Meeting the Challenge of COVID-19 in DHQ Orthopaedic Department

  • Obaid ur Rahman assistant professor orthopedics
  • Nayyur Qayyum
  • Afzal Aleem Khan
  • Muhammad Ammar Aslam
  • Syed Zohaib Haider
Keywords: COVID-19, Pandemic, Orthopaedics.

Abstract

Introduction: The World Health Organization (WHO) declared Covid-19 as a pandemic on March 11, 2020. Not only that the COVID-19 pandemic has brought the world to a complete lockdown but also burdened healthcare systems across the world immensely.

Objective: In this paper, we discuss the different strategies we adopted in the Orthopaedics Department of District Head Quarter [DHQ] hospital Rawalpindi, during this ongoing pandemic and share our experience of successfully but cautiously providing orthopedic services to patients in a public hospital. We compare our workload and output of May 2020 [pandemic phase] to May 2019 [standard/normal phase].

Methodology: The Hospital policy was changed after the COVID-19 pandemic. We increased public awareness and reduced load in the OPD using different strategies. We postponed all elective cases; focusing our logistics and resources only on the patients in urgent need of surgical management. A minimum number of doctors and OTAs were allocated on each list. Inwards, the patient stay was reduced. As a standard PCR test for COVID-19 was expensive, we devised our screening through history, examination, and routine investigations.

Results:  The average stay inwards was reduced from 6.4±4.6 days in May 2019 to 2.7±3.6 days in May 2020. The decrease in the stay was statistically significant (p=.0206) and was associated with a 24.4% increase in the number of total patient admissions in May 2020 (n=56) as compared to May 2019 (n=45). The number of surgeries performed month to month was very similar in normal and pandemic periods.

Our OPD patient attendance dropped from 200-250 patients per day in 2019 to 60-70 during the ongoing pandemic phase.

Conclusion: We believe that sharing experiences between health care actors allows us to develop an effective strategy to provide the very best care to our patients during the COVID-19 pandemic.

References

1.R.U. Ashford, J.S. Nichols, J. MangwaniAnnotation: the COVID-19 pandemic and clinical orthopaedic and trauma surgery.J Clin Orthop Trauma (2020 Apr)
S0976566220301168
Google Scholar

2.Y. Shi, J. Wang, Y. Yang, Z. Wang, G. Wang, K. Hashimoto, et al.Knowledge and attitudes of medical staff in Chinese psychiatric hospitals regarding COVID-19
Brain Behav Immun - Health, 4 (2020 Apr 1), p. 100064
ArticleDownload PDFGoogle Scholar


3. P. Giacomo, S. Damiano, D. Elena, B. Giulia, S. VincenzoCoViD-19 and Ortho and Trauma Surgery: the Italian Experience.Injury (2020 Apr)
S0020138320303430


4. Z. Chang Liang, W. Wang, D. Murphy, J.H. Po HuiNovel coronavirus and orthopaedic surgery: early experiences from Singapore. JBJS [Internet]
[cited 2020 Apr 18];Latest Articles. Available from:
https://journals.lww.com/jbjsjournal/Citation/9000/Novel_Coronavirus_and_Orthopaedic_Surgery__Early.99807.aspx (2020 Apr 20)
Google Scholar

5. S. Ahmed, T.W. Leong Glenn, Y.-L. ChongSurgical response to COVID-19 pandemic: a Singapore perspective.J. Am. Coll. Surg. (2020 Apr)
S1072751520303082


6. Brindle, Mary MD, MPH*; gawande, atul MD, MPH† managing COVID-19 in surgical systems, Ann. Surg.: Mar 23, 2020 - Volume Publish Ahead of Print - Issue - doi: 10.1097/SLA.0000000000003923.
Google Scholar


7. M.E. Awad, J.C.L. Rumley, J.A. Vazquez, J.G. DevinePeri-operative considerations in urgent surgical care of suspected and confirmed COVID-19 orthopedic patients: operating rooms protocols and recommendations in the current COVID-19 pandemic
[Internet]. JAAOS - J Am Acad Orthop Surg (2020 Apr 15)
[cited 2020 Apr 18];Publish Ahead of Print. Available from:
https://journals.lww.com/jaaos/Abstract/publishahead/Peri_operative_Considerations_in_Urgent_Surgical.99132.aspx
Google Scholar
8. Z. Tan, P.H.Y. Phoon, L.A. Zeng, J. Fu, X.T. Lim, T.E. Tan, et al.Response and operating room preparation for the COVID-19 outbreak: a perspective from the national heart centre in Singapore. J cardiothorac vasc anesth. 2020 mar;S1053077020303001.4. Viswanath A, monga P. Working through the COVID-19 outbreak: rapid review and recommendations for MSK and allied heath personnel
J Clin Orthop Trauma (2020 Mar)
S0976566220300977
Google Scholar


.9. R. Ellis, et al.Operating during the COVID-19 pandemic: how to reduce medical error
Br. J. Oral Maxillofac. Surg. (2020), 10.1016/j.bjoms.2020.04.002

10.A. Viswanath, P. MongaWorking through the COVID-19 outbreak: rapid review and recommendations for MSK and allied heath personnel.J Clin Orthop Trauma (2020 Mar)
S0976566220300977

11. K. Tay, T. Kamarul, W.Y. Lok, M. Mansor, X. Li, J. Wong, A. SawCOVID-19 in Singapore and Malaysia: rising to the challenges of orthopaedic practice in an evolving pandemic.Malaysian Orthopaedic Journal, 14 (2) (2020)
http://10.5704/MOJ.2007.001
Google Scholar

12. A.R. Vaccaro, C.L. Getz, B.E. Cohen, B.J. Cole, C.J.I. DonnallyPractice management during the COVID-19 pandemic.[Internet]JAAOS - J Am Acad Orthop Surg (2020 Apr 15)[cited 2020 Apr 18];Publish Ahead of Print. Available from:
https://journals.lww.com/jaaos/Abstract/publishahead/Practice_Management_During_the_COVID_19_Pandemic.99131.aspx
Google Scholar

13.A.E. Loeb, S.S. Rao, J.R. Ficke, C.D. Morris, L.H.I. Riley, A.S. LevinDepartmental experience and lessons learned with accelerated introduction of telemedicine during the COVID-19 crisis [Internet] JAAOS - J Am Acad Orthop Surg (2020 Apr 15)
[cited 2020 Apr 18];Publish Ahead of Print. Available from:
https://journals.lww.com/jaaos/Abstract/9000/Departmental_Experience_and_Lessons_Learned_With.99128.aspx
Google Scholar
Published
2020-08-13
How to Cite
1.
Rahman O, Qayyum N, Khan A, Aslam M, Haider S. Meeting the Challenge of COVID-19 in DHQ Orthopaedic Department. JRMC [Internet]. 13Aug.2020 [cited 27Sep.2020];24(Supp-1):21-5. Available from: http://journalrmc.com/index.php/JRMC/article/view/1416