Hand Call Coverage at Busy Urban Trauma Centers
Dr. Andrew Berson
aberson at agvscs.com
Sun Mar 9 17:55:49 GMT 2008
That's helpful
AJB
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of kmattox at aol.com
Sent: Friday, March 07, 2008 10:44 AM
To: Trauma & Critical Care mailing list
Subject: Re: Hand Call Coverage at Busy Urban Trauma Centers
The very injury you described were for decades managed by general surgeons
with good results. This injury can and are currently managed by interested
general, pediatric, orthopedic, plastic, vascular, and even neuro surgeons.
It is not a turf war it is a value and committment issue to the discipline
of surgery. I tend to believe that surgeons that find reasons they must
excessively limit their surgery skills simply should not be surgeons.
Sent via BlackBerry by AT&T
-----Original Message-----
From: "Dr. Andrew Berson" <aberson at agvscs.com>
Date: Fri, 7 Mar 2008 07:14:15
To:"'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
Subject: RE: Hand Call Coverage at Busy Urban Trauma Centers
Dr. Mattox,
I agree with the care of the simple lacerations, etc and that is what is
occuring. The muddy issue centers around injuries that are somewhere in
between. i.e. a deep laceration that severs tendons or neural structures,
but is not a near amputation. I feel that this could/should be handled by a
qualified orthopedic surgeon, but we are getting significant push back in
this area. Thoughts?
AJB
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Thursday, March 06, 2008 8:44 PM
To: trauma-list at trauma.org
Subject: Re: Hand Call Coverage at Busy Urban Trauma Centers
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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