title: Disproportionate Availability Between Emergency and Elective Hand Coverage: A National Trend?
abstract: BACKGROUND
  Traumatic hand injuries represent approximately 20% of emergency department visits; yet, access to emergency care remains inadequate. Recent surveys from several states report a wider availability of hand specialists providing elective care than emergency care. The authors aim to examine this phenomenon in the state of New Jersey and whether there is a national trend toward disproportionate availability between emergency and elective hand coverage.
  
  
  METHODS
  A survey was conducted of all New Jersey hospitals, excepting university hospitals, in August 2014. To assess the availability of hand surgery coverage, the following questions were asked: (1) Does your hospital provide elective hand surgery? and (2) Is there a hand specialist/surgeon on call always, sometimes, or never?
  
  
  RESULTS
  A total of 58 hospitals were called, with a 67.2% response rate (n = 39). The majority (87.2%) of hospitals offered elective hand surgery, whereas only 64.1% provided immediate 24/7 hand coverage. Only 38.5% of hospitals located in the same county as a level I trauma center provided 24/7 emergency hand care, whereas 76.9% of hospitals in counties without any level I trauma center did (P < .05). Cities with a higher poverty level were less likely to provide emergency coverage than cities with a lower poverty level (47.4% vs 80.0%; P < .05).
  
  
  CONCLUSIONS
  There is a discrepancy between emergency and elective hand care in New Jersey. Similar findings across the nation suggest a concerning trend of limited access to emergency hand health care. Alternative systems that can appropriately triage and treat patients are warranted.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Stella Y
authors.initials: SY
authors.lastname: Chung
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Aditya
authors.initials: A
authors.lastname: Sood
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Granick
keywords: disproportionate availability; elective hand coverage; emergency hand coverage; hand trauma; national trend