Elzagh Alaa, Shah Savan, De Berker Henry, Reid Adam J, Wong Jason K, Bedford James D, Amin Kavit R
Department of Burns and Plastic Surgery, Manchester University National Health Service Foundation Trust, Manchester, GBR.
Department of Otolaryngology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, GBR.
Cureus. 2024 Jul 6;16(7):e63968. doi: 10.7759/cureus.63968. eCollection 2024 Jul.
The regional hand trauma service in Greater Manchester, United Kingdom, underwent significant reorganisation early in the COVID-19 pandemic, with a shift from predominantly general anaesthesia (GA) procedures to the adoption of a Wide-Awake Local Anaesthetic No Tourniquet (WALANT) technique. We implemented strategies targeted towards optimising patient experience, largely applicable to most healthcare settings.
Four domains were explored: (i) compliance in timing to nationally agreed treatment guidelines, (ii) the role of patient information leaflets, (iii) the introduction of a post-operative analgesia protocol, and (iv) broadly evaluating the environmental impact following the implementation of a same-day 'see and treat' service.
Following reorganisation to a predominantly WALANT service, we observed an increase in compliance with nationally agreed standards for the treatment of common hand injuries. Patient education and peri-operative counselling reduced anxiety, whereas post-operative pain was better managed with the introduction of an analgesic protocol. Using a travel carbon calculator, it can be inferred that there are significant reductions in carbon emissions generated when patients are evaluated and treated on the same day as their clinical presentation.
It is widely acknowledged that WALANT benefits patients and the healthcare system. We contemplated whether further incremental changes in clinical practice could further improve patient experience. Given our findings, we advocate a multi-modal approach with a greater focus on patient outcomes (trials are currently underway, e.g., WAFER) supplemented by universally accepted validated patient-reported outcome measures (PROMs).
英国大曼彻斯特地区的手部创伤服务在新冠疫情早期经历了重大重组，从主要采用全身麻醉（GA）手术转变为采用清醒局部麻醉无止血带（WALANT）技术。我们实施了旨在优化患者体验的策略，这些策略在很大程度上适用于大多数医疗环境。
探讨了四个领域：（i）遵守国家商定的治疗指南的时间合规性，（ii）患者信息手册的作用，（iii）引入术后镇痛方案，以及（iv）广泛评估实施当日“看诊并治疗”服务后的环境影响。
在重组为主要采用WALANT服务后，我们观察到在治疗常见手部损伤方面，遵守国家商定标准的情况有所增加。患者教育和围手术期咨询减轻了焦虑，而引入镇痛方案后，术后疼痛得到了更好的管理。使用旅行碳计算器可以推断，当患者在就诊当天接受评估和治疗时，碳排放会显著减少。
人们普遍认识到WALANT对患者和医疗系统有益。我们思考临床实践中进一步的渐进性改变是否能进一步改善患者体验。鉴于我们的研究结果，我们提倡采用多模式方法，更加关注患者结局（目前正在进行试验，例如WAFER），并辅以普遍接受的经过验证的患者报告结局指标（PROMs）。
