How has the scope of practice of your department changed due to the COVID-19 pandemic?
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Surgical cancellation, postponement
The Northwell Health System is the largest health care system in New York with 23 hospitals and a total of 5,692 beds and 14 ASC sites carrying out more than 33,000 inpatient and ambulatory orthopedic surgical cases per year. Our healthcare footprint spans the New York City region and surrounding counties, including Long Island. This is essentially the epicenter of the pandemic. My colleagues have treated more than 6,000 admitted COVID-19 patients to date. In early March, we initiated a large-scale contraction of all of our orthopedic operations, including cancellation of 13,900 ambulatory patient visits at our 18 offices and postponement of more than 2,520 surgeries. Efforts to expand the workforce in the face of admission surges prompted our department to redeploy 14% of our orthopedic attendings and 82% of our physician assistants. Clearly, the scope of our practice has been dramatically altered.
As the health care crisis recedes, we are actively working on transitioning our practices. We have continued to maintain emergent office-based and surgical services at selected sites. Several weeks ago, we were able to implement telehealth services within days to engage our patients. We are currently analyzing all canceled surgical cases stratifying urgency and comorbidities in order to optimize the restart of our elective schedules.
Our orthopedic emergency management teams are carefully looking at opportunities to rapidly rebuild. Changing paradigms will include improved workflows, enhanced patient access and safety, optimized technologies and regionalization strategies, including greater outpatient shifts. Although the future will certainly look different, our goal will be to take an innovative approach to preemptively improve patient care.
Nicholas A. Sgaglione, MD, is professor and chair of the department of orthopedic surgery at Zucker Hofstra Northwell School of Medicine, senior vice president and executive director of Orthopedic Institute at Northwell Health Orthopaedics and an Orthopedics Today Editorial Board Member.
Disclosure: Sgaglione reports he receives royalties for device design from Zimmer Biomet, royalties for textbook authorship from Wolters Kluwer and is a consultant for Embody.
Increase in traumatic injuries
I am a private practice orthopedic surgeon specializing in hand, upper extremity and microsurgery. The COVID-19 pandemic created worldwide uncertainty. In light of this, our practice promptly suspended all elective surgeries in order to maintain hospital resources and supplies. Emergent and urgent cases were performed per usual in our area hospitals and surgery centers. Statewide shelter-in-place mandates resulted in a transient rise in traumatic home-renovation hand injuries as quarantined individuals took on various home projects. This unique pattern of injury created a steady stream of emergent and urgent referrals to my practice, which greatly supplemented lost work from suspending elective cases. Overall, my surgical case volume decreased about 33%.
At early onset, our practice smartly mandated screening measures including risk assessment, mask wear and temperature measurements at one single location for all entrants, including all staff and surgeons. We promptly implemented telemedicine options for our patients. In mid-March, despite several COVID-19 cases already present in our area, I did not experience many no-shows in clinic. However, as the pandemic soon ravaged New York City, our patients further utilized our telemedicine options and we saw more no-shows and cancellations. As a result, I reduced my clinic hours for my physician assistant and nurse practitioner about 25% from late March to mid-April. My clinic numbers dropped 33% during this time. As the curve shifted and we saw decreases in the incidence of COVID-19 in our region, our hospital systems and our privately owned surgery centers stopped suspending elective cases. Starting May 4, our practice fully opened for elective cases and returned to regular hours. Our region and our practice were extremely fortunate. We did not experience an upsurge of COVID-19 cases as in other areas and I believe our early adoption of smart, protective measures kept our practice afloat with modest financial loss.
Gregory P. Kolovich, MD, MPH, is an orthopedic surgeon with Optim Orthopedics in Savannah, Georgia.
Disclosure: Kolovich reports he is a paid consultant for Axogen and an owner of Optim Orthopedics and Oxos Medical.
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