Ian Hoppe, MDMark Granick, MD, FACSDepartment of Surgery (Plastic)New Jersey Medical SchoolNewark, New Jersey, USA

Plastic Surgeons in the Emergency Department Top 5 consultant

service Hand injuries Acute wounds Facial fractures

Hardest service to get

Resident complaints

Study of PS Consultations Inner city university hospital ED Level 1 Trauma Center 4 month study period Collect digital images and basic data

on all ED consults, no Trauma consults

Analyzed by store and forward technology

Findings

79 consults 66 male, 13 female, 2-71 years old, mean 35 Hand injuries

14 bony 25 soft tissue 15 complex

Head and Neck injuries 4 bony 9 soft tissue 3 complex

Other injuries – all soft tissue 1 leg 2 trunk 5 upper extremity

Findings

Head and Neck injuries 4 bony 9 soft tissue 3 complex

Other injuries – all soft tissue 1 leg 2 trunk 5 upper extremity

Spectrum of Injuries

Hand - bonyHand – soft tissueHand -complexFacial - bony

Facial- soft tissueFacial - complex

Assessment

All cases required specialist consultation

All cases appropriate for Plastic Surgery

All cases educational for the residents

What happened to all the other cases?Incorrect ulnar gutter splint Ineffective thumb spica

Sent to Plastic Surgery Clinic374 patients seen in clinic with 44 no shows154 of the 374 seen were ED referrals

QA Analysis

All patients referred were appropriate

Numerous patients missed

First therapeutic intervention is critical

Better to call than to treat a late complication

Recommendations

Digital imaging provides sufficient information to make an accurate assessment

Store and Forward analysis can make ED consultation more efficient and more effective

Digital image review is an appropriate QA tool Develop telemedical/telehealth system with

specialists to insure proper initial care Patient privacy Medical Licensing Malpractice International and regional legal boundaries www.iConsultMD.com

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