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Disproportionate Availability between Emergency and Elective Hand Coverage: a National Trend?
Aditya Sood, MD, MBA, Stella Chung, M.S., Mark S. Granick, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.

Purpose:
Traumatic hand injuries represent approximately 20% of emergency department visits, yet access to emergency hand care remains inadequate. Recent surveys from several states report a wider availability of elective care. The authors aim to examine this phenomenon in New Jersey, and whether there is a national trend towards disproportionate availability between emergency and elective hand coverage.
Methods:
A survey was conducted by telephone, email, and fax in August 2014. The following questions were asked to the medical staff coordinator or director of emergency department: (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 62% response rate (n = 36). 86% of hospitals offered elective hand surgery while only 67% provided 24/7 hand coverage. 11% of hospitals had a hand surgeon on call occasionally and 19% never did. Hospitals located in the same county as a level 1 trauma center provided less 24/7 service (40% vs. 81%, p<0.05).
Conclusions:
There is a discrepancy between emergency and elective hand service in NJ. Similar findings across Florida, Massachusetts, upstate New York, and Tennessee suggest a concerning trend of gaps in access to hand care (7%-55% emergency vs. 77%-88% elective). As disproportionate availability between emergency and elective coverage can lead to suboptimal patient care and inappropriate transfers, a nationwide system that can adequately triage and treat patients is warranted.


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