Perceptions of emergency medicine residency and hand surgery fellowship program directors in the appropriate disposition of upper extremity emergencies

Brian C. Drolet, Scott D. Lifchez, Sidney M. Jacoby, Andrew Varone, Linda A. Regan, Jill M. Baren, Edward Akelman, A. Lee Osterman, L. Scott Levin

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose To survey emergency medicine (EM) residency and hand surgery fellowship program directors (PDs) to identify consensus in their perceptions of appropriate emergency care of upper extremity emergencies. Methods We created a framework to group common upper extremity emergency diagnoses and surveyed PDs to evaluate the training background - EM, general orthopedic or plastic surgery, or hand fellowship - most appropriate to provide acute, point-of-care management for each of these diagnostic groupings. Responses were pooled and consensus was established with greater than 75% agreement between groups. Results We received 79 responses from hand fellowship PDs (90% response rate) and 151 responses from EM PDs (49% response rate). We identified consensus for the training background that PDs in both specialties felt was appropriate to care for 17 of 21 diagnostic groupings in the framework. Conclusions There was a high level of consensus between EM and hand surgery PDs regarding diagnoses that acutely require training in hand surgery versus those that can be managed by an EM physician. Our diagnostic framework may help reduce unnecessary hand surgery consultation and may help to identify patients who do not require more specialized acute care and thus decrease unnecessary transfers. Type of study/level of evidence Economic and Decision Analyses IV.

Original languageEnglish (US)
Pages (from-to)2435-2439
Number of pages5
JournalJournal of Hand Surgery
Volume40
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • Emergency guidelines
  • emergency evaluation
  • health care delivery
  • transfer
  • triage

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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