The majority of emergency department directors in a recent survey report inadequate on-call trauma coverage, and nearly one-quarter report a loss or downgrade of their hospitals’ trauma center designations.
The study, “The Shortage of On-Call Surgical Specialist Coverage: A National Survey of Emergency Department Directors,” appears in the December issue of Academic Emergency Medicine.
“Without adequate on-call surgical coverage, our healthcare system cannot provide for emergency and trauma patients,” said lead study author Mitesh Rao, MD, of the department of emergency medicine at Yale University in New Haven, Conn., and a clinical scholar with the Robert Wood Johnson Foundation. “Twenty-one percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. Transferring patients significant distances to an available specialist is sometimes the only option, but it can create a dangerous delay in care.”
According to the study:
- Sixty percent of respondents reported losing the ability to provide round-the-clock coverage for at least one medical specialty in the last four years.
- More than three-quarters of respondents reported that their emergency departments have inadequate coverage for plastic surgery, hand surgery and neurosurgery.
- Almost one-quarter of respondents reported an increase in patients leaving before being seen by a specialist, which is known to lead to worse outcomes and increased need for hospitalization.
"More than 70 percent of respondents noted difficulties with their neurosurgical coverage, and 80 percent reported inadequate hand surgery coverage," said Rao. "Patients with traumatic brain or hand injuries have a substantial risk of lifetime disability if they cannot get appropriate care in a timely fashion. We need to change the system to better handle the incentives and disincentives for surgeons who are willing to take call in the emergency department."
Teaching hospitals fare better than non-teaching hospitals in the study – 68 percent inadequate coverage, while 78 percent of non-teaching hospitals report inadequate coverage. However, that may increase the burden on what the Institute of Medicine considers “core safety net providers” if non-teaching hospitals transfer patients who need surgical care to teaching hospitals, officials said.
“This study highlights one of the most critical threats to the emergency medical care system,” said Sandra Schneider, MD, president of the American College of Emergency Physicians. “As we implement healthcare reform, lawmakers must take steps to ensure that emergency surgery is available to anyone who needs it. Medical liability reform would be a great first step.”
Dallas-based ACEP is a national medical specialty society representing emergency medicine.