title: Perceptions of Emergency Medicine Residency and Hand Surgery Fellowship Program Directors in the Appropriate Disposition of Upper Extremity Emergencies.
abstract: OBJECTIVE
  To survey emergency medicine (EM) residency and hand surgery fellowship program directors (PDs) to identify consensus in their perceptions of appropriate emergency care of upper extremity emergencies.
  
  
  METHODS
  We created a framework to group common upper extremity emergency diagnoses and surveyed PDs to evaluate the training background--EM, general orthopedic or plastic surgery, or hand fellowship--most appropriate to provide acute, point-of-care management for each of these diagnostic groupings. Responses were pooled and consensus was established with greater than 75% agreement between groups.
  
  
  RESULTS
  We received 79 responses from hand fellowship PDs (90% response rate) and 151 responses from EM PDs (49% response rate). We identified consensus for the training background that PDs in both specialties felt was appropriate to care for 17 of 21 diagnostic groupings in the framework.
  
  
  CONCLUSIONS
  There was a high level of consensus between EM and hand surgery PDs regarding diagnoses that acutely require training in hand surgery versus those that can be managed by an EM physician. Our diagnostic framework may help reduce unnecessary hand surgery consultation and may help to identify patients who do not require more specialized acute care and thus decrease unnecessary transfers.
  
  
  METHODS
  Economic and Decision Analyses IV.
authors.affiliation: Department of Plastic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD. Electronic address: brian.c.drolet@gmail.com.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Drolet
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lifchez
authors.affiliation: Philadelphia Hand Center, Philadelphia, PA.
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Jacoby
authors.affiliation: Warren Alpert Medical School of Brown University; Providence, RI.
authors.forename: Andrew
authors.initials: A
authors.lastname: Varone
authors.affiliation: Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Regan
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Baren
authors.affiliation: Department of Orthopaedic Surgery, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Edward
authors.initials: E
authors.lastname: Akelman
authors.affiliation: Philadelphia Hand Center, Philadelphia, PA.
authors.forename: A Lee
authors.initials: AL
authors.lastname: Osterman
authors.affiliation: Department of Orthopaedics and Surgery, Division of Plastic Surgery, Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
mesh_terms: D004503:Education, Medical, Graduate; D004630:Emergencies; D004635:Emergency Medicine / Q000193:education*; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009985:Orthopedics / Q000193:education*; D008486:Physician Executives; D013518:Surgery, Plastic / Q000193:education*; D011795:Surveys and Questionnaires; D014481:United States; D034941:Upper Extremity / Q000601:surgery*
keywords: Emergency guidelines; emergency evaluation; health care delivery; transfer; triage