Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2022; 13(10): 921-931
Published online Oct 18, 2022. doi: 10.5312/wjo.v13.i10.921
Utilising the impact of COVID-19 on trauma throughput to adapt elective care models for more efficient trauma care
Kunal Kulkarni, Rohi Shah, Jitendra Mangwani, Aamer Ullah, Omar Gabbar, Elaine James, Joseph Dias
Kunal Kulkarni, Rohi Shah, Jitendra Mangwani, Aamer Ullah, Omar Gabbar, Elaine James, Joseph Dias, Department of Trauma & Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting, critical revision, editing and approval of the final manuscript.
Institutional review board statement: This study was formally registered and approved by our Clinical Audit and Quality Improvement Team.
Informed consent statement: No individual patient consent was required as this study utilised unidentifable and anonymised grouped datasets.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kunal Kulkarni, BMBCh, MA (Oxon), MSc, FRCS (Tr&Orth), European Board of Hand Surgery Diploma, Consultant Trauma & Orthopaedic Surgeon, Department of Trauma & Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom. kunalkulkarni@doctors.org.uk
Received: May 8, 2022
Peer-review started: May 8, 2022
First decision: August 4, 2022
Revised: August 17, 2022
Accepted: September 23, 2022
Article in press: September 23, 2022
Published online: October 18, 2022
Processing time: 161 Days and 12.8 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) has necessitated adaptations in local trauma services, with implementation of novel methods of practice, strategic adaptations, and shifting of resource management. Many of these may serve the driver for landmark changes to future healthcare provision.

AIM

To analyse the impact of COVID-19 on service provision by comparing throughput and productivity metrics with preceding years to identify differences in practice that were successful, cost-effective, and sustainable.

METHODS

We quantified orthopaedic trauma care provision at a single University Teaching Hospital over a three consecutive year period, from 1st January 2018 to 31st December 2020. Each year was split into four phases based on the 2020 national COVID-19 pandemic periods. We quantitatively analysed change in rates of inpatient trauma operative case load, sub-specialty variation, theatre throughput, and changes in management strategy. Qualitative analysis was based on multidisciplinary team interviews to highlight changes to care pathways.

RESULTS

Of 1704 cases were admitted in 2020, 11.9% and 12.4% fewer than 2019 and 2018, respectively. During phase 1, hip fractures encompassed the majority (48.8%) of trauma throughput, with all other subspecialties seeing a reduction. Mean length of stay was shorter during phase 1 (5.7 d); however, the time in theatre was longer (144.3 min). Both, Charlson (0.90) and Elixhauser (1.55) Comorbidity Indices indicated the most co-morbid admissions during 2020 phase 1.

CONCLUSION

COVID-19 has resulted in a paradigm shift in how care is accessed and delivered, with many evolving changes and adaptations likely to leave an impression upon healthcare provision in the future.

Keywords: COVID-19; Trauma; Surgery; Throughput; Care provision

Core Tip: Based on our findings, we have made several recommendations that we will adopt locally going forward. We encourage other teams facing similar challenges to consider these factors to improve the care of trauma patients: (1) Dynamic elective approaches to care can reduce length of stay (LOS): The ‘elective mindset’ of the elective hospital nursing/physical therapy/occupational therapy teams yielded more expeditious post-operative rehabilitation our trauma patients, ensuring faster optimisation of a more co-morbid cohort of patients and reduced LOS; (2) Sustain the rising trend in safe non-operative management to reduce inpatient workload: This was a trend particularly observed in hand and wrist/foot and ankle trauma where the care pathways were altered in the face of rising coronavirus disease 2019 cases; and (3) Maintaining rapid re-education of skills: By rapidly adopting locally-relevant versions of national guidance and developing standardised algorithms and training pathways.