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BOA issues new guidance on restarting non-urgent trauma and orthopaedic care


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13 May 2020

This Summary document provides core principles about resuming aspects of Trauma and Orthopaedic care that have been suspended because of COVID-19. It comprises three sections: capacity issues for resuming surgery; infection prevention and control measures for planned surgery and prioritising patients for surgery. For more detail on each of the points, please refer to our full guidance document. This document will be updated as needed over the coming weeks and months.

Capacity issues for resuming surgery

When considering resuming surgery and what capacity there will be, factors include:

• Likely theatre throughput (considering that theatres often will work at a slower pace, each requiring more staff and the increased use of consumables).

• Materials needed for surgery, including PPE and anaesthetic drugs.

• Availability of staff and facilities for all stages of the treatment pathway, including post-operative care, postdischarge care and rehabilitation.

Infection prevention and control measures for planned surgery & ‘Green pathways’

Changes to previous care pathways should include the creation of ‘green’, COVID-free pathways in order for planned surgery to be safe. Evidence so far is limited but if a patient undergoes a procedure and experiences COVID-19 infection soon after operation, this increases their likelihood of needing ICU care and of dying, hence the need for measures to reduce infections prior to and after surgery.

In these green areas, measures to ensure COVID-free facilities could include:

Patients

• Self-isolation or shielding for 14 days prior to surgery (and 14 days after discharge in order to avoid infection in the post-operative period).


• Attend pre-admission clinic prior to the 14 day period wherever possible.

• Testing (RT-PCR) for COVID-19 72-48 hours prior to surgery

• Screening for symptoms, temperature testing, and whether household members have had recent symptoms.

• Social distancing measures to reduce contact at reception, waiting rooms and other communal facilities.

• No visitors during inpatient stays.

• For child patients, special consideration of appropriate measures needed.

Staff

• Daily screening for symptoms and temperature testing, and whether household members have symptoms.

• Regularly (weekly?) RT-PCR testing for COVID-19 (as testing capacity expands).

• Follow social distancing principles.

• Changes to work patterns/rotas to avoid interaction with COVIDunknown pathways

Facilities

• Different levels of COVID-19-free settings likely to exist, and gold/silver/bronze criteria are discussed in full guidance document.

• Regional and local decision making will be needed as to how best to use the buildings/facilities available to establish COVID-free pathways in a given locality.



The Summary Guidance document can be found here, and the full guidance here


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