By: Mr Sarkhell Radha MBChB, PG Cert, MSc, MBA, MRCS, FRCS (Tr & Orth)
Consultant Trauma and Orthopaedic Surgeon and Clinical Lead at Croydon University Hospital & The South West London Elective Orthopaedic Centre.
The COVID-19 pandemic continues to be a dark period in the history of medicine. The impact of the virus on the UK population, health system and economy has been profound. Just like all other specialities, the pandemic has had an immense impact on Trauma and Orthopaedics.
During the first wave, I was asked to step up as COVID-19 Co-ordinating Consultant and Business Continuity Manager for the Trauma and Orthopaedic division at Croydon University Hospital (CUH). Despite all the new challenges of leading a department through turbulent times, I still had to practice as a Consultant Trauma and Orthopaedic Surgeon with a specialist interest in complex trauma and complex arthroplasty.
In my role as the COVID-19 Co-ordinating Consultant, I led on the implementation of the first Trauma and Orthopaedic strategy at CUH to keep our trauma services running safely and efficiently. This was the first local strategy in the country to keep trauma services running in this way. The strategy was later adapted in the region and outside England. As a result, we were able to reduce pressures on Major Trauma Centres and continue to operate on complex upper and lower limb trauma in-house.
As the number of COVID-19 cases decreased, my colleague, Irrum Afzal – Research Manager for the Academic Surgical Unit at SWLEOC, and I went on to implement a strategy to plan the resumption of elective services safely. This was presented during a National Orthopaedic Alliance webinar and published by the British Orthopaedic Association.
From these innovative yet comprehensive strategies, a ‘Hospital Within a Hospital’ concept was developed and supported by our Clinical Director, Stella Vig. The aim of this new concept was to provide separation between the ‘Green Site’ and ‘COVID-19 protected’ areas for patients and healthcare professionals. The ‘Green Site’ was established through reconfiguration of existing resources and concise pathways allowing for dedicated operating theatres, ring fenced elective beds on a surgical enhanced care unit, a separate staff canteen and an access-controlled entrance, entirely separate from the rest of the District General Hospital.
In the pre COVID-19 era, an average of 153 elective procedures were performed monthly representing the established baseline. Within the first month of resuming elective orthopaedic activity in the new ‘Hospital within a Hospital’ site, 54% of elective activity was achieved, followed by 117% in the second month. Despite continued winter bed pressures, a significant resurgence in COVID-19 cases and new SARS-CoV-2 variant, 110% elective activity was achieved in December 2020. In the six months of the establishment of this way of working, 113% of elective activity has been achieved on average per month.
As the country entered the second wave, hospitals were again under immense pressure. However, we have been able to keep up with trauma and most of our priority 2 (P2) cases. Our hospital, Croydon University Hospital, is now being asked by a reputable centre across South West London to support them with their existing (P2) backlog.
From the strategies, we have adapted during the COVID-19 pandemic, we have been able to promote minimal access and key-hole surgery for various upper and lower limb trauma cases. To date, we have undertaken more than 50 minimal access surgeries with good patient reported outcomes post-operatively.
Throughout the COVID-19 pandemic, teamwork has been paramount. I’d like to thank all those working for the NHS for your tremendous hard work. A special thank you to those working at CUH and South West London Elective Orthopaedic Centre (SWLEOC), my consultant colleagues, nurses, our SpRs and juniors, the management teams, admin support, porters, domestics, and security.
Our teams have worked tirelessly together and reinforced a stronger infrastructure. Our surgeons have rapidly adopted minimally invasive surgical techniques for a wide range of applications. We have now established MDT decision-making across sub-specialities, which has led to improved PROMs and shared learning. Croydon University Hospital has played a pivotal role in improving partnership working in South West London especially with the SWLEOC and regional revision network MDT. Our MSK team has developed and improved 11 MSK pathways and the departmental goal is to disseminate these throughout the South West London region. As a department, our vision to implement pathways to maximise self-care and management in the primary care to reduce pressures within secondary care, where appropriate.
Throughout the on-going difficult times, we have been and are able to support all our juniors and SpRs despite the reduced elective activity and redeployment. As we move forward, our department is now ready to engage in discussions to help the wider region and London through our innovative ‘Hospital in Hospital model’.
Mr Sarkhell Radha is Consultant Trauma and Orthopaedic Surgeon and Clinical Lead at Croydon University Hospital & The South West London Elective Orthopaedic Centre.
He has specialist interests in complex trauma, complex primary and revision hip and knee arthroplasty including Prosthetic Joint Infection and Massive Endoprosthesis, minimally invasive arthroplasty including piriformis sparing hip arthroplasty & muscle sparing Direct Anterior Approach, hip preservation surgery including hip arthroscopy, hip resurfacing surgery, navigation and robotic assisted knee replacement surgery, complex upper and lower limb trauma surgery.