3 in 4 ED Managers Report Shortage of Specialists

Updated November 29, 2010.

Emergency department directors are reporting inadequate on-call trauma coverage, and many report a loss or downgrade of their hospitals' trauma center designations, according to a survey in the journal Academic Emergency Medicine.

"Without adequate on-call surgical coverage, our healthcare system cannot provide for emergency and trauma patients," said Mitesh Rao, MD, lead author of the survey and study: The Shortage of On-Call Surgical Specialist Coverage: A National Survey of Emergency Department Directors.

Rao, with the department of emergency medicine at Yale University, and clinical scholar with the Robert Wood Johnson Foundation, said 21% of ED deaths and permanent injury can be linked to shortages of 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," he said.

The survey found that 60% of respondents could no longer provide 24-hour coverage for at least one medical specialty in the last four years. More than three-quarters of respondents reported that their EDs have inadequate coverage for plastic surgery, hand surgery and neurosurgery. Almost one-quarter of survey respondents reported an increase in patients leaving before being seen by a specialist.

"More than 70% of respondents noted difficulties with their neurosurgical coverage, and 80% reported inadequate hand surgery coverage," Rao said. "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, with inadequate coverage reported at 68% of the former and 78% of the latter. However, that may increase the burden on what the Institute of Medicine considers "core safety net providers" if non-teaching hospitals increasingly transfer patients who need surgical care to teaching hospitals, the study said. 

"If you are in a car crash or even slice open your hand carving the holiday turkey, you need fast access to emergency surgery," said Sandra Schneider, MD, president of the American College of Emergency Physicians. "This study highlights one of the most critical threats to the emergency medical care system. 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."