Published online Oct 18, 2022. doi: 10.5312/wjo.v13.i10.921
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
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.
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.
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.
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.
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.
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.