Utilising the impact of COVID-19 on trauma throughput to adapt elective care models for more efficient trauma care

Table 1 Timelines for each phase evaluated

Phase	Description	Dates	Days
Phase 0	Pre-lockdown	1st January - 22nd March	81
Phase 1	Lockdown	23rd March - 31st May	70
Phase 2	Post-lockdown	1st June - 30st September	122
Phase 3	To year end	1st October - 31st December	92

Table 2 Subspecialty trauma breakdown (2018-2020)

Subspecialty	Year	Phase 0	Phase 1	Phase 2	Phase 3	Total
		Pre-lockdown	Lockdown	Post-lockdown	To year end
Hip	2018	183 (39.8%)	131 (37.9%)	311 (37.0%)	118 (39.6%)	743 (38.2%)
	2019	172 (39.3%)	146 (41.6%)	339 (40.4%)	139 (45.4%)	796 (41.2%)
	2020	163 (41.3%)	146 (48.8%)	291 (36.6%)	76 (35.3%)	676 (39.7%)
Knee	2018	26 (5.7%)	14 (4.0%)	47 (5.6%)	16 (5.4%)	103 (5.3%)
	2019	37 (8.4%)	24 (6.8%)	53 (6.3%)	27 (8.8%)	141 (7.3%)
	2020	36 (9.1%)	16 (5.4%)	55 (6.9%)	7 (3.3%)	114 (6.7%)
Foot & ankle	2018	69 (15.0%)	60 (17.3%)	120 (14.3%)	45 (15.1%)	294 (15.1%)
	2019	65 (14.8%)	47 (13.4%)	102 (12.2%)	39 (12.7%)	253 (13.1%)
	2020	45 (11.4%)	26 (8.7%)	98 (12.3%)	36 (16.7%)	205 (12.0%)
Hand & wrist	2018	70 (15.2%)	53 (15.3%)	148 (17.6%)	51 (17.1%)	322 (16.6%)
	2019	58 (13.2%)	54 (15.4%)	149 (17.8%)	33 (10.8%)	294 (15.2%)
	2020	60 (15.2%)	44 (14.7%)	147 (18.5%)	42 (19.5%)	293 (17.2%)
Shoulder	2018	27 (5.9%)	25 (7.2%)	45 (5.4%)	20 (6.7%)	117 (6.0%)
	2019	30 (6.8%)	22 (6.3%)	47 (5.6%)	21 (6.9%)	120 (6.2%)
	2020	27 (6.8%)	13 (4.3%)	52 (6.5%)	21 (9.8%)	113 (6.6%)
Elbow	2018	32 (7.0%)	32 (9.2%)	87 (10.3%)	16 (5.4%)	167 (8.6%)
	2019	29 (6.6%)	19 (5.4%)	62 (7.4%)	12 (3.9%)	122 (6.3%)
	2020	24 (6.1%)	21 (7.0%)	75 (9.4%)	15 (7.0%)	135 (7.9%)
Complex multi-site	2018	16 (3.5%)	8 (2.3%)	16 (1.9%)	7 (2.3%)	47 (2.4%)
	2019	4 (0.9%)	7 (2.0%)	14 (1.7%)	7 (2.3%)	32 (1.7%)
	2020	4 (1.0%)	1 (0.3%)	9 (1.1%)	3 (1.4%)	17 (1.0%)
Polytrauma	2018	37 (8.0%)	23 (6.6%)	67 (8.0%)	25 (8.4%)	152 (7.8%)
	2019	43 (9.8%)	32 (9.1%)	73 (8.7%)	28 (9.2%)	176 (9.1%)
	2020	36 (9.1%)	32 (10.7%)	68 (8.6%)	15 (7.0%)	151 (8.9%)

Table 3 Patient demographics, length of stay, comorbidity indices and theatre parameters for 2018

	Phase 0 (n = 709)	Phase 1 (n = 571)	Phase 2 (n = 1363)	Phase 3 (n = 486)	Total (n = 3129)
	mean ± SD
Age at injury	61.23 ± 22.40	56.40 ± 24.04	57.52 ± 24.36	59.06 ± 23.79	58.39 ± 23.83
Length of spell (d)	8.39 ± 10.31	6.84 ± 8.57	6.76 ± 10.19	7.02 ± 9.45	7.18 ± 9.84
Charlson Comorbidity Index	0.72 ± 1.31	0.65 ± 1.24	0.68 ± 1.26	0.60 ± 1.21	0.67 ± 1.26
Elixhauser Comorbidity Index	1.19 ± 1.39	1.09 ± 1.36	1.14 ± 1.38	1.06 ± 1.31	1.13 ± 1.37
Hours to surgery	29.24 ± 50.75	31.46 ± 48.29	34.72 ± 91.27	26.22 ± 52.95	31.54 ± 71.10
Time in theatre	98.59 ± 58.34	92.86 ± 48.23	94.33 ± 46.30	95.49 ± 48.66	95.23 ± 50.04
Time in theatre/recovery	61.23 ± 22.40	56.40 ± 24.04	57.52 ± 24.36	59.06 ± 23.79	58.39 ± 23.83
Sex: Female	383 ± 54.0%	296 ± 51.8%	726 ± 53.3%	249 ± 51.2%	1654 ± 52.9%
Sex: Male	326 ± 46.0%	275 ± 48.2%	637 ± 46.7%	237 ± 48.8%	1475 ± 47.1%

Table 4 Patient demographics, length of stay, comorbidity indices and theatre parameters for 2019

	Phase 0 (n = 664)	Phase 1 (n = 563)	Phase 2 (n = 1315)	Phase 3 (n = 471)	Total (n = 3013)
	mean ± SD
Age at injury	58.89 ± 24.03	60.66 ± 23.17	58.66 ± 23.95	61.11 ± 22.98	59.47 ± 23.68
Length of spell (d)	7.30 ± 8.05	7.50 ± 9.90	6.67 ± 8.60	8.01 ± 10.88	7.18 ± 9.14
Charlson Comorbidity Index	0.71 ± 1.28	0.84 ± 1.49	0.78 ± 1.35	0.77 ± 1.30	0.77 ± 1.35
Elixhauser Comorbidity Index	1.20 ± 1.38	1.36 ± 1.55	1.39 ± 1.53	1.34 ± 1.42	1.33 ± 1.49
Hours to surgery	32.02 ± 57.64	32.13 ± 51.56	29.17 ± 47.03	31.96 ± 56.83	30.79 ± 51.99
Time in theatre	101.03 ± 49.49	96.30 ± 67.04	94.85 ± 57.61	95.95 ± 47.63	96.64 ± 56.36
Time in theatre/recovery	213.08 ± 110.23	208.29 ± 115.17	214.99 ± 141.51	228.39 ± 146.20	215.56 ± 131.70
Sex: Female	332 ± 50.0%	291 ± 51.7%	675 ± 51.3%	239 ± 50.7%	1537 ± 51.0%
Sex: Male	332 ± 50.0%	272 ± 48.3%	640 ± 48.7%	232 ± 49.3%	1476 ± 49.0%

Table 5 Patient demographics, length of stay, comorbidity indices and theatre parameters for 2020

	Phase 0 (n = 640)	Phase 1 (n = 425)	Phase 2 (n = 1210)	Phase 3 (n = 413)	Total (n = 2688)
	mean ± SD
Age at injury	59.46 ± 23.95	62.16 ± 23.61	57.70 ± 24.07	60.97 ± 23.47	59.33 ± 23.93
Length of spell (d)	7.05 ± 7.87	5.69 ± 5.90	5.71 ± 7.54	7.53 ± 8.86	6.30 ± 7.64
Charlson Comorbidity Index	0.77 ± 1.23	0.90 ± 1.45	0.68 ± 1.19	0.68 ± 1.25	0.73 ± 1.26
Elixhauser Comorbidity Index	1.27 ± 1.46	1.55 ± 1.63	1.21 ± 1.37	1.19 ± 1.39	1.28 ± 1.44
Hours to surgery	30.71 ± 49.37	30.84 ± 34.56	24.50 ± 37.98	24.59 ± 37.14	26.97 ± 40.41
Time in theatre	95.62 ± 50.10	144.25 ± 64.24	127.98 ± 54.37	123.20 ± 54.48	122.11 ± 57.35
Time in theatre/recovery	215.97 ± 124.31	175.22 ± 117.92	195.23 ± 106.09	203.28 ± 132.37	199.65 ± 117.42
Sex: Female	347 ± 54.2%	237 ± 55.8%	649 ± 53.6%	234 ± 56.7%	1467 ± 54.6%
Sex: Male	293 ± 45.8%	188 ± 44.2%	561 ± 46.4%	179 ± 43.3%	1221 ± 45.4%