Response to: “Managing hand trauma during the COVID-19 pandemic using a one-stop clinic” https://doi.org/10.1016/j.bjps.2020.05.026

Abstract

Earlier in the year we wrote detailing the changes in our hand trauma service in response to the COVID-19 pandemic.1Sadr M.A.H. Gardiner M.S. Burr M.N. Nikkhah M.D. Jemec M.B. Managing Hand Trauma during the COVID-19 pandemic using a One-Stop Clinic.J Plast Reconstr Aesthet Surg. 2020; 73: 1357-1404Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar We have now been able to review our experiences during this period, and particularly whether changes to the service have impacted patient care. As described previously,1Sadr M.A.H. Gardiner M.S. Burr M.N. Nikkhah M.D. Jemec M.B. Managing Hand Trauma during the COVID-19 pandemic using a One-Stop Clinic.J Plast Reconstr Aesthet Surg. 2020; 73: 1357-1404Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar during this period we made several changes to our hand trauma service. This included the introduction of the “one-stop clinic” – where patients underwent their initial plastic surgery assessment, surgery and initial hand therapy review +/- splinting on the same day. Other changes included the introduction of a “trauma co-ordinator” role staffed by a senior member of the hand therapy team 7 days a week who, amongst other things, was able to co-ordinate theatre bookings and patient attendance to maximise the use of our limited time in the operating theatre. Additionally, a consultant plastic surgeon was always present in both the trauma theatre and trauma clinic to ensure senior decision making on decision to operate vs conservative management. We also saw a shift away from general anaesthetic procedures to local anaesthetic and particularly the WALANT technique. As a result, our hand trauma service was one of very few non-COVID services that was able to continue uninterrupted throughout the entire pandemic. We have reviewed cases of open tendon repair with regard to compliance with the BSSH hand trauma standards prior to COVID-19 (October-December 2019) and compared these outcomes with those during the first wave of the pandemic (late March – June 2020). As experienced in other units,2Stallard J. Hughes B.A. West C.C. et al.Response to - 'Managing hand trauma during the COVID-19 pandemic using a one-stop clinic.J Plast Reconstr Aesthet Surg. 2020; Abstract Full Text Full Text PDF Scopus (1) Google Scholar,3Welman T. Hobday D. El-Ali K. Pahal G.S. The COVID-19 Pandemic: the effect on hand trauma in Europe's busiest major trauma centre.J Plast Reconstr Aesthet Surg. 2020; Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar our workload overall was significantly reduced during the COVID-19 period (63 tendon repairs March-June 2020 vs 103 repairs Oct-Dec 2019). However, during this period our compliance with BSSH standards were significantly improved. Time from injury to clinic improved from 2.5 days to 0.8 days (target 24 h) and time from injury to surgical repair improved from 5.6 days to 2.2 days (target 4 days). Of the 63 patients treated in the COVID-19 period 33.3% were treated in the “one-stop clinic” and 40% of patients treated saw hand therapy on the day of surgery. Time to hand therapy post-operatively improved from 3.9 days to 1.7 days (target 3–5 days). Additionally, we saw a decrease in complication rates during this period. Rates of tendon rupture fell from 8.7% to 3% and post-operative infection rates fell from 6.8% to just 1.6%, this is despite much of the follow up care being conducted remotely. Therefore, the rapid changes necessitated by the onset of the pandemic have actually resulted in an enhanced hand trauma service in our unit with improved outcomes for patients. We believe we must strive to consolidate these changes and integrate them into the long-term future of our service to allow us to continue to deliver this enhanced level of care as the caseload increases. For example, we intend to use this data to support long term funding for the trauma co-ordinator role in our hand trauma unit, as the efficiency of booking and managing patient flow through theatre lists becomes even more critical as the post-COVID workload increases. We believe that many lessons can be learned from our experiences throughout the COVID-19 pandemic. Services were able to make structural changes rapidly without many of the bureaucratic processes and barriers that are routinely encountered in changing NHS practice and out of the crisis we have seen many new innovations take hold to streamline services and enhance patient experience and care.4Nikkhah M.D. COVID-19 The Great Disruptor.J Plast Reconstr Aesthet Surg. 2020; 73: 1575-1592Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar As we steadily recover from the pandemic, we must ensure that these innovations and experiences are secured and built upon to avoid a return to the status quo. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This work has not been presented or published elsewhere. None.