Department of Orthopaedic Surgery, National Orthopaedic Hospital, Cappagh, Cappagh Road, Finglas, Dublin 11, Ireland.
Department of Internal Medicine, National Orthopaedic Hospital, Cappagh, Cappagh Road, Finglas, Dublin 11, Ireland.
Surgeon. 2021 Jun;19(3):e59-e66. doi: 10.1016/j.surge.2020.08.008. Epub 2020 Sep 8.
With the emergence of the 2019 novel coronavirus and its resulting pandemic status in March 2020 all routine elective orthopaedic surgery was cancelled in our institution. The developing picture in Italy, of acute hospitals becoming overwhelmed with treating patients suffering with severe and life-threatening symptoms from the disease, prompted the orthopaedic surgeons to formulate a plan to transfer trauma patients requiring surgery to the elective hospital to unburden the acute hospital system.
Under the threat of this pandemic; protocols and algorithms were established for referral, acceptance and care of trauma patients from acute hospitals in the region. Each day, as new guidance on COVID-19 emerged, our process and algorithms were adjusted to reflect pertinent change.
The screening of all patients referred, worked well in keeping our hospital "COVID-free" with respect to patients undergoing operations. An upward trend in cases referred reflected the decreased capacity in the acute hospitals due to rising cases of COVID-19 within the hospital network. During the first 7 weeks of the pandemic 308 operations were performed, (31.1% upper limb, 33.4% lower limb, 4.1% spine, 14.1% urgent elective, 17.4% plastic surgery cases). Regular review and audit of the activity in the hospital as well as communication with the referring teams enabled appropriate planning to accommodate the increase in case-mix as the need arose.
This paper details the steps that were taken in planning for such a change in management specific to the orthopaedic surgery setting and the lessons learnt during this process. The success of the development of this pathway was facilitated by clear communication channels, flexibility to adapt to changing process and feedback from all stakeholders. The implementation of this pathway allowed the unburdening of acute hospitals dealing with the pandemic that was steadily reducing access to operating theatres and anaesthetic resources.
随着 2019 年新型冠状病毒的出现以及 2020 年 3 月该病在全球大流行，我们机构取消了所有常规的择期骨科手术。意大利的情况表明，急性医院因治疗患有该病的重症和危及生命症状的患者而不堪重负，这促使骨科医生制定了一项计划，将需要手术的创伤患者转至择期医院，以减轻急性医院系统的负担。
在这场大流行的威胁下，我们为该地区的急性医院的创伤患者制定了转诊、接收和治疗的协议和算法。每天，随着关于 COVID-19 的新指南的出现，我们的流程和算法都进行了调整，以反映相关变化。
对所有转诊患者的筛查工作非常有效，使我们医院在接受手术的患者方面保持了“无 COVID-19”状态。转诊病例的上升趋势反映了由于医院网络内 COVID-19 病例的增加，急性医院的容量下降。在大流行的前 7 周内，进行了 308 例手术（上肢 31.1%、下肢 33.4%、脊柱 4.1%、紧急择期手术 14.1%、整形手术 17.4%）。对医院活动的定期审查和审计，以及与转诊团队的沟通，使我们能够根据需要适当规划增加病例组合。
本文详细介绍了在骨科手术环境中针对这种管理变化所采取的步骤，以及在这一过程中吸取的经验教训。明确的沟通渠道、适应不断变化的流程的灵活性以及来自所有利益相关者的反馈，促进了这一路径的成功实施。该路径的实施使处理大流行的急性医院减轻了负担，因为大流行稳步减少了手术室和麻醉资源的使用。
