Emergency Hand Surgeons in Short Supply

Hand surgeons available on call to treat emergency patients

(RxWiki News) Injuries to the hand, fingers or wrist are among the most common at hospital emergency rooms, yet few medical facilities have hand surgeons capable of treating these patients on call.

The study looked at hospitals in Tennessee, finding that only 7 percent of hospitals have a hand specialist on call 24 hours a day, but the findings suggest a wider problem.

"Go to the nearest hospital if you suffer a traumatic hand injury."

Wesley Thayer, MD, PhD, assistant professor of Plastic Surgery, and of Orthopaedic Surgery and Rehabilitation at Vanderbilt University Medical Center, said the results almost certainly suggest a national problem because the hospital frequently gets requests from states including Arkansas, Mississippi and Alabama where a patient needs a finger replanted or a consultation for a reattachment since there is no one available in their whole state to consult.

Researchers conducted telephone surveys with emergency department and operating facility management at 111 Tennessee hospitals, a response rate of 93 percent.

They found that 77 percent of hospitals offer elective hand surgery, 58 percent offer basic emergency hand services and 18 percent offer occasional hand specialist call coverage. Only 7 percent of hospitals surveyed said they had a hand specialist on call that could be available 24 hours a day.

"I was surprised that most Tennessee hospitals are able to offer elective hand surgery but only 7 percent of them have a hand specialist on call 24/7 to treat emergency injuries to the hand," Dr. Thayer said.

"There are a lot of injuries that actually need to come here to Vanderbilt, but I just hate it when I feel like somebody has traveled an incredibly long way for an injury that probably could have been treated locally."

Many of these hand injuries are common to blue collar workers and include getting fingers caught in presses or rolling machines, hand injuries while doing home automotive work or those that happen in home construction projects that often involve power tools.

About 12 percent of traumatic injuries treated in hospital emergency rooms are wrist, hand or finger injuries, according to the study.

Dr. Thayer said he does not believe hospitals are refusing to treat hand injuries, but that there is a shortage of hand surgeons in the community. He said that medical centers should have trained hand specialists on call, particularly if they offer elective hand surgery.

Creating multi-hospital coordinated call schedules, increasing incentives for call coverage and training more hand specialists could help with the shortage, Dr. Thayer said.

The study was recently published in the Annals of Plastic Surgery.

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Review Date: 
May 1, 2012