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

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Health Services Research

Background:

• Traumatic hand injuries constitute 20% of emergency department visits.
• Access to emergency hand care is often inadequate.
• Disparities exist in specialist availability for emergency versus elective hand care.

Purpose of the Study:

• To investigate the availability of emergency versus elective hand surgery coverage in New Jersey.
• To determine if a national trend of disproportionate coverage exists.

Main Methods:

• A survey of New Jersey hospitals (excluding university hospitals) was conducted in August 2014.
• Hospitals were queried on elective hand surgery provision and 24/7 hand specialist on-call availability.
• Response rate was 67.2% (39 out of 58 hospitals).

Main Results:

• 87.2% of hospitals offered elective hand surgery, but only 64.1% provided 24/7 emergency hand coverage.
• Hospitals in counties without Level I trauma centers were more likely to offer 24/7 emergency care (76.9%) than those in counties with Level I trauma centers (38.5%).
• Cities with higher poverty levels showed reduced likelihood of providing emergency coverage (47.4%) compared to lower poverty areas (80.0%).

Conclusions:

• A significant discrepancy exists between emergency and elective hand care availability in New Jersey.
• National trends suggest limited access to emergency hand healthcare, necessitating alternative treatment systems.
• Urgent need for improved systems to triage and treat patients with emergency hand injuries.