Hand Call Coverage at Busy Urban Trauma Centers

[KMATTOX at aol.com]

I have no real idea what a "Trauma" orthopedist is that is different from a  
regular orthopedic surgeon?    I also have taken a close  look at what has 
been attempted to be sent to us at the BTGH as "hand" trauma  from the immediate 
14 count area.      Every day we  repeatedly get calls for a transfer for a 
higher level of care for a "hand  trauma" case, because they do not have a hand 
surgeon on  call.     When we ask about the case, it might be a minor  (or 
even major) hand bone fracture.   That is general  orthopedics.    If the case 
comes to us, it will be treated by an  orthopedist, or a plastic surgeon.    Our 
"HAND SURGEON" is  called in for basically a "replantation" and a couple of 
other  diagnoses.      So....................when we have a  finger tip 
amputation, that just needs a closure, we do not accept a patient in  transfer and 
ask that the emergency physician at the sending hospital close the  wound, as 
will be done when we receive the patient.   NOT a higher  liver of care.      By 
FAR the majority of cases  that are labeled "hand" can and probably should be 
managed by the ACUTE CARE  SURGEON (the new name for what was the routine 
garden variety "general surgeon  of the past.        
 
k
 
 
 
 
In a message dated 3/6/2008 9:35:02 P.M. Central Standard Time,  
deanlutrin at gmail.com writes:

Andrew

Barring an amputation which could be immediately  salvaged, almost all hands
can wait till the morning. That's how it is done  in most teaching hospitals
in South Africa. Where I work, we have so much  hand trauma that there is a
daily 'hand list' done under axillary block or  some other local anaesthetic.
The occasional abscess needs to be drained at  night and some debridemens
should be done - surely a ortho guy can do that?  As long as you can make a
plan that there is someone who can reimplant  fingers and hands when that
occasionally occurs, I think you can tell the  greedy guys to get lost.

My two cents

Dean Lutrin
JHB, South  Africa

-----Original Message-----
From:  trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On  Behalf Of Dr. Andrew Berson
Sent: Thursday, March 06, 2008 11:45 PM
To:  'Trauma & Critical Care mailing list'
Subject: Hand Call Coverage  at Busy Urban Trauma Centers


To list members:

I'm looking  for input from busy level I and II centers on how hand call
coverage issues  are being handled.  Specifically, is this coverage provided
by the  ortho traumatologist or by a separate hand call list.  The issue  that
we are dealing with is that after years of a very successful call  roster for
this subspecialty, we are running into a very untenable  situation.  In the
past this coverage was provided by the  ortho-traumatologists that had a
robust elective hand surgery  practice.  These surgeons are already part of
the paid call roster for  orthopedics, and were providing hand "coverage" on
nights where one of  their non-hand surgery colleagues might be on call for
general ortho  trauma.  Now, the hand surgeons are refusing to provide this
coverage  unless they are given an additional stipend.  The general
ortho-trauma  physicians do not feel comfortable in caring for significant
hand issues,  since this is not part of their elective practice.

The question is,  should a board certified orthopedic surgeon, on a paid
trauma call list at  a busy level II trauma center be capable of evaluating
an injured hand and  at least providing initial management of the injury,
until their "hand  surgery" partner is available the next day, or are we
forced to give into  the demands of the hand specialists and provide another
stipend position on  the call roster.  (It should be mentioned that the
amount being  requested outpaces the stipend paid to the IN HOUSE
Trauma/Acute Care  surgeon, even thought hand call is a home based call which
does not receive  many true emergencies).  

Please give any constructive  feedback.  I would also be interested to know
how many list members  are seeing similar issues with their hand call
rosters.

Thank you in  advance.

Andrew J. Berson, M.D.
Assist. Trauma Director
Memorial  Health System,
Colorado Springs, CO

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