Shah Rohi, Ahad Abdul, Faizi Murtuza, Mangwani Jitendra
Trauma & Orthopaedic Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, United Kingdom.
J Clin Orthop Trauma. 2021 May;16:285-291. doi: 10.1016/j.jcot.2021.01.014. Epub 2021 Feb 12.
The COVID-19 pandemic has resulted in a paradigm shift in clinical practice, particularly in ways in which healthcare is accessed by patients and delivered by healthcare practitioners. Many of these changes have been serially modified in adaptation to growing service demands and department provision capacity. We evaluated the impact of the pandemic on the foot and ankle service at our trauma unit, assessing whether these adaptations to practice were justifiable, successful and sustainable for the future. This was a single-centre, retrospective cohort study analysing the patient care pathway from admission to discharge, for two pre-defined timeframes: Phase 0 (pre-lockdown phase) and Phase 1 (lockdown phase). Patients were split into stable and unstable injuries depending on their fracture pattern. The follow-up modality and duration were evaluated. Trauma throughput for the equivalent timeframe in 2019 was also analysed for comparison. There were 106 unstable fractures and 100 stable fractures in 2020.78 interventional procedures were performed on 72 patients with unstable fractures in Phase-1. Close contact casting was performed on 13 patients at presentation in the ED. Selective patients underwent partial fixation in theatre, which still provided adequate stability. 35% of patients with a stable fracture were discharged directly from the ED with written advice from a review letter. The treatment modality in selective patients, particularly the vulnerable should be carefully assessed. Interventions performed at presentation often negate the need for admission. Partial fixation reduces intraoperative time and surgical insult. Integrating telemedicine into the care pathway, particularly for stable ankle fractures reduces the need for physician-patient contact and eases follow-up burden. Many of our recommended changes are easily replicated in other clinical settings. Should these adaptations demonstrate long-term sustainability, it is likely they will remain incorporated into future clinical practice.
新冠疫情导致了临床实践的范式转变，尤其是在患者获取医疗服务以及医护人员提供医疗服务的方式上。其中许多变化经过了一系列调整，以适应不断增长的服务需求和科室供应能力。我们评估了疫情对我们创伤科足踝服务的影响，评估这些实践调整在未来是否合理、成功且可持续。这是一项单中心回顾性队列研究，分析了两个预定义时间段（0阶段：封锁前阶段和1阶段：封锁阶段）从入院到出院的患者护理路径。根据骨折类型将患者分为稳定型和不稳定型损伤。评估了随访方式和持续时间。还分析了2019年同期的创伤诊疗量以作比较。2020年有106例不稳定骨折和100例稳定骨折。在1阶段，对72例不稳定骨折患者进行了78项介入手术。13例患者在急诊科就诊时进行了紧密接触石膏固定。部分患者在手术室接受了部分固定，这仍提供了足够的稳定性。35%的稳定骨折患者在收到复查信的书面建议后直接从急诊科出院。对于选择性患者，尤其是易感染患者的治疗方式应仔细评估。就诊时进行的干预通常无需住院。部分固定减少了手术时间和手术创伤。将远程医疗纳入护理路径，特别是对于稳定的踝关节骨折，减少了医患接触的需求，减轻了随访负担。我们推荐的许多改变很容易在其他临床环境中复制。如果这些调整显示出长期可持续性，它们很可能会被纳入未来的临床实践。
