title: Characteristics of emergency department transfers for hand surgery consultation.
abstract: BACKGROUND
  The purpose of this study was to establish the characteristics of patients who are transferred from referring emergency departments (EDs) to two receiving institutions for hand-related emergencies. Our primary hypothesis was that many transferred patients would not require emergent specialty intervention. Our secondary hypotheses were that treatment would differ by day of presentation and type of insurance coverage.
  
  
  METHODS
  We searched ED records for all hand-related cases over 1 year. We reviewed charts for demographics and treatment details. The main outcome measures were whether patients were seen by a hand surgeon or underwent surgery within 24 h of transfer.
  
  
  RESULTS
  The study group comprised 296 patients. Ninety-two percent saw a specialty resident, and 48 % saw a hand surgeon. Thirty-nine percent of patients were taken to the operating room within 24 h of presentation. Of patients transferred on the weekends, 48 % saw a hand surgeon versus 61 % of those transferred on weekdays. Similarly, 51 % of patients transferred on a weekday were taken to the OR within 24 h, while 38 % of patients transferred on a weekend were taken to the OR in the same time frame.
  
  
  CONCLUSIONS
  More than half of transfers for hand emergencies did not result in examination by a hand surgeon, and nearly two thirds did not require a visit to the OR within 24 h. Patients transferred on the weekend were less likely to see a hand surgeon than those transferred on weekdays. Alternative methods of consultation might allow avoidance of transfer.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA ; Shriners Hospital for Children Northern California, 2425 Stockton Blvd., Sacramento, CA 95817 USA.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Bauer
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Blazar
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA.
authors.forename: Brandon E
authors.initials: BE
authors.lastname: Earp
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA.
authors.forename: Dexter L
authors.initials: DL
authors.lastname: Louie
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
keywords: Hand call; Hand emergency; Inter-hospital transfer