Rao, who is 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 past four years.
"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 nonteaching 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."
Reported by John Commins on November 29.