Critical adjustments in a department of orthopaedics through the COVID-19 pandemic
Critical adjustments in a department of orthopaedics through the COVID-19 pandemic
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DOI：
10.1007/s00264-020-04647-1
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发表时间：
2020-05-30
影响因子：
2.7
通讯作者：
Calvo, Emilio
中科院分区：
文献类型：
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作者：
Luengo-Alonso, Gonzalo;Garcia-Seisdedos Perez-Tabernero, Fernando;Calvo, Emilio
目的 SARS-CoV-2 的新情况迫使卫生系统在极端压力下工作，敦促对我们的手段和活动的组织方式进行彻底重组。骨科和创伤科室已重新安排活动以帮助 SARS-CoV-2 科室，但创伤患者也需要治疗，且尚未制定标准化方案。 方法 在三级医院进行单中心横断面研究。分析了两个不同的时间段：2019 年 3 月的两周时间段（SARS-CoV-2 之前）和 2020 年 3 月的同一时间段（SARS-CoV-2 大流行时间）。对门诊患者的数据、急诊活动、手术程序和入院情况进行了评估。还通过调查评估了外科医生和患者的意见。结果 总共对 16,000 名 (15,953) 名患者进行了评估。预定的临床预约减少了约 22%。紧急咨询和出院率也有所下降（分别约为 37% 和 20%）。 90% 的门诊临床评估使用了远程医疗。 SARS-CoV-2 期间没有安排择期手术，扣除择期手术的影响后，住院手术量有所减少，从 85% 左右减少到 59% 左右。 13 例（35%）患者延迟创伤救助超过 48 小时。髋部骨折的术前入院时间平均在十小时内减少。最后，调查表明，患者比外科医生更赞成这种基于远程医疗的评估骨科和创伤患者的新方法。 结论 在大流行期间，应该对外科部门制定详细的方案进行标准化。本文提供了该病毒如何影响骨科单位的总体观点，并可以作为骨科和创伤科单位的协议和示例。即使在最糟糕的情况下，骨科和创伤科也可以提供有效、高效和优质的服务。 SARS-CoV-2 将为骨科和创伤领域的医疗保健树立新的典范。
Purpose SARS-CoV-2's new scenario has forced health systems to work under extreme stress urging to perform a complete reorganization of the way our means and activities were organized. The orthopaedic and trauma units have rescheduled their activities to help SARS-CoV-2 units, but trauma patients require also treatment, and no standardized protocols have been established.Methods A single-centre cross-sectional study was performed in a tertiary hospital. Two different periods of time were analyzed: a two week period of time in March 2019 (pre-SARS-CoV-2) and the same period in March 2020 (SARS-CoV-2 pandemic time). Outpatient's data, emergency activity, surgical procedures, and admissions were evaluated. Surgeons' and patient's opinion was also evaluated using a survey.Results A total of similar to 16k (15,953) patients were evaluated. Scheduled clinical appointments decreased by similar to 22%. Urgent consultations and discharge from clinics also descended (similar to 37% and similar to 20% respectively). Telemedicine was used in 90% of outpatient clinical evaluations. No elective surgical procedures during SARS-CoV-2 time were scheduled, and subtracting the effect of elective surgeries, there was a reduction of inpatient surgeries, from similar to 85% to similar to 59%. Patients delayed trauma assistance more than 48 hours in 13 cases (35%). Pre-operative admission for hip fractures decreased in ten hours on average. Finally, surveys stated that patients were more in favour than surgeons were to this new way to evaluate orthopaedic and trauma patients based strongly on telemedicine.Conclusion Detailed protocols should be standardized for surgical departments during the pandemic. This paper offers a general view in how this virus affects an orthopaedic unit and could serve as a protocol and example for orthopaedic and trauma units. Even in the worst scenario, an orthopaedic and trauma unit could offer an effective, efficient, and quality service. SARS-CoV-2 will set up a new paradigm for health care in orthopaedics and trauma.