treatment, surgeons might detect other health issues that can be addressed. For example, Dr. Juern said a woman may come to the Emergency Department with a severe skin infection that requires surgery. While planning for the operation, the surgeon and his team might discover the patient has undiagnosed diabetes. “We would get her diabetes under control during the hospital stay and, at discharge, arrange a follow-up appointment to help her manage it,” he said.
The Go-To Resource
Froedtert Hospital offers formidable resources to treat acute care surgical patients. “We have a group of 15 trauma surgeons who provide this level of dedicated care 24/7,” Dr. de Moya said. “During the day we have five surgeons at any given time. At night and on weekends, two attending physicians are in the hospital all the time.” All faculty are double board-certified in general surgery and surgical critical care, and the team includes trauma-trained nurse practitioners and physician assistants.
In addition to the 32 surgical suites at Froedtert Hospital, there are two specialized operating rooms, one for trauma and another for acute care surgery. The surgical teams have 24-hour access. Like the Trauma Center, these rooms are well-used. About 1,800 emergency surgeries are performed at Froedtert Hospital every year.
A “fast-track” pathway Froedtert Hospital has implemented for emergency surgery means some patients may not even need to be admitted. “In cases of acute appendicitis or cholecystitis, patients come in to the Emergency Department, go directly to an observation unit, then to an operating room, back to the observation unit and then home,” Dr. de Moya said. “The total length of stay is less than 12 hours.”
Our trauma surgeons are sharing with colleagues around the world what they’ve learned from being on the forefront of acute care surgery. “We’ve also developed a global surgery program, bringing this expertise to Ethiopia and Cuba,” Dr. de Moya said. “We work with hospitals and universities in these countries to develop trauma and acute care surgery systems.”
Froedtert Hospital is also part of a Department of Defense military civilian training program. A team of army physicians, nurses and technicians are embedded at Froedtert Hospital either before or between deployments. “The idea is to help them maintain their skills at a civilian trauma setting because not every deployment is busy from a surgical standpoint,” Dr. de Moya said.
The Acute Care Surgery Program at Froedtert Hospital is an important asset to patients and the medical community alike. If acute health problems occur, Froedtert Hospital is the go-to resource.
“Acute care surgeons are broadly trained to treat critically ill patients,” Dr. de Moya said. “They provide immediate in-house evaluation and high-level surgical care, 24/7.”
For Our Referring Physicians:
Academic Advantage of Acute Care Surgery
The Froedtert & MCW health network gives patients and their referring physicians a distinct advantage.
Contact our physician liaison team for more information about our Acute Care Surgery Program or if you would be interested in meeting with any of the trauma surgery team members.