On Friday, June 27, the American College of Surgeons (ACS) hosted the ACS Surgical Healthcare Quality Forum Iowa, featuring a panel of healthcare leaders who shared insights into the unique healthcare issues that rural areas face today, including workforce shortages, quality education and training for the next generation of rural surgeons, and access to trauma care. Speakers at the forum highlighted how the trauma system has evolved in Iowa and discussed best practices for improving patient outcomes and reducing healthcare costs among the rural population.
Although 24 percent of Americans live in small rural communities, only 10 percent of general surgeons practice in those areas. In addition, the lack of proximity to a trauma center or to the appropriate level of care results in a higher death rate for motor vehicle traffic accident victims, and the death rates are higher in areas that have a lower number of surgeons per county.
"The issues related to access to quality rural surgical care continue to burden many Iowa communities," said forum co-host Ronald J. Weigel, MD, PhD, MBA, FACS, associate vice president for the UI Health Alliance; and the EA Crowell Jr. Professor and Chair of Surgery, professor of surgery – surgical oncology and endocrine surgery, professor of biochemistry, anatomy and cell biology, University of Iowa Carver College of Medicine, Iowa City. "A big issue many of us are concerned about right now is workforce shortages and the impact that will have on the future of rural healthcare. Many general surgeons in rural areas are nearing retirement, while at the same time residents and younger surgeons are choosing to specialize. It will be important for our profession to focus on recruiting highly skilled and qualified general surgeons to the communities that need them most. Finding a way to fund graduate medical education is a serious problem facing our country and will affect this as well."
Forum presenters discussed the implementation of Iowa's trauma system in 2001 and how it has helped improve outcomes of trauma patients throughout the state. According to the Iowa Trauma System Ten-Year Report, released by the Iowa Department of Public Health in 2010, since the system was implemented there has been a 49 percent decrease in traumatic brain injury, a 35 percent decrease in chest injury, and a 20 percent overall decrease in mortality among non-transfer patients. In addition, the trauma system has enabled faster arrival to definitive care, faster and more appropriate resuscitation, patients seen by a trauma surgeon sooner, and more patients discharged home.
Co-host Carol Scott-Conner, MD, PhD, MBA, FACS, professor of surgery, division of oncology and endocrine surgery at the University of Iowa Carver College of Medicine, added, "Quality can mean many different things for patient care, but for rural surgical care, it really boils down to having access to the right surgeon at the right time, and for that surgeon to have the resources he or she needs to do the job well. It can be a real challenge, but having discussions like these and coming together as a network to share resources and best practices will make a big difference."
The forum also highlighted ACS programs and initiatives that support rural surgeons in their quest to provide high-quality care, including the creation of the ACS Advisory Council on Rural Surgery and the ACS Rural Listserv, a "hub" for 1,000 rural surgeons across the country to use in sharing information. The Listserv has proved to be a valued resource, facilitating more than 5 million e-mail exchanges to date on a variety of topics and clinical questions affecting rural surgery practice.
"The Iowa Forum's focus on rural quality couldn't align more with ACS's mission to ensure all patients have access to high-quality surgical care wherever they are," said David B. Hoyt, MD, FACS, Executive Director of ACS. "From rural residency training programs to recruitment and retention support, continuing education and training, to trauma system verification, the College is committed to working with rural surgeons and hospitals to help identify and rectify the challenges that they face on a daily basis."
Although "quality" is not always easy to measure in rural areas due to the volume and nature of surgical cases, panelists also discussed the resources and metrics available to rural surgeons and hospitals to assess performance, including the ACS National Surgical Quality Improvement Program® (ACS NSQIP®), a leading and successful model giving more than 500 hospitals across the country reliable data to help pinpoint areas for improvement. ACS NSQIP is unique from other quality programs because it uses risk- and procedure mix-adjusted data that are taken from the patient's medical chart, not insurance claims, and is based on 30-day patient outcomes.
The ACS Surgical Healthcare Quality Forum Iowa is the 19th in a series of community forums held across the U.S. since 2011 to share examples of how quality improvement programs have set higher standards, reduced costs and improved patient outcomes at a state and national level.
 Frangou C. Rural hospitals feel the pinch of general surgeon shortage. General Surgery News. 2008. Available at: www.generalsurgerynews.com/ViewArticle.aspx?d_id=69&a_id=9929. Accessed November 20, 2012.
 Eastman AB. Scudder Oration on Trauma. J Am Coll Surg. 2010;211(2):153-168.
 Melleker M., Torner J., Young T., Sparling, K. Iowa Trauma System Ten Year Report. 2010.