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 Emergency Hand Care Position Statement

April 2006

The members of the ASSH encourage all providers of emergency hand care to develop ways to ensure that every patient receives the treatment necessary to recover the best possible hand function.  The ASSH believes this will require a concerted and cooperative effort among physicians, nurses, allied health professionals, and administrators of health care facilities. To this goal, the Society recognizes key problems impacting emergent hand care and recommends several changes to improve the current state.

Current state of emergency hand care:

According to the CDC, injuries to the wrist, hand, and fingers are the most common injury-related diagnoses treated in emergency departments, accounting for 12% of all injuries.*

The number of patients presenting with emergency hand conditions exceeds the capacity of hand surgery specialists.  From 1989 (the first year certification was available) to 2004, only 2,424 surgeons in the United States have received certification in specialized care of the hand.

Of hand surgeons surveyed across the United States in 2005, 44% are currently on call 7 or more times per month. Major concerns discouraging hand surgeons from taking call include lack of reimbursement for uninsured patients, frequent inappropriate referrals, increased liability risks, and inadequate support by the medical facility.

Recommendations to improve patient care:

To increase the number of physicians providing emergent hand care, all physicians trained in basic care of the hand, particularly those with training in plastic surgery, orthopedic surgery and emergency medicine, can substantially contribute to the treatment of acute hand conditions.

For patients with complex hand conditions who require immediate transfer (e.g. replantations, severe open injuries) as well as patients with less complex problems who are being considered for transfer, professionalism mandates that both the referring physician and institution perform proper initial care and ensure complete communication with the accepting physician before the transfer is initiated.

To ensure a sufficient number of physicians remain available for all patients, there must be appropriate financial compensation for the initial care as well as all services related to the continuation of care. For physicians, compensation could be based per diem or on a guaranteed fee schedule for the services provided.

In order to provide efficient and quality care, hospitals accepting patients with emergent hand conditions must supply all necessary resources, including trained personnel, proper equipment, and an available operating facility.

To ensure quality and timely care of patients with severe limb trauma, particularly those requiring emergent microsurgery, some communities or regions may need to develop specialized facilities with unique resources, including support personnel and properly skilled physicians.
To reduce the negative impact that malpractice litigation has on the availability of emergent medical care, all emergency care providers should urge their state and federal representatives to introduce or support legislation that will improve the current medical-legal environment.

* McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Surgery: 2003 Emergency Department Summary. Advance data from vital and health statistics; no 358. Hyattsville, Maryland: National Center for Health Statistics. 2005.

Approved by ASSH Council 3/28/06

© 2006 American Society for Surgery of the Hand