President of the British Orthopaedic Association discusses patient handling during the COVID-19 pandemic
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Managing the treatment and follow-up of ambulatory orthopedic and trauma patients during the COVID-19 pandemic requires thorough short-, medium- and long-term planning, according to Donald J. McBride, FRCS, president of the British Orthopaedic Association.
McBride, who also is a foot and ankle surgeon in the department of trauma and orthopedic surgery at the University Hospital of North Staffordshire, England, presented his advice for orthopedic and trauma patient handling amid the COVID-19 pandemic at the EFORT Special Edition Webinar.
Limiting face-to-face interaction with patients by using virtual consultations is the first short-term precautionary step, he said.
“We should try and avoid [face-to-face consultation] if at all possible. I see there have been some questions on the internet about whether or not patients have been tested. I think it is like a lot of infections in the past – just presume that the patient is positive,” McBride said in the webinar. “Of course, the other thing is, the patients should also presume the surgeon may be positive as well.”
Physicians should take advantage of virtual consultation when possible, he said. It is not too different from telephone consultations that physicians have been doing for years, but it is important to keep clinical guidelines in mind.
“So, when you are actually doing a virtual consultation, you need to do this either from your workplace or at home – you can do either – but please always have two monitors,” McBride said. He recommended that physicians have a headset as well.
“I think if you are going to use any of these, you really need to check with your own hospital regarding clinical governance, [general data protection regulation] and legal issues. The lawyers will say that we're going to get away with things, but I'm sure we won't get away with anything,” he said.
“I think that you will probably find that you will have a tendency to discharge more patients than you normally would,” McBride said. “If you are discharging patients and you have a little bit of a concern in any way, have a plan B. Think about how they can get back into the system to you.”
“At the private facilities, really, we should treat the patients exactly the same. There should be no difference in what we do in our NHS and private practice,” he said.
In the medium term, McBride recommended that physicians be aware of the effects of delaying treatments.
“For example in joint replacement, if you are elderly [and] having a hip replacement or knee replacement and it is delayed, that can have quite significant effects – an increased use of opiates and other issues with pain,” he said.
Finally, in the long term, orthopedic specialists should prepare for some changes in practice, McBride said.
“They may reduce outpatient appointments. They may expand virtual consultation which, of course, may not be a bad thing,” he said.
Keeping track of an ever-increasing waitlist should also be a priority, McBride said.
“So my conclusions are, really, in order to keep your patients safe, you need to keep yourself and your family safe and healthy. Looking across Europe, is it really 70 [years old] that is dangerous for doctors? I have to say, looking at some of the mortality, it seems to me that it is doctors over 50 [years old] who are at risk,” McBride said.
“So, in the short term, do what you can. In medium term, plan ahead,” McBride said. “Long term, be prepared for the tsunami of patients.” – by Max R. Wursta
References:
McBride D. How ambulatory O&T patients can be followed. Presented at: EFORT Webinar Special Edition: Orthopaedic & trauma surgeons in the time of COVID-19; April 6, 2020.
https://efortnet.conference2web.com/
Disclosure: McBride reports no relevant financial disclosures.
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McBride D. How ambulatory O&T patients can be followed. Presented at: EFORT Webinar Special Edition: Orthopaedic & trauma surgeons in the time of COVID-19; April 6, 2020.
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