title: Hand and microvascular replantation call availability study: a national real-time survey of level-I and level-II trauma centers.
abstract: BACKGROUND
  Inconsistent availability of subspecialty hand and microvascular emergency call services could influence patient outcomes and the efficiency of a system dependent on limited resources and timely intervention because declining reimbursements, increased medicolegal risk, lack of confidence in microsurgical skills, and the disruption of elective schedules present a deterrent to call panel participation. This study assessed the availability of hand and microvascular replantation surgery call services at all level-I and level-II trauma centers in the United States.
  
  
  METHODS
  Between May and December 2010, all level-I (N = 137) and level-II (N = 153) trauma centers across the U.S. were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our institutional review board-approved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital.
  
  
  RESULTS
  Level-I trauma centers: 117 (85%) of 137 participated, and sixty-four (55%) of these had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services for fifteen to thirty-one days per month, and three hospitals supported services for one to fifteen days per month. Ten hospitals indicated inconsistent coverage, which was difficult to estimate, and thirty-four hospitals reported no coverage. Level-II trauma centers: 132 (86%) of 153 participated, and thirty-eight (29%) of these had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services for fifteen to thirty-one days per month, and three hospitals provided coverage for one to fifteen days per month. Eighty-four hospitals reported no specific coverage protocol.
  
  
  CONCLUSIONS
  Inconsistency in the definition and coverage of emergency hand and microvascular replantation services was identified at level-I and level-II trauma centers across the U.S. Many hospitals indicated the presence of subspecialty hand surgery coverage; however, the determination of microvascular replantation resources was not available consistently. The results of our study strengthen previous conclusions about the need for a more defined and coordinated system of emergency microvascular replantation surgery services in order to improve the efficiency of a limited resource and, ultimately, improve patient care.
authors: Department of Orthopaedic Surgery, Duke University, DUMC Box 2836, Durham, NC 27710, USA.
authors: Bret C
authors: BC
authors: Peterson
authors: Daniel
authors: D
authors: Mangiapani
authors: Ryan
authors: R
authors: Kellogg
authors: Fraser J
authors: FJ
authors: Leversedge
mesh_terms: D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008866:Microsurgery; D012092:Replantation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014481:United States; D000078329:Workforce