title: Lack of emergency hand surgery: discrepancy between elective and emergency hand care.
abstract: Wrist, hand, and finger trauma are the most common injuries presenting to emergency departments. Shortage of emergency hand care is an emerging problem, as on-call hand coverage declines. This study evaluates the availability of elective and emergency hand surgery services in Tennessee, with the use of telephone surveys administered to emergency department and operating facility management. One hundred eleven Tennessee hospitals completed the surveys (93% response rate). In all, 77% of hospitals offer elective hand surgery, 58% offer basic emergency hand services, 18% offer occasional hand specialist call coverage and only 7% of hospitals have 24/7 hand specialist call coverage. Hospitals with hand specialists have significantly more payer charges from commercial insurance than hospitals without hand specialists (26.1% vs. 16.1%, P < 0.001). Our results strongly support the need for increased emergency hand coverage. Solutions include creating multihospital coordinated call schedules, increasing incentives for call coverage, and training more hand specialists.
authors.affiliation: Department of Plastic Surgery, Vanderbilt University, Nashville, TN, USA
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Mueller
authors.forename: Victor
authors.initials: V
authors.lastname: Zaydfudim
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Sexton
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Shack
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Thayer
mesh_terms: D017558:Elective Surgical Procedures; D004632:Emergency Medical Services / Q000600:supply & distribution*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006230:Hand Injuries / Q000601:surgery*; D019538:Health Care Surveys; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D013043:Specialties, Surgical; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013714:Tennessee; D000078329:Workforce