In US Level I and Level II trauma centers, the trauma surgeons must typically stay in the hospital to be ready for incoming major trauma patients. But most of our specialty colleagues have the luxury of sleeping at home. They are immediately available when needed, and we know it.

One thing that has struck me over the years is our reflex to call our consultants as soon as we find a diagnosis in their specialty. Even at 2:00 am. And even when we know they won’t see the patient until the morning.

Why do we do this? Specialty coverage is increasingly difficult to secure for many centers. Why not use our specialist colleagues more intelligently so we don’t burn them out?

About half of the major injuries seen at a trauma center require some type of orthopedic surgery management. When consulting your orthopedic surgeon (or any other specialty service), always keep the patient’s best interests paramount in your decision-making. Then think about how soon and under what context they really need to see the patient. Can it wait until morning? Do they even really need to be seen in the ED, or can this be an outpatient visit?

I’ve created a cheat sheet to help you decide whether you need your orthopod now, in the morning, or if the patient can be seen in their office in a few days. Because orthopedics is such a broad area, this sheet is a bit lengthy. But I think you will find it quite valuable.

Note: Before implementing this guideline, run it by your orthopedic surgeons to see if their preferences for some of the fractures are different from those listed.

Click on the image below to download the full guideline.

In the next post: Expectations on how your consultants should conduct themselves when seeing your patients.