scholarly journals 535 Private Trauma Lists: A Pragmatic Panacea During This Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Biggs ◽  
E Moore ◽  
M Zbaeda ◽  
K Shah ◽  
A Keightley
Keyword(s):  
Surgical Training ◽  
Service Provision ◽  
Private Hospital ◽  
Trauma Surgery ◽  
Satisfaction Questionnaire ◽  
Operating Capacity ◽  
Trauma Service ◽  
Safe Management ◽  
Reduce Risk ◽  
Mean Time

Abstract Introduction COVID-19 has disrupted the efficiency of hospitals nationwide. Ambulant trauma surgery was minimised to reduce risk of contracting COVID-19. Operating capacity significantly reduced and surgical training dramatically curtailed. Locally, a private hospital has been utilised as a green site with consultant-lead trauma lists. Our aim is to review the safety and efficiency of this service. Method Patients underwent pre-assessment, COVID-19 swabs and 7 days isolation pre and post-op. Staff also underwent swabbing. Prospectively data was gathered for all patients operated on at this site from 12/05/2020 to 20/08/2020. Records reviewed for readmission, complications and COVID status. A satisfaction questionnaire was sent to trainees who operated at this site. Results 79 operations were completed during this period. 50 male and 29 female, average age 49, average ASA 2. No complications or COVID-19 infections were recorded. Mean time to theatre was 18 days. Delays to theatre led to 2 complications. 87% of trainees felt training was maintained. Conclusions Establishing a green site enabled efficient and safe management whilst still facilitating surgical training. This requires clear guidelines for staff and patients. We believe this model can help trauma service provision as the pandemic evolves.

scholarly journals 1465 Anaesthetic Preferences in a Tertiary Hand Surgery Unit & Aetiology of Hand Trauma Presentations During the First UK lockdown: Lessons for the Future

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Khoury ◽  
D Thomson ◽  
M Jones
Keyword(s):  
Local Anaesthetic ◽  
Trauma Surgery ◽  
Anaesthetic Techniques ◽  
Hand Surgery ◽  
Third Wave ◽  
Hand Trauma ◽  
Workplace Injuries ◽  
Exact Test ◽  
Trauma Service ◽  
Reduce Risk

Abstract Introduction Our tertiary plastics unit serves a 4.3 million population in the South East, providing a seven-day hand trauma service. Our aim was to assess differences in quantity and aetiology of hand trauma during the April 2020 lockdown compared with the equivalent period in 2019, and our ability to reduce risk by carrying out more procedures under local anaesthetic. Method Retrospective notes review for hand trauma surgery patients in April 2020 (3 weeks in first UK lockdown), with a comparative period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthetia, injury location (workplace vs home) and DIY versus non-DIY aetiology. Results 2020 group: n = 165. 2019: n = 239. (31% reduction). Mean age 45 during lockdown vs 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22% vs 29%), but the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%). DIY injuries increased significantly (33.5% versus 9.2%). Use of local anaeshesia including increased significantly in our unit (84.2% vs 66.1% 2019) with reduction in use of regional and general anaesthesia. Conclusions Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit made good use of local anaesthetic techniques to avoid regional anaesthesia (and risk of need for GA conversion) wherever possible. Public safety warnings existed (BAPRAS and BSSH), but perhaps were less publicly available than desirable. Improving awareness further could reduce trauma surgery burden as we enter a third wave of the pandemic.

scholarly journals Military General Surgical Training Opportunities on Operations in Afghanistan

2009 ◽  
Vol 91 (5) ◽  
pp. 417-419 ◽  
Author(s):  
Adam J Brooks ◽  
Arul Ramasamy ◽  
David Hinsley ◽  
Mark Midwinter
Keyword(s):  
Surgical Management ◽  
Surgical Training ◽  
Trauma Surgery ◽  
Organ Injury ◽  
Surgical Trauma ◽  
Training Opportunity ◽  
Injury Management ◽  
Surgical Trainees ◽  
Specific Organ ◽  
The Uk

INTRODUCTION In the UK, general surgical specialist trainees have limited exposure to general surgical trauma. Previous work has shown that trainees are involved in only two blunt and one penetrating trauma laparotomies per annum. During their training, nearly half of trainees will not be involved in the surgical management of liver injury, 20% will not undertake a trauma splenectomy and only a quarter will see a trauma thoracotomy. Military general surgical trainees require training in, and exposure to, the surgical management of trauma and specifically military wounding patterns that is not available in the UK. The objective of this study was to determine whether operative workload in the sole British surgical unit in Helmand Province, Afghanistan (Operation HERRICK) would provide a training opportunity for military general surgical trainees. PATIENTS AND METHODS A retrospective theatre log-book review of all surgical cases performed at the Role 2 (Enhanced) treatment facility at Camp Bastion, Helmand Province on Operation HERRICK between October 2006 and October 2007, inclusive. Operative cases were analysed for general surgical trauma, laparotomy, thoracotomy, vascular trauma and specific organ injury management where available. RESULTS A total of 968 operative cases were performed during the study period. General surgical procedures included 51 laparotomies, 17 thoracotomies and 11 vascular repairs. There were a further 70 debridements of general surgical wounds. Specific organ management included five cases of liver packing for trauma, five trauma splenectomies and four nephrectomies. CONCLUSIONS A training opportunity currently exists on Operation HERRICK for military general surgical specialist trainees. If the tempo of the last 12 months is maintained, a 2-month deployment would essentially provide trainees with the equivalent trauma surgery experience to the whole of their surgical training in the UK NHS. Trainees would gain experience in military trauma as well as specific organ injury management.

scholarly journals Evaluating the efficacy of a two-site (‘COVID-19’ and ‘COVID-19-free’) trauma and orthopaedic service for the management of hip fractures during the COVID-19 pandemic in the UK

2020 ◽  
Vol 1 (6) ◽  
pp. 190-197 ◽  
Author(s):  
Karen Chui ◽  
Amit Thakrar ◽  
Shivakumar Shankar
Keyword(s):  
Hip Fracture ◽  
Medical Patients ◽  
Clinical Frailty Scale ◽  
Time To Surgery ◽  
Patient Demographics ◽  
Trauma Service ◽  
Free Model ◽  
Bed Capacity ◽  
The Uk ◽  
Mean Time

Aims Hip fracture patients are at higher risk of severe COVID-19 illness, and admission into hospital puts them at further risk. We implemented a two-site orthopaedic trauma service, with ‘COVID’ and ‘COVID-free’ hubs, to deliver urgent and infection-controlled trauma care for hip fracture patients, while increasing bed capacity for medical patients during the COVID-19 pandemic. Methods A vacated private elective surgical centre was repurposed to facilitate a two-site, ‘COVID’ and ‘COVID-free’, hip fracture service. Patients were screened for COVID-19 infection and either kept at our ‘COVID’ site or transferred to our ‘COVID-free’ site. We collected data for 30 days on patient demographics, Clinical Frailty Scale (CFS), Nottingham Hip Fracture Scores (NHFS), time to surgery, COVID-19 status, mortality, and length of stay (LOS). Results In all, 47 hip fracture patients presented to our service: 12 were admitted to the ‘COVID’ site and 35 to the ‘COVID-free’ site. The ‘COVID’ site cohort were older (mean 86.8 vs 78.5 years, p = 0.0427) and with poorer CFS (p = 0.0147) and NHFS (p = 0.0023) scores. At the ‘COVID-free’ site, mean time to surgery was less (29.8 vs 52.8 hours, p = 0.0146), and mean LOS seemed shorter (8.7 vs 12.6 days, p = 0.0592). No patients tested positive for COVID-19 infection while at the ‘COVID-free’ site. We redirected 74% of our admissions from the base ‘COVID’ site and created 304 inpatient days’ capacity for medical COVID patients. Conclusion Acquisition of unused elective orthopaedic capacity from the private sector facilitated a two-site trauma service. Patients were treated expeditiously, while successfully achieving strict infection control. We achieved significant gains in medical bed capacity in response to the COVID-19 demand. The authors propose the repurposing of unused elective operating facilities for a two-site ‘COVID’ and ‘COVID-free’ model as a safe and effective way of managing hip fracture patients during the pandemic. Cite this article: Bone Joint Open 2020;1-6:190–197.

The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees

2018 ◽  
Vol 164 (5) ◽  
pp. 360-361 ◽  
Author(s):  
Douglas Hammond ◽  
J Breeze ◽  
D Evriviades
Keyword(s):  
Surgical Training ◽  
Major Trauma ◽  
Complex Trauma ◽  
Trauma Surgery ◽  
Queen Elizabeth Hospital ◽  
Trauma Patients ◽  
Multidisciplinary Management ◽  
Leadership Experience ◽  
The Uk ◽  
The Military

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees.

Patent Foramen Ovale Closure Before Orthopedic Trauma Surgery to Reduce Risk of Recurrent Systemic Fat Embolism

2007 ◽  
Vol PAP ◽  
Author(s):  
Paul Leeson ◽  
Ahmed Al-Mousawi ◽  
Jonathan Timperley ◽  
Andrew R. Mitchell ◽  
Keith Willett ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Trauma Surgery ◽  
Fat Embolism ◽  
Orthopedic Trauma ◽  
Foramen Ovale ◽  
Reduce Risk ◽  
Orthopedic Trauma Surgery

Patient satisfaction with HIV service provision in NPMS hospitals: The development of a standard satisfaction questionnaire

AIDS Care ◽  
1999 ◽  
Vol 11 (3) ◽  
pp. 331-343 ◽  
Author(s):  
E. J. Beck ◽  
R. Griffith ◽  
R. Fitzpatrick ◽  
S. Mandalia ◽  
J. Carrier ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Service Provision ◽  
Satisfaction Questionnaire

scholarly journals Trauma surgery at a designated COVID-19-free site during the pandemic

2020 ◽  
Vol 1 (6) ◽  
pp. 302-308
Author(s):  
Gianluca Gonzi ◽  
Kathryn Rooney ◽  
Rhodri Gwyn ◽  
Kunal Roy ◽  
Matthew Horner ◽  
...  
Keyword(s):  
Trauma Surgery ◽  
Electronic Record ◽  
Health Board ◽  
Trauma Patients ◽  
Staff Members ◽  
Patient Demographics ◽  
Orthopaedic Patients ◽  
Trauma Service ◽  
Surgical Unit

Aims Elective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos’ Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service. Methods All patients undergoing surgery during the COVID-19 pandemic at the orthopaedic surgical unit (OSU) in St. Woolos’ Hospital from 23 March 2020 to 24 April 2020 were included. All patients that were operated on had a telephone follow-up two weeks after surgery to assess if they had experienced COVID-19 symptoms or had been tested for COVID-19. The nature of admission, operative details, and patient demographics were obtained from the health board’s electronic record. Staff were assessed for sickness, self-isolation, and COVID-19 status. Results A total of 58 surgical procedures were undertaken at the OSU during the study period; 93% (n = 54) of patients completed the telephone follow-up. Open reduction and internal fixation of ankle and wrist fractures were the most common procedures. None of the patients nor members of their households had developed symptoms suggestive of COVID-19 or required testing. No staff members reported sick days or were advised by occupational health to undergo viral testing. Conclusion This study provides optimism that orthopaedic patients planned for surgery can be protected from COVID-19 nosocomial transmission at separate COVID-19-free sites. Cite this article: Bone Joint Open 2020;1-6:302–308.

scholarly journals Daycase trauma list: a safe and cost-effective service delivery

2019 ◽  
Vol 101 (7) ◽  
pp. 519-521
Author(s):  
MS Athar ◽  
MA Fazal ◽  
N Ashwood ◽  
G Arealis ◽  
D Buchanan ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lower Limb ◽  
Trauma Surgery ◽  
Cost Effective ◽  
High Patient Satisfaction ◽  
Trauma Service ◽  
Novel Approach ◽  
Wide Range ◽  
The Mean ◽  
Effective Service

Introduction Daycase trauma surgery is an evolving and a novel approach. The aim of our study was to report our experience of daycase trauma surgery with a focus on safety, patient experience, complications and limitations. Material and methods Patients scheduled and operated on a daycase trauma list from January 2013 to December 2016 were included in the study. Age, sex, case mix, readmissions within 48 hours, complications, patient satisfaction, reasons for overnight stay and cost effectiveness were evaluated. Results A total of 229 procedures were carried out. The mean age of the patients was 44.3 years (range 16–85 years) . There were 128 men and 101 women, 178 upper-limb and 51 lower-limb cases. Only 2.6% of the patients had stayed overnight for pain control, physiotherapy and neurological observations; 94.5% of the patients were satisfied. The mean visual analogue scale score for satisfaction was 8.7. There were no admissions within 48 hours of discharge and one complication with failure of ankle fixation. The estimated cost saving was £65,562. Conclusion We conclude that a daycase trauma service is safe, cost effective, and yields high patient satisfaction. It reduces the burden on hospital beds and a wide range of upper- and lower-limb cases can be performed as daycase trauma surgery with adequate planning and teamwork.

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