Abstract
Background
Emergency hand service is a national problem both for civilian and veteran patients. The North Florida/South Georgia Veterans Health system began coordinating emergency hand coverage within the plastic surgery service in 2008. Consult templates were designed to facilitate access to the appropriate service. Trainees were taken out of transfer decisions. Clinic templates were designed to fast track urgent patients to 8 a.m. appointments. The purpose of this study was to evaluate the effectiveness of our templates and triage system.
Methods
All consults completed by the plastic surgery service were reviewed retrospectively. Emergent and urgent hand consults were identified. Time from consult submission to the patient being seen by the plastic surgery provider was recorded. Time frames were categorized as same day, next day, within 2 days, less than or equal to 7 days, and greater than 7 days. Type of emergency (trauma or infection) and treatment plan were noted.
Results
There were 1,090 consults in 2007 and 1,868 consults in 2012 that were completed by the plastic surgery service. We found the number of urgent and emergent hand consults increased by a factor of 6 (49 to 294). Furthermore, 16.3 % (8/49) of patients were seen greater than 1 week after consult submission in 2007, compared with 8.1 % (24/294) of patients in 2012. Only one patient from 2007 and two patients from 2012 went to the OR after regular operating room hours.
Conclusion
A well-coordinated effort to speed access for hand emergencies can minimize expenses and improve quality of care
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References
Anthony JR, Poole VN, Sexton KW, et al. Tennessee emergency hand care distributions and disparities: emergent hand care disparities. Hand. 2013;82:172–8.
Caffee H, Rudnick C. Access to hand surgery emergency care. Ann Plast Surg. 2007;58(2):207–8.
Friebe I, Isaacs J, Mallu S, et al. Evaluation of appropriateness of patient transfers for hand and microsurgery to a level 1 trauma center. Hand. 2013;8(4):417–21.
Labs JD. Standard of care for hand trauma: where should we be going? Hand. 2008;3(3):197–202.
Lifchez S. Hand education for emergency medicine residents: results of a pilot program. J Hand Surg. 2012;37(6):1245–8.
Mueller MA, Zaydfudim V, Sexton KW, Shack RB, Thayer WP. Lack of emergency hand surgery: discrepancy between elective and emergency hand care. Ann Plast Surg. 2012;68(5):513–7.
Potini VC, Bratchenko W, Jacob G, et al. Repeat emergency room visits for hand and wrist injuries. J Hand Surg [Am]. 2014;39(4):752–6.
Rao MB, Lerro C, Gross CP. The shortage of on-call surgical specialist coverage: a national survey of emergency department directors. Acad Emerg Med. 2010;17(12):1374–82.
Acknowledgment
This project is the result of work supported with resources and use of facilities at the Malcom Randall VA Medical Center, Gainesville, FL.
Conflict of Interest
Loretta Coady-Fariborzian declared that she has no conflict of interest.
Amy McGreane declared that she has no conflict of interest.
Statement of Human and Animal Rights
This article does not contain any studies with human or animal subjects.
Statement of Informed Consent
No patient-identifiable information was disclosed in this study.
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Coady-Fariborzian, L., McGreane, A. Comparison of hand emergency triage before and after specialty templates (2007 vs. 2012). HAND 10, 215–220 (2015). https://doi.org/10.1007/s11552-014-9664-4
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DOI: https://doi.org/10.1007/s11552-014-9664-4