Continuity of care in a rural critical access hospital: Surgeons as primary care providers

BACKGROUND: The question of volume and outcomes has perfused the surgical literature. Hopedale Hospital is a critical access hospital located in central Illinois. The authors elected to review surgical outcomes to establish quality benchmarks for similar facilities. They also propose a practice model in which general surgeons provide primary care. METHODS: The authors consecutively reviewed retrospectively 100 each of 5 commonly performed procedures. These included carotid endarterectomy, laparoscopic cholecystectomy, laparoscopic Nissen fundoplication, hysterectomy, and inguinal hernia repair. Demographic data, c-morbidities, and outcomes up to 30 days postoperatively were summarized. RESULTS: The overall complication rate was 4%. This exceeded any benchmarks found in a surgical literature review through Medline. CONCLUSIONS: Critical access hospitals are capable of producing excellent surgical outcomes. Having a surgeon totally involved in perioperative management may contribute to the improved outcomes. This practice model could be used to recruit medical students into surgical training, perhaps alleviating shortages of rural surgeons and primary care physicians simultaneously. (C) 2011 Elsevier Inc. All rights reserved.