Comparison of hand emergency triage before and after specialty templates (2007 vs. 2012)

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.

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.

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.

A well-coordinated effort to speed access for hand emergencies can minimize expenses and improve quality of care.