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Fri Mar 7 03:33:06 GMT 2008

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 &amp; 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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Hand Call Coverage at Busy Urban Trauma Centers