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How do emergency department physicians rate their orthopaedic on-call coverage?
Robert Victor Cantu1, John Erik Bell, William V Padula
1Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03755, USA. Robert.V.Cantu@Hitchcock.org
Journal of Orthopaedic Trauma
|September 10, 2011
Summary
Emergency department physicians report inadequate orthopaedic on-call coverage, especially at night and on weekends. Many feel orthopaedists are reluctant to respond, impacting patient care and necessitating transfers.
Area of Science:
- Orthopaedic Surgery
- Emergency Medicine
- Healthcare Access
Background:
- The lack of orthopaedic on-call coverage is a recognized crisis in the United States.
- Emergency departments (EDs) face challenges in managing patients requiring orthopaedic consultations.
Purpose of the Study:
- To assess emergency department (ED) physicians' perceptions of orthopaedic on-call coverage.
- To evaluate the availability and adequacy of orthopaedic services for ED patients.
- To identify reasons for patient transfers due to insufficient orthopaedic care.
Main Methods:
- Anonymous questionnaires were distributed to ED directors in New Hampshire and Vermont.
- The survey included 25 items covering physician demographics, coverage availability, and transfer reasons.
- 31 out of 41 targeted EDs returned completed questionnaires.
Main Results:
- Only 36% of ED physicians reported full-time orthopaedic coverage; 8% reported never having coverage.
- Adequacy of coverage decreased from daytime (64%) to night (52%) and weekend (48%).
- 55% felt orthopaedists were reluctant to respond, and 52% believed patient care could be improved with timely orthopaedic evaluation.
Conclusions:
- Significant improvements are needed in orthopaedic on-call coverage for emergency departments.
- Physician reluctance, time of day, and complexity of injury were key barriers to care.
- Addressing these issues is crucial for enhancing patient outcomes in emergency settings.
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