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. 2021 Mar;103(3):167-172.
doi: 10.1308/rcsann.2020.7069.

Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)

J W Lim  1 , H Rehman  1 , S Gaba  1 , H Sargeant  1 , I M Stevenson  1 , D E Boddie  1
Affiliations

Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)

J W Lim et al. Ann R Coll Surg Engl. 2021 Mar.

Abstract

Introduction: We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU.

Methods: We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann-Whitney and Fisher Exact tests were used to test the statistical significance of data.

Results: A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001).

Conclusions: Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.

Keywords: COVID-19; Orthopaedic trauma; Redeployment; Service reconfiguration; Specialist assessment unit.

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Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Figures

Figure 1
Figure 1
Layout of OAU. ED = emergency department; OAU = orthopaedic assessment unit.
Figure 2
Figure 2
Breakdown of the number of patient attendances over a 32-day period
Figure 3
Figure 3
Total number of patient attendances in 32 days over a 24h period
Figure 4
Figure 4
Types of injuries presented to the unit
See this image and copyright information in PMC

References

    1. Willan J, King AJ, Jeffery Ket al. Challenges for NHS hospitals during covid-19 epidemic. BMJ 2020; 368: m1117. 10.1136/bmj.m1117 - DOI - PubMed
    1. Armocida B, Formenti B, Ussai Set al. The Italian health system and the COVID-19 challenge. Lancet Public Health 2020; 5: e253. 10.1016/S2468-2667(20)30074-8 - DOI - PMC - PubMed
    1. Worldometer. COVID-19 coronavirus pandemic .. https://www.worldometers.info/coronavirus/#countries (cited July 2020).
    1. NHS Employers. Workforce supply and deployment. https://www.nhsemployers.org/covid19/increasing-workforce-supply (cited June 2020).
    1. British Orthopaedic Association. Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic. https://www.boa.ac.uk/uploads/assets/ee39d8a8-9457-4533-9774e973c835246d... (cited June 2020).

MeSH terms