By: Sarkhell Radha and Irrum Afzal
The COVID-19 pandemic, a crisis that changed our lives almost overnight and forced the world to change the way they work at the speed of light has been a challenge as well as an opportunity for healthcare.
Despite initial fears that pressure would be too great, the healthcare profession worked incredibly hard around the clock to provide on-going exceptional care by adapting to change and being resilient. Every country used different strategies to deal with the pandemic. However, the use of technology (WhatsApp, Zoom and MS Teams) became the norm across various professions.
During the pandemic, many Trauma and Orthopaedic cases that were historically managed at Major Trauma Centres (MTC) were encouraged to have their management at District General Hospitals (DGH) subject to ensuring patient care was not compromised. It was on 30th March 2020, a WhatsApp group named “Major Trauma advice MTC” was created. The aim of this group was to improve communication between hospitals within the South West London region and to provide rapid advice on managing patients who would usually present at an MTC. The group also created an MS Teams meeting where consultants were invited to discuss their cases to receive support and guidance on case management. A whole array of cases such as open fractures and complex upper and lower limb cases were routinely discussed.
The Trauma and Orthopaedic Department at Croydon University Hospital (CUH) adopted the first local strategy in the UK to deal with various trauma cases. This surgery was then adopted by other hospitals nationally and internationally. The primary aim of the strategy was to provide support to surgeons working locally to provide effective and efficient care by adopting different innovative approaches such as the promotion of minimally invasive surgery, where appropriate. In addition, the strategy also highlighted opportunities for a skill mix of surgeons to undertake complex trauma aiming at reducing workload sent to MTC.
At CUH, it was not unusual to witness a dual consultant approach throughout the pandemic to deal with upper and lower limb cases including complex ankle and periprosthetic fractures. CUH T&O also established a complex trauma MDT which was an excellent platform to discuss all complex trauma and provide shared decision making and promote shared learning and expertise between consultant colleagues.
All of these strategies have resulted in a strong workforce with a range of skill-mixes and competencies providing effective and cohesive care through the pandemic. Although these strategies were regulated locally and often were applied to respond to change, attention needs to be given to promote collaborative trauma care and encourage DGH and local hospitals to provide level of trauma to offload MTC.
All Consultant Trauma and Orthopaedic Surgeons have completed subspecialty training to achieve CCT or CESAR. The pandemic presented us with the opportunity to consolidate these skills in complex trauma often with specialist advice. Our experience shows that the actual surgical procedures can be undertaken in a satisfactory manner with guidance and support often from in-house subspecialist surgeons. The availability of expertise from MTC provided us with another level of support, which has to be appreciated and certainly helped us to work collaboratively to cope with the challenges the pandemic presented.
The question is: “Do we build on the skills and expertise acquired or consolidated during pandemic or are we going back to specialisation in trauma again making the orthopaedic community vulnerable for potential future crisis?”
The skills obtained should be recognised and promoted not only regionally but also nationally, taking advantage of organisations such as the National Orthopaedic Alliance (NOA), the British Orthopaedic Association (BOA) and specialist trauma and orthopaedic societies, to establish a pool of expertise in times of urgent need. Supporting and expanding traditional centralised trauma networks beyond specialist centres is imperative to motivate and empower surgeons in preparation for any more unbeknown crisis to come.