The Crisis of Deficiency in Emergency Coverage for Hand and Facial Trauma: Exploring the Discrepancy Between Availability of Elective and Emergency Surgical Coverage.

Abstract

Injuries are one of the most common reasons for emergency department visits, with approximately 40.2 million injury-related visits occurring in 2011. Facial, hand, and wrist injuries make up a large portion of these visits. Despite the high demand for specialists to attend to these injury-related emergency department visits, recent studies have suggested a discrepancy between elective surgical coverage and trauma care in general. The goal of this study was to determine if there was a difference between access to elective surgical procedures in comparison with on-call emergency care for facial and hand/wrist conditions in New York State. Hospitals throughout New York State, excluding New York City, were selected from the Department of Health Web site, hospitals.nyhealth.gov. A phone survey was administered between May 2012 and October 2013, to quantify the availability of elective and emergent procedures for facial and hand/wrist conditions. We compared the availability of emergency facial and hand/wrist surgical care based on hospital characteristics such as bed size and access to a surgical intensive care unit. We selected 113 hospitals, and 52 hospitals participated for a response rate of 46%. A total of 88% of hospitals offered elective hand procedures, but only 27% had consistent coverage for emergency hand trauma. Furthermore, only 29 % of hospitals had a facial specialist consistently available whereas the availability for elective facial procedures was 79%. Our study results show a discrepancy between the availability of surgeons for elective procedures and on-call emergency care for facial and hand/wrist condition.