Lessons From the Pandemic for Hand Surgery in Wales

Abstract

Aims In March 2020 the World Health Organisation (WHO) declared the COVID-19 virus a global pandemic. The United Kingdom's National Health Service (NHS) was placed under unprecedented pressure and hospitals were forced to adapt their working practices to continue offering world-leading healthcare. This project aims to highlight the lessons learnt within hand surgical departments throughout Wales. Using this knowledge, we can consider how these lessons can be implemented in both emergency and elective hand practice. Methods A qualitative questionnaire was distributed to hand consultants working across Health Boards within Wales during the pandemic. The questionnaire encompasses the impact of the pandemic on usual practices and what local departmental changes have been implemented in response to patient needs. Results Across the Welsh Health Boards, we received 12 of 19 consultant responses achieving a 63% response rate and captured data from five of seven (71%) major health boards. The questionnaire revealed that 100% of respondents changed their routine management of elective cases whilst 83% changed their management of hand trauma. 50% reported the need to issue updated management guidelines to junior doctors. The major highlighted lessons were the importance of a dedicated hand fracture clinic, coupled with a ring-fenced day-surgical unit (offering regional anaesthetic support) to manage trauma and elective patients independently from general trauma. Conclusion This qualitative research demonstrates that the pandemic drove the restructuring of many hand departments enabling us to find new, efficient ways of working. We must take these lessons forward to tackle the ever-growing waiting list, increased patient expectations and increasingly complex workloads.

Keywords: covid-19 pandemic; elective hand surgery; hand trauma management; qualitative study; quality improvement research; walant principles.

Figure 1. Chart Depicting the Number of Responses to the Questionnaire From the Respective Health Board Within Wales

Figure 2. Chart Highlighting Change in Practice Seen in Trauma Setting due to the COVID-19 Pandemic

Figure 3. Chart Demonstrating Rating of Postoperative Hand Therapy in Trauma Patients

Figure 4. Summary of Negative Effects Noted in Managing Trauma Patients During the COVID-19 Pandemic

A+E: Accident and Emergency

Figure 5. Chart Highlighting Change in Practice Seen in Elective Setting due to COVID-19 Pandemic

Figure 6. Chart Demonstrating Summary of Negative Effects seen in Elective Practice due to COVID-19 Pandemic

GP: General Practitioner

Figure 7. Chart Demonstrating Rating of Postpperative Hand Therapy in Elective Hand Patients