The results of a survey published this month details problems caused by the lack of surgical specialists on call to emergency departments. It was conducted by the Robert Wood Johnson Clinical Scholars program and Yale University. They sent the survey to ED directors at 715 randomly selected hospitals around the country. The response rate was very good, with 62% returning their surveys.
An overwhelming majority (74%) of EDs indicated that they experience inadequate call coverage by surgical specialists. Notable comparisons included:
- Teaching hospital (68% had problems) vs non-teaching hospital (78%)
- Level I trauma center (60% had problems) vs Level II trauma center (59%) vs Level III trauma center (77%)
Almost two thirds of respondents said they had lost 24/7 coverage of at least one surgical specialty within the last 4 years. Hospitals in metropolitan areas were more likely to experience this problem, as were hospitals in the Northeast and South, compared to the West and the Midwest.
As you can imagine, coverage issues can cause larger problems. Nearly a quarter of hospitals either lost or downgraded their trauma center level due to lack of surgical specialist coverage. And 27% reported patients leaving before they could be seen by the specialist.
The percentage of hospitals with no coverage or problem coverage by surgical specialty was as follows:
- General surgery - 36%
- Trauma surgery - 64%
- Neurosurgery - 75%
- Plastics - 81%
- Hand - 80%
- Ortho - 50%
It is becoming apparent that there are limits to the amount of on-call specialty coverage that money can buy. Careful coordination and regionalization may offer aid to some centers, but we need to look critically at strategies in use that work and find ways to disseminate them to maintain the best emergency care possible.
Reference: The Shortage of On-call Surgical Specialist Coverage: A National Survey of Emergency Department Directors. Academic Emerg Med 17(12):1374-82, Dec 2010.