This Division’s Emergency Surgery Service, (ESS) located at the Los Angeles County + USC Medical Center (LAC+USCMC), focuses on emergent and urgent surgery.  In addition, it also does a large volume of elective general surgery.  Much of the surgery, emergency and elective, is done laparoscopically.  The Division supports the Minimally Invasive Surgery Program and the Advanced Laparoscopy Fellowship.

The ESS and the Trauma Service share a 12 bed surgical observation unit adjacent to the emergency room of the LAC+USCMC.  There are, on average, 10 emergency non-trauma consults a day called in from the ER and inpatient services (usually Internal Medicine) for a wide variety of conditions from appendicitis to dissecting thoracic aneurysms.  These consults yield an average 3-4 major cases (in the operating room) and 1 bedside case.  An attending staff/faculty member is in house 24/7 and in the operating room for every case.

The elective surgery carried out on the ESS is largely done at the LAC+USC Medical Center in 5-6 operating rooms per week, and about 15 cases are done per week.  One operating room session per week is reserved for advanced laparoscopic cases.  Additionally, the ESS does one outpatient surgery session, all “easy” hernia repairs and laparoscopic cholecystectomies, at the Hudson Clinic each week.  All elective surgery is done with an attending staff/faculty member in the operating room.

The Service has an active educational program including a weekly journal club, a morbidity and mortality conference and an attending staff bedside round.  These are in addition to the other Department of Surgery educational activities on Friday mornings (M&M, Grand Rounds, “Core” Lecture and Skills Lab).    The nine weeks of the Skills Lab covering basic open and laparoscopic techniques are taught by the ESS faculty.

With only PGY 1-3s on the service, except for one Chief Resident (who gets the “big cases”), the Service is geared toward teaching basic general surgical principles such as diagnosis, pre-operative care, risk assessment, operative selection, resuscitation and post-operative management.  Residents perform a large number of basic surgical procedures (cholecystectomies, appendectomies, hernia repairs, exploratory laparotomies, etc.).  Areas such as wound care, infection prevention, wound healing, use of prosthetic materials, nutrition, team management, communication skills, ethics, prevention of complications and avoidance of errors are covered almost every day while on this Service.