Study: Many patients travel long distances for emergency hand care even though local hospitals may offer elective hand surgery
Most EDs see a high number of patients presenting with hand, wrist, or finger trauma. However, new research highlights the fact that many patients have to travel long distances for appropriate treatment because their local hospital does not have a hand specialist on call. In the study, researchers from Vanderbilt University in Nashville, TN, found that 42% of 119 hospitals surveyed in Tennessee offer no emergency coverage for these common injuries, and only 7% of the hospitals reported having a hand specialist on call 24/7.1 This was the case even though 80% of the hospitals surveyed offer elective or non-emergent hand surgery, according to the study.
While this study just looked at hospitals in Tennessee, researchers believe it is a national problem. "Patients who are traumatically injured are finding themselves traveling further and further distances," explains Wesley Thayer, MD, PhD, a co-author of the study, and an assistant professor of plastic surgery and of orthopaedic surgery and rehabilitation at Vanderbilt University Medical Center. "I have patients who come from Arkansas or Mississippi to Nashville, and I know they drive past towns that have local surgeons available who might be able to take care of their injuries."
Most patients with these types of injuries are able to get the care they need, says Thayer, but he says there are cases where delays in care could have serious consequences. For example, time to treatment is a critical factor with respect to necrotizing fasciitis, compartment syndrome of the hand, and some amputations, says Thayer. "I don't think there is a crisis in care yet, but I do think there is a potential for that to develop," he says.
While it is clear that there is a shortage of hand specialists, Thayer observes that there has also been an evolution away from providing emergency hand care, although he is not sure why. Nonetheless, Thayer points out that hospitals tend to be in the driver's seat when it comes to developing on-call schedules. "If the hospitals wanted people on call for hand surgery, they would figure out a way to do it," he says. "If hospitals are going to offer significant volumes of elective hand surgery, then maybe they should have trained hand specialists on call."
Thayer believes there is an opportunity for clusters of hospitals in specific regions to work cooperatively to come up with a way to offer their communities emergency hand coverage. "We are not going to be able to rapidly increase the number of hand surgeons that we put in a community. That is a very complex thing," he says. "But the hospitals might be able to pool their hand resources and at least offer some version of emergency hand coverage to a two- or three-county area."
- Mueller M, Zaydfudim V, Sexton K, et al. Lack of emergency hand surgery: Discrepancy between elective and emergency hand care. Ann Plastic Surg. 2012;68:513-517.
Wesley Thayer, MD, PhD, Assistant Professor, Plastic Surgery, Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN. E-mail: Wesley.Thayer@Vanderbilt.edu.