Factors responsible for delay in provision of care to suspected COVID-19 patients presenting in surgical emergency and ways to combat it

  • Tariq Nawaz
  • Muhammad Waqas Ayub
  • Faryal Munir
  • Qasim Ali
  • Atif Khan
  • Muhammad Idrees Anwar
Keywords: Delay in management of emergency Covid-19 positive surgical patients, factors in delay, steps to decrease delay rime., COVID-19, Medical Surgery.

Abstract

Introduction: Health care workers are found to be at three times greater risk of getting infected as compared to the general public.  Scientists and doctors all over the world have agreed upon the use of PPE including gloves, masks, head covers, face shields, goggles, and jumpsuits in protection against COVID-19.

Materials and Methods: This observational prospective study was conducted in the surgical emergency of Holy Family Hospital, Rawalpindi over a period of 2 months and 21 days. Patients included all those who presented to surgical emergency with suspicion of being positive for COVID-19 and time taken by first-line health care workers in attending them. 157 patients were observed for this purpose and 23 first-line surgeons including general, orthopedic, and neurosurgeons were interviewed regarding their fears and concerns about contracting COVID-19 and infecting their families.

Results: It was observed that a surgeon took on an average of 10 minutes (+/-3 minutes) in wearing all the personal protective equipment and a total of 14minutes (+/- 5 minutes) in reaching a patient in the trauma room with symptoms suggestive of COVID-19. This was in contrast to a patient presenting to a trauma room who had no respiratory symptoms or fever, in which case, the patient was seen within 3 minutes (+/- 2 minutes) of presentation to a surgical emergency. Out of 23 surgeons, 15 had reasonably aware of the disease while 7 were knowledgeable up to the mark. 17 surgeons were extremely fearful about contracting the disease and infecting their friends and families. 7 surgeons confessed to avoiding COVID-19 patients and 9 surgeons confessed that they commanded their junior surgeons to see suspected COVID-19 patients in the emergency room.

Conclusion: We concluded that delay in attending trauma patients suspected of being positive for COVID-19 was a worrisome problem that needed to be addressed. Numerous local and regional circumstances served as a factor for this delay, most important of which came out to be an inadequate provision of PPE, time consumed in collecting and wearing PPE, fear of the disease, and anxiety provoked due to this fear among surgeons.

References

1. Ross SW, Lauer CW, Miles WS, Green JM, Christmas AB, May AK, Matthews BD. Maximizing the calm before the storm: tiered surgical response plan for novel coronavirus (COVID-19). Journal of the American College of Surgeons. 2020 Mar 30.
2. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, Tan KS, Wang DY, Yan Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Military Medical Research. 2020 Dec;7(1):1-0.
3. Pandey AS, Ringer AJ, Rai AT, et AL Minimizing SARS-CoV-2 exposure when performing surgical interventions during the covid-19 pandemic Journal of NeuroInterventional Surgery Published Online First: 20 May 2020. doe: 10.1136/neurintsurg-2020-016161
4. Brindle ME, Gawande A. Managing COVID-19 in surgical systems. Annals of Surgery. 2020 Mar 20.
5. Ranney ML, Griffith V, Jha AK. Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic. New England Journal of Medicine. 2020 Apr 30;382(18)e41.
6. Hirschman MT, Hart A, Henckels J, Sadeghi P, Seil R, Mouton C. COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Apr 27.
7. Ong JJ, Bharatendu C, Goh Y, Tang JZ, Sooi KW, Tan YL, Tan BY, Teoh HL, Ong ST, Allen DM, Sharma VK. Headaches associated with personal protective equipment–A cross‐sectional study among frontline healthcare workers during COVID‐19. Headache: The Journal of Head and Face Pain. 2020 May;60(5):864-77.
Published
2020-08-17
How to Cite
1.
Nawaz T, Ayub M, Munir F, Ali Q, Khan A, Anwar M. Factors responsible for delay in provision of care to suspected COVID-19 patients presenting in surgical emergency and ways to combat it. JRMC [Internet]. 17Aug.2020 [cited 27Sep.2020];24(Supp-1):10-4. Available from: http://journalrmc.com/index.php/JRMC/article/view/1438
Section
Short Communication