Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers

ABSTRACT Purpose The inconsistency of subspecialty emergency call services is a growing concern as declining reimbursements, increased legal risk, and challenging social and professional issues present a deterrent to call panel participation. This study assessed call availability of hand and microvascular replantation surgery at all level I and II trauma centers in the US. Materials and methods Between May and December 2010, all level I (n = 137) and level II (n = 153) trauma centers across the US were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our IRBapproved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital. Results: Level 1 centers: 117 of 137 (85%) participated, of which 64 (54.7%) had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services 15 to 31 days per month and 3 hospitals supported 1 to 15 days per month. Ten hospitals indicated an inconsistent coverage which was difficult to estimate and 34 hospitals reported no coverage. Level 2 centers 132 of 153 (86.3%) participated, of which 38 (29%) had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services 15 to 31 days per month and 3 hospitals for 1 to 15 days per month. 84 hospitals reported no specific coverage protocol. Conclusion Consistent on-call availability for emergency hand and microvascular replantation services remains a challenge across the US: • 54.7% of level I trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage; • 29% of level II trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage. Over 50% had no specific coverage protocol; • Many hospitals indicated the presence of subspecialty hand surgery coverage, however microvascular replantation resources were not available consistently; • While not confirmed, the current study findings suggest that a more clearly defined and coordinated system of hand surgery and microvascular replantation emergency call coverage will likely improve the efficiency of a limited resource and, ultimately, improve patient care. Peterson BC, Mangiapani DS, Kellogg R, Leversedge FJ. Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers. The Duke Orthop J 2013;3(1):88-92.