Acute Care Surgery at UVA
A Note From Dr. Robert G. Sawyer
Chief of the Division of Acute Care Surgery & Outcomes Research
The Division of Acute Care Surgery and Outcomes Research was established in October 2008 in response to a need for a focused approach to the most seriously ill and injured surgical patients treated in the University of Virginia Health System. The scope of service encompasses trauma, surgical critical care, emergency general surgery, burn critical care, surgical nutrition support, and surgical infectious diseases.
The Section of Trauma is directed by Jeffrey Young, MD, and manages over 1700 acutely injured patients yearly. Dr. Young is a nationally recognized leader in the field of trauma, exemplified by his recent election to the prestigious American College of Surgeons Committee on Trauma. The University of Virginia is one of only five Commonwealth of Virginia level one trauma centers after initial designation in 1983. The University maintains an emergency air transport service which is an integral part of the commonwealth-wide EMS system. This service, named Pegasus, has both helicopter and fixed-wing aircraft to allow the rapid transport of the most critically injured patients to the University. The majority of patients seen by the trauma service have suffered blunt trauma, most commonly due to motor vehicle crashes, although there is a steady number of victims of penetrating trauma who also are treated. The University is also proud to act as the main referral center for gravely injured trauma patients from the western, southern, and central parts of Virginia and eastern part of West Virginia. The trauma service offers access to all resources necessary for the modern management of trauma, including a state-of-the-art critical care unit, radiology facilities, and operating rooms. In addition, all affiliated specialties are immediately available for the active care of the traumatized patient, including emergency medicine, neurosurgery, orthopedic surgery, head and neck surgery, urology and plastic surgery. Using this multidisciplinary approach and the efforts of Dr. Young, the University of Virginia Trauma service is consistently ranked very highly when compared to similar university centers.
The Surgical Critical Care service at the University of Virginia is based out of the Surgical Trauma Burn Intensive Care Unit, a modern, sixteen bed intensive care unit that incorporates all that modern medicine has to offer. The service is truly multidisciplinary and includes faculty in the Departments of Surgery, Emergency Medicine, Anesthesiology, Internal Medicine, and Public Health Sciences. The medical co-directors of this unit are Stewart Lowson, MD, from the Department of Anesthesiology and Robert Sawyer, MD, from the Departments of Surgery and Public Health Sciences. The Surgical Critical Care Service manages patients with severe illness who are not victims of trauma, most commonly those with severe infections of the abdomen or lungs, patients who have undergone highly complex surgical procedures, or patients who have received organ transplants. Areas of strength include complex ventilator management and hospital-acquired infections. Similar to the trauma service, the Surgical Trauma Burn Intensive Care Unit receives patients from a wide geographical area and a large percentage of patients are referred from other hospitals. Additionally, a Fellowship in Surgical Critical Care was approved in 2003. One individual per year is trained and is eligible to examine for a Certificate of Added Qualification in Surgical Critical Care.
The Emergency Surgery Service is directed by Michael D. Williams, M.D., and was also created in October 2008. The area of focus for this effort is to more consistently and efficiently care for patients who require an emergent surgical procedure or have conditions that are likely to require emergent or urgent surgical procedures in the near future. Over 500 cases of this nature are performed per year, and the patient population, due to their severity of illness, can be quite challenging. The most common conditions seen are perforations of the gastrointestinal tract, complex skin and skin structure infections, acute appendicitis, acute cholecystitis and other infections of the liver and bile ducts, and bowel obstructions. In order to optimally care for these patients, the Division employs a Nurse Practitioner, Vonda Johnston, RN, ACNP, who is vital in the non-surgical care of these patients as well as their transition back to health throughout their hospital stay. The emergency general surgery and trauma remain the two areas of most intense research, with ongoing projects in the areas of intra-abdominal infections, resuscitation, trauma and burns outcomes benchmarking, and educational simulation currently up and running.
Finally, the surgical nutrition service is part of the Division of Acute Care Surgery. This unit provides complex nutritional support to an average of 50 hospitalized patients at any given time. The most common populations are those with severe trauma or other illness requiring critical care, patients with neurological or neurosurgical diseases, complicated cardiothoracic surgical illnesses, and patients with complicated gastrointestinal diseases, including short bowel and entrocutaneous fistulae. Five nutrition support specialists led by Kate Willcutts, CNSD, and Associate Professor of Nursing, help provide cutting edge nutrition support to the most vulnerable patients in the hospital. Research is also very active in this realm, including an National Institutes of Health-funded study examining the most appropriate level of calories to be provided to critically ill surgical patients.
The Division of Acute Care Surgery and Outcomes Research is dedicated to the optimum management of the sickest patients in the Commonwealth of Virginia, as well as developing new knowledge that will improve survival in the future. Although no one ever wants to need us, when the need arises, we are dedicated to providing better care and sending more people home alive than any other hospital in the country. Our job is to save lives.