The Crisis Of Deficiency In Emergency Coverage For Hand And Facial Trauma: Exploring The Discrepancy Between Availability Of Elective And Emergency Surgical Coverage
Lauren Whipple, BS, Tara Kelly, BA, Malcolm Z. Roth, MD, Ashit Patel, MBChB.
Albany Medical Center, Albany, NY, USA.
Purpose: Hand and facial trauma made up approximately 20% of the 37.9 million emergency department visits for injuries reported in 2010. Despite the necessity for surgeons who specialize in hand and facial injuries, studies have demonstrated a shortage of trauma coverage. Furthermore there may be a discrepancy between the availability of surgeons who perform elective procedures and who provide emergency coverage. The lack of coverage of hand and facial injuries in the acute setting creates implications in both patient care and costs of transport. To examine this discrepancy between acute and elective care, this study aims to assess the availability of facial and hand surgeons in upstate New York. The goal of the study is to determine if there is a difference between the availability of specialists providing elective surgical procedures in comparison to on-call emergency care.
Methods:The study was conducted by use of a telephone survey to quantify the availability of surgeons providing both elective and emergent procedures for both hand and facial surgeries. A telephone survey was conducted of all hospitals in Upstate New York from May 2012-October 2013 and assessed the hospital’s hand and facial surgical care at that time. The survey was administered to the director of surgical services or the medical staff coordinator to determine the availability of facial and hand specialist emergency care. All hospitals in New York State with an emergency department were contacted, excluding Long Island and New York City.
Results:A total of 113 hospitals were called, and 46% of the hospitals participated in the survey.88% of hospitals offered elective hand surgeries (e.g. carpal tunnel release) performed by a fellowship trained hand surgeon. Despite this high percentage only 27% of hospitals had a hand specialist on call 24/7, while 17% had one occasionally on call and 56% never did. Of the hospitals surveyed 79% offered elective facial procedures (e.g. septoplasty). Despite the high percentage of elective procedures, only 29% of the hospitals had a facial specialist on call 24/7, while 32% had one occasionally and 39% never did.
Conclusions:The results of our study demonstrate a deficiency in both hand and facial emergency surgical care in upstate New York. Furthermore there is a discrepancy between the availability of
surgeons for elective procedures and the lack of on-call emergency care. These findings demonstrate a possible need to increase specialist coverage for traumatic hand and facial injuries to improve access to care and potentially decrease societal healthcare expenses. With this emerging lack of readily available emergency care, institutional funding or subsidies for providing emergency call coverage should be explored as an incentive for change.
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