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Ian Crowther is a ST5 Orthopaedic trainee in the Northern Deanery. He completed his undergraduate studies at Newcastle University and has completed both his foundation and early surgical years in the North East of England.
Nick Kalson is an NIHR Clinical Lecturer in Orthopaedics and ST7 trainee, Newcastle.
Simon Chambers is a Consultant Orthopaedic surgeon and is the Clinical Lead for Trauma at the Newcastle MTC. His subspecialty interests are in limb reconstruction and foot and ankle.
Post-COVID-19 trauma care: The end of the new patient trauma clinic? Ian Crowther, Nick Kalson and Simon Chambers
(On behalf of the Orthopaedic and Emergency Departments, Great North Trauma Centre, Royal Victoria Infirmary, Newcastle upon Tyne)
The COVID-19 pandemic that struck in March 2020 has forced hospitals to adopt new ways of working. To protect the public and reduce pressure on a stretched workforce systems were implemented to reduce hospital attendance.
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overnment and BOA guidance recommended1,2 that patients with traumatic injuries receive consultant delivered care with an emphasis on providing a definitive management plan at first presentation to the emergency department minor injury unit (ED-MIU). In our unit, a major trauma centre in England, we removed the new patient trauma clinic and instead provided the ED-MIU with 12-hour consultant cover. This successfully reduced the patient re-attendance rate by over 50%. One year later and with a successful vaccination programme, decreasing COVID-19 incidence and a return to more familiar working patterns, rather than return to the tried and tested pre-COVID system we have developed a sustainable model to deliver definitive management on day of presentation without the need for a next-day newpatient trauma clinic.
Traditional nextday trauma clinic pathway The pre-COVID-19 trauma pathway at our unit was similar to many other hospitals nationwide. A normal
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day would see 120-150 patients attend the ED-MIU; of these a significant proportion would have a musculoskeletal problem. Initial consultation was by the ED doctors/MIU nurse practitioners, who either discharged the patient or referred to the orthopaedic team. Typically, this would be via a next-day face-to-face acute trauma clinic. On average our consultant led clinic was seeing ~20 new patients per day (~7,000 appointments annually).
“With a successful vaccination programme, decreasing COVID-19 incidence and a return to more familiar working patterns, rather than return to the tried and tested pre-COVID system we have developed a sustainable model to deliver definitive management on day of presentation without the need for a next-day newpatient trauma clinic.”
COVID-19 pathway During the early stages of the pandemic ED-MIU attendance dropped ~50% to an average of 64 presentations per day. A move to a virtual fracture clinic was considered but not implemented in particular because of the potential need for reattendance, which would fail to reduce hospital visits. To optimise patient flow and minimise further attendance our unit redeployed a consultant to the ED-MIU from 08:00 to 20:00. This resulted in patients receiving specialist review at first presentation, often without the need for re-attendance. An emphasis on definitive care and the increased use of removable casts,
