The state of ED on-call coverage in California - 25/08/11
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, Jennifer Oman, MD , Mark I. Langdorf, MD, MHPE , Maryann Hill, PhD , John Bauché , Paul Kivela, MD, MBA †, Loren Johnson, MD † University of California, Irvine, Department of Emergency Medicine, Irvine, CA, USA Abstract |
The ED provides initial treatment, but failure of specialists to respond unravels the safety net. To assess the scope of problems with on-call physicians in California. A mailed anonymous survey to all CAL/ACEP physician members (1876) asking patient, physician and ED demographics, specialist availability for consultation, insurance profile, and availability of follow-up care. 608/1876 physicians responded (32.4%), representing 320/353 California EDs (90.6%). The seven specialties in which the greatest proportion of EDs reported trouble with specialty response were: plastic surgery (37.5%), ENT (35.9%), dentistry (34.9%), psychiatry (26.0%), neurosurgery (22.9%), ophthalmology (18.4%) and orthopedics (18.0%). 71.6% of responder EDs reported that their medical staff rules required ED on-call coverage. However, the percentage of responders who stated that hospitals paid each specialty for call was low: neurosurgery (37.3%), orthopedics (34.4%), ENT (17.9%), plastic surgery (15.1%) and ophthalmology (13.1%). On-call problems were more acute at night (77.2%) or on weekends (72.4%). Patient insurance negatively affected (69.9%) willingness of on-call physicians to consult for at least a quarter of patients. Regarding follow-up, 91% reported some trouble, whereas 64% reported a problem at least half the time. Surgical sub-specialists are the most problematic on-call physicians. Insurance status has a major negative effect on ED and follow-up care. The on-call situation in California has reached crisis proportions.
Le texte complet de cet article est disponible en PDF.Keywords : On-call, emergency department, specialty, consultation
Plan
 | Statistical analysis and data management were provided by the local General Clinical Research Center, all other expenses were covered by internal departmental funds. |
Vol 22 - N° 7
P. 575-581 - novembre 2004 Retour au numéro
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