All Boats Rise: A Dedicated Hand Trauma Operating Room Improves Patient Care, Decreases Costs, and Can Improve Physician Wellness

Wong et al. should be congratulated for accomplishing a remarkable feat: improving care for patients, reducing costs, and, notably, improving physician wellness within a complex health-care system. It is rare to effect positive change for both patients and the hospital, and it is more exceptional for physicians to benefit from that change. Although one of the outcomes is described simply as reduced after-hours cases, the greater impact of the dedicated trauma operating room (DTOR) for hand surgery on the health and well-being of the surgeons must not be overlooked. This study should be celebrated for prioritizing the welfare of physicians as well as demonstrating the value of surgeons as key decision-makers in hospital operations. Hand surgeons, by the nature of their specialty, must balance frequent emergency call responsibilities with busy elective practices. The struggle to meet the needs of both emergency cases and scheduled patients while finding time for rest in order to continue to care for those patients and themselves is a Sisyphean task now widely recognized as creating moral injury1. First acknowledged by Dean et al., the effect of moral injury on physicians has been linked to diminished quality of life, poor mental health, and higher physician turnover2,3. After the implementation of the DTOR, after-hours hand procedures were performed one-half as frequently. This granted 2 precious commodities to the surgeons: time and sleep. By having brought together hospital administrators and clinicians, Wong et al. illustrate a collaborative approach recommended by Dean et al. to combat moral injury. This current study reveals the power that surgeons have in shaping their own destiny and that of their patients. There are important aspects of this study that were not specifically addressed by the authors. First and foremost are the time and energy required to tackle these challenges. There is great value in reporting how many hours were spent gathering internal data to justify a shift in practice, in verifying that standard of care will be maintained, and in identifying any roadblocks encountered during negotiations with administrators and OR staff. Sharing these pearls and pitfalls would benefit others looking to implement a DTOR. Another factor only hinted at is the critical importance of teamwork. The implementation of a DTOR is only possible when surgeons mutually agree upon criteria for patient eligibility and are willing to adjust their individual schedules in order to accomplish the mission. Collaboration in this regard is essential and must be emphasized. Those struggling to raise the standard of care for their patients and colleagues should consider the playbook outlined in this study: Identify a patient-centered and physician-centered need. Gather and analyze relevant data. Consider replicating existing models. Build a team willing to collaborate and compromise. Publish the findings. Wong et al. should be recognized as heroes for rejecting a system that did not meet the needs of their community and for achieving an extraordinary trifecta of success, raising the bar for patients, the health-care system, and physicians. It is up to us to stand on the shoulders of these leaders and to continue to promote physicians in decision-making roles so that all boats can rise.