Orthopaedic Surgical Selection and Inpatient Paradigms During the Coronavirus (COVID-19) Pandemic

Abstract

The novel coronavirus pandemic, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed an immense strain on healthcare systems across the entire world. Consequently, multiple federal and state governments have placed restrictions on hospitals such as limiting "elective surgery" and recommending social or physical distancing. We review the literature on several areas that have been affected including surgical selection, inpatient care, and physician well-being. These areas affecting inpatient paradigms include surgical priority, physical or social distancing, file sharing for online clinical communications, and physician wellness. During this crisis, it is important that orthopaedic departments place an emphasis on personnel safety and slowing the spread of the virus so that the department can still maintain vital functions. Physical distancing and emerging technologies such as inpatient telemedicine and online file sharing applications can enable orthopaedic programs to still function while attempting to protect medical staff and patients from the novel coronavirus spread. This literature review sought to provide evidence-based guidance to orthopaedic departments during an unprecedented time. Orthopaedic surgeons should follow the Centers for Disease Control and Prevention guidelines, wear personal protective equipment (PPE) when appropriate, have teams created using physical distancing, understand the department's policy on elective surgery, and engage in routines which enhance physician wellness.

Figure 1

Chart showing resource-based strategy of orthopaedic surgery priorities. Based on which resources are needed, surgeons may prioritize different surgeries. Surgeons may move between phases on a continuum. During all phases, outpatient surgery may be moved to a separate surgery center to mitigate risk and conserve resources at the inpatient hospital. Surgeries that may be postponed in different phases are shaded gray.

Figure 2

Photograph showing the cubicles setup for physician workstations. Each workstation is assigned to a single physician with a clear sign so that no others will use their works station.

Figure 3

A, Photograph showing the Bayou box: an intravenous (IV) fluid management system, with ECG, pulseoximeter, and blood pressure monitor which can be accessed outside of a novel coronavirus patient's room. The IV fluids can be secured by closing the cabinet doors and placing a lock. B, IV tubing and monitor cables pass through a portal in the exterior wall. C, Monitoring cables and IV fluid tubing enters the patient's room through another portal. Video can be viewed at https://www.youtube.com/watch?v=gf_u_CrSCd4.