{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T18:05:07Z","timestamp":1758477907303,"version":"3.44.0"},"reference-count":24,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2020,8,16]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Emergency general surgery (EGS) conditions encompass a variety of diseases treated by acute care surgeons. The heterogeneity of these diseases limits infrastructure to facilitate EGS-specific quality improvement (QI) and research. A uniform anatomic severity grading system for EGS conditions was recently developed to fill this need. We integrated this system into our clinical workflow and examined its impact on research, surgical training, communication, and patient care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The grading system was integrated into our clinical workflow in a phased fashion through formal education and a written handbook. A documentation template was also deployed in our electronic medical record to prospectively assign severity scores at the time of patient evaluation. Mixed methods including a quantitative survey and qualitative interviews of trainees and attending surgeons were used to evaluate the impact of the new workflow and to identify obstacles to its adoption.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 2291 patients presenting with EGS conditions during our study period. The most common diagnoses were small bowel obstruction (n=470, 20.5%), acute cholecystitis (n=384, 16.8%), and appendicitis (n=370, 16.1%). A total of 21 qualitative interviews were conducted. Twenty interviewees (95.2%) had a positive impression of the clinical workflow, citing enhanced patient care and research opportunities. Fifteen interviewees (75.0%) reported the severity grading system was a useful framework for clinical management, with five participants (25.0%) indicating the system was useful to facilitate clinical communication. Participants identified solutions to overcome barriers to adoption of the clinical workflow.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The uniform anatomic severity grading system can be readily integrated into a clinical workflow to facilitate prospective data collection for QI and research. The system is perceived as valuable by users. Educational initiatives that focus on increasing familiarity with the system and its benefits will likely improve adoption of the classification system and the clinical workflow that uses it.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Level III.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2020-000552","type":"journal-article","created":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T04:02:00Z","timestamp":1599624120000},"page":"e000552","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5626-4027","authenticated-orcid":false,"given":"Kovi E","family":"Bessoff","sequence":"first","affiliation":[{"name":"General Surgery, Stanford University, Stanford, California, USA"},{"name":"Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1639-8781","authenticated-orcid":false,"given":"Jeff","family":"Choi","sequence":"additional","affiliation":[{"name":"General Surgery, Stanford University, Stanford, California, USA"},{"name":"Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Bereknyei Merrell","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aussama Khalaf","family":"Nassar","sequence":"additional","affiliation":[{"name":"Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA"},{"name":"Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Spain","sequence":"additional","affiliation":[{"name":"Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA"},{"name":"Department of Surgery, Stanford University, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa Marie","family":"Knowlton","sequence":"additional","affiliation":[{"name":"General Surgery, Stanford University, Stanford, California, USA"},{"name":"Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,9,8]]},"reference":[{"key":"2025082410411472000_5.1.e000552.1","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1097\/TA.0000000000000444","article-title":"Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses","volume":"77","author":"Crandall","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410411472000_5.1.e000552.2","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1097\/TA.0000000000000362","article-title":"The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample--2001 to 2010","volume":"77","author":"Gale","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410411472000_5.1.e000552.3","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/TA.0000000000000787","article-title":"The financial burden of emergency general surgery: national estimates 2010 to 2060","volume":"79","author":"Ogola","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410411472000_5.1.e000552.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.09.026"},{"key":"2025082410411472000_5.1.e000552.5","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1097\/TA.0000000000001670","article-title":"Expanding the scope of quality measurement in surgery to include nonoperative care: results from the American College of surgeons national surgical quality improvement program emergency general surgery pilot","volume":"83","author":"Wandling","year":"2017","journal-title":"J Trauma Acute Care 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III: chest wall, abdominal vascular, ureter, bladder, and urethra","volume":"33","author":"Moore","year":"1992","journal-title":"J Trauma"},{"key":"2025082410411472000_5.1.e000552.9","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199011000-00035"},{"key":"2025082410411472000_5.1.e000552.10","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198912000-00013"},{"key":"2025082410411472000_5.1.e000552.11","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1097\/TA.0b013e3182aafdba","article-title":"Measuring anatomic severity of disease in emergency general surgery","volume":"76","author":"Shafi","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410411472000_5.1.e000552.12","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.surg.2018.05.061","article-title":"Validation of the AAST EGS grading system for perforated peptic ulcer disease","volume":"164","author":"Hernandez","year":"2018","journal-title":"Surgery"},{"key":"2025082410411472000_5.1.e000552.13","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s11605-017-3662-0","article-title":"Validation of AAST EGS grade for acute pancreatitis","volume":"22","author":"Younis","year":"2018","journal-title":"J Gastrointest Surg"},{"key":"2025082410411472000_5.1.e000552.14","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/TA.0000000000001274","article-title":"Increased anatomic severity predicts outcomes: validation of the American association for the surgery of trauma's emergency general surgery score in appendicitis","volume":"82","author":"Hernandez","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410411472000_5.1.e000552.15","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.surg.2017.10.041","article-title":"Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines","volume":"163","author":"Hernandez","year":"2018","journal-title":"Surgery"},{"key":"2025082410411472000_5.1.e000552.16","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/TA.0000000000001736","article-title":"The American association for the surgery of trauma severity grade is valid and generalizable in adhesive small bowel obstruction","volume":"84","author":"Hernandez","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410411472000_5.1.e000552.17","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/TA.0000000000002319","article-title":"Validation of the American association for the surgery of trauma emergency general surgery score for acute appendicitis-an East multicenter study","volume":"87","author":"Vasileiou","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410411472000_5.1.e000552.18","first-page":"391","article-title":"STRIDE--An integrated standards-based translational research informatics platform","volume":"2009","author":"Lowe","year":"2009","journal-title":"AMIA Annu Symp Proc"},{"key":"2025082410411472000_5.1.e000552.19","unstructured":"Creswell JW . 30 essential skills for the qualitative researcher: SAGE Publications, 2015."},{"key":"2025082410411472000_5.1.e000552.20","unstructured":"ACS . Trauma Quality Improvement Program (TQIP) Bibliography. https:\/\/www.facs.org\/-\/media\/files\/quality-programs\/trauma\/tqip\/tqip_bibliography.ashx (9 Jun 2020)."},{"key":"2025082410411472000_5.1.e000552.21","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1055\/s-0038-1673353","article-title":"Using the National surgical quality improvement project (NSQIP) to perform clinical research in colon and rectal surgery","volume":"32","author":"Eisenstein","year":"2019","journal-title":"Clin Colon Rectal Surg"},{"key":"2025082410411472000_5.1.e000552.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004268"},{"key":"2025082410411472000_5.1.e000552.23","doi-asserted-by":"publisher","DOI":"10.1891\/1078-4535.24.2.116"},{"key":"2025082410411472000_5.1.e000552.24","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1001\/jamasurg.2017.5440","article-title":"Effect of standardized handoff curriculum on improved clinician preparedness in the intensive care unit: a Stepped-Wedge cluster randomized clinical trial","volume":"153","author":"Parent","year":"2018","journal-title":"JAMA Surg"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2020-000552","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T17:41:28Z","timestamp":1756057288000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2020-000552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,9,8]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/tsaco-2020-000552"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2020-000552","relation":{},"ISSN":["2397-5776"],"issn-type":[{"type":"electronic","value":"2397-5776"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}