Disproportionate Availability Between Emergency and Elective Hand Coverage: A National Trend?

Abstract

Background: Traumatic hand injuries represent approximately 20% of emergency department visits; yet, access to emergency care remains inadequate. Recent surveys from several states report a wider availability of hand specialists providing elective care than emergency care. The authors aim to examine this phenomenon in the state of New Jersey and whether there is a national trend toward disproportionate availability between emergency and elective hand coverage.

Methods: A survey was conducted of all New Jersey hospitals, excepting university hospitals, in August 2014. To assess the availability of hand surgery coverage, the following questions were asked: (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 67.2% response rate (n = 39). The majority (87.2%) of hospitals offered elective hand surgery, whereas only 64.1% provided immediate 24/7 hand coverage. Only 38.5% of hospitals located in the same county as a level I trauma center provided 24/7 emergency hand care, whereas 76.9% of hospitals in counties without any level I trauma center did (P < .05). Cities with a higher poverty level were less likely to provide emergency coverage than cities with a lower poverty level (47.4% vs 80.0%; P < .05).

Conclusions: There is a discrepancy between emergency and elective hand care in New Jersey. Similar findings across the nation suggest a concerning trend of limited access to emergency hand health care. Alternative systems that can appropriately triage and treat patients are warranted.

Keywords: disproportionate availability; elective hand coverage; emergency hand coverage; hand trauma; national trend.

Figure 1

Provision of emergency hand coverage in relation to level I trauma center proximity. Three level I trauma centers in New Jersey are marked in red.

Figure 2

Proportions of hospitals that provide emergency hand coverage distributed by socioeconomic factors at the city level (%), P < .05. Less than state average is labeled as “no poverty,” and above state average is labeled as “poverty”; n represents total sample size. P value by the Fisher exact test.

Figure 3

Availability of emergency and elective hand coverage in 5 US states (%). The proportion is based on survey respondents, *P < .05. Dotted represents emergency, checkered represents elective, and n represents total sample size. California indicates CA; FL, Florida; NJ, New Jersey; NY, New York; TN, Tennessee. P value by the Fisher exact test.