TY  - JOUR
T1  - Hand and Microvascular Replantation Call Availability Study: A National Real-Time Survey of Level-I and Level-II Trauma Centers
AU  - Peterson, Bret C.
AU  - Mangiapani, Daniel
AU  - Kellogg, Ryan
AU  - Leversedge, Fraser J.
Y1  - 2012/12/19
N1  - 10.2106/JBJS.K.01167
JO  - The Journal of Bone & Joint Surgery
SP  - e185 1
EP  - 5
VL  - 94
IS  - 24
N2  - Background: 
  Inconsistent availability of subspecialty hand and microvascular emergency call services could influence patient outcomes and the efficiency of a system dependent on limited resources and timely intervention because declining reimbursements, increased medicolegal risk, lack of confidence in microsurgical skills, and the disruption of elective schedules present a deterrent to call panel participation. This study assessed the availability of hand and microvascular replantation surgery call services at all level-I and level-II trauma centers in the United States.Methods: 
  Between May and December 2010, all level-I (N = 137) and level-II (N = 153) trauma centers across the U.S. were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our institutional review board-approved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital.Results: 
  Level-I trauma centers: 117 (85%) of 137 participated, and sixty-four (55%) of these had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services for fifteen to thirty-one days per month, and three hospitals supported services for one to fifteen days per month. Ten hospitals indicated inconsistent coverage, which was difficult to estimate, and thirty-four hospitals reported no coverage. Level-II trauma centers: 132 (86%) of 153 participated, and thirty-eight (29%) of these had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services for fifteen to thirty-one days per month, and three hospitals provided coverage for one to fifteen days per month. Eighty-four hospitals reported no specific coverage protocol.Conclusions: 
  Inconsistency in the definition and coverage of emergency hand and microvascular replantation services was identified at level-I and level-II trauma centers across the U.S. Many hospitals indicated the presence of subspecialty hand surgery coverage; however, the determination of microvascular replantation resources was not available consistently. The results of our study strengthen previous conclusions about the need for a more defined and coordinated system of emergency microvascular replantation surgery services in order to improve the efficiency of a limited resource and, ultimately, improve patient care.
SN  - 0021-9355
M3  - doi: 10.2106/JBJS.K.01167
UR  - http://dx.doi.org/10.2106/JBJS.K.01167
ER  -