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

Ann Plast Surg. 2017 Oct;79(4):354-358. doi: 10.1097/SAP.0000000000001155.

Abstract

Introduction: 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.

Methods: 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.

Results: 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%.

Conclusion: 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.

MeSH terms

  • Elective Surgical Procedures*
  • Emergencies
  • Emergency Service, Hospital*
  • Facial Injuries / surgery*
  • Hand Injuries / surgery*
  • Health Services Accessibility / statistics & numerical data*
  • Health Surveys
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • New York
  • Plastic Surgery Procedures*
  • Surgery, Plastic*
  • Workforce