A feasibility model for restructuring the role of the hand surgeon taking call at a level I trauma center

The discrepancy between the volume of hand-related consults and the concurrent lack of specialized hand surgeons available continues to strain an overburdened system. Recent attention has focused on the redistribution of this workload towards management in the outpatient realm.

This is a retrospective review of hand consults for the plastic surgery service over summer and winter intervals at a Level I trauma center. Consults were triaged with non-plastic surgery residents managing consults through remote direction of a plastic surgery resident. Demographic, clinical and outcomes data were analyzed to make inferences regarding care.

There were 116 hand consults of which 94.8 ​% were managed acutely by non-plastic surgery clinicians. Lacerations and fractures were more common in the summer, while infections and dislocations were more common in the wintertime (p value ​= ​0.0029). The three most common procedures were reduction and splinting (41.4 ​%), suturing (28.4 ​%), and incision and drainage (6.0 ​%). 12.1 ​% were admitted for management of the hand-related issue. Average time to the OR was shortest for infections or compartment syndrome as compared to that for other acquired concerns (1.0 days versus 11.6 days, p ​= ​0.0027). There were two complications (1.7 ​%) involving an unplanned return to the OR, but neither resulted from a delay in treatment.

We propose a model of offloading the majority of hand consults through coverage by trainees with trauma experience knowledgeable in the basics of hand exams and general procedures. This model was safe and effective across a wide range of hand-related complaints.