Authors (including presenting author) :
Chang WYE, Chung WTE, Lee QJ, Wong YC
Affiliation :
Total Joint Replacement Centre, Department of Orthopaedics & Traumatology, Yan Chai Hospital
Introduction :
The coronavirus (COVID-19) pandemic caused more than one million deaths in the world in 2020. In the early pandemics, elective surgeries such as total joint replacement (TJR) surgeries were suspended to preserve essential resources and maintain the workforce for staff deployment. There were about 140 TJR sessions canceled from February to April 2020 in Yan Chai Hospital. The cancellation caused the unprecedented accumulation of patients on the TJR waiting list. The deferment of TJR surgeries also has a detrimental health impact on the patient, such as worsening their physical function and comfort. To address the growing patient backlog, TJR surgery has been restarted since May 2020. Several strategies were made to streamline patient care: 1. Modifying the surgical list management 2. Special Honorarium Scheme (SHS) Project with throughput 3. Communicating with the patients by designated nurse/ clerk 4. Maintaining a connection with patients through teleservices
Objectives :
To evaluate the effectiveness of the strategies used to confront the impact during COVID-19.
Methodology :
All patients who had TJR surgery rescheduled from May to December 2020 were included. Data reviewed included hospital and ICU length of stays (ALOS), readmission rate.
Result & Outcome :
In the 2020 backlog list, there were 480 cases scheduled for TJR surgery. Only 334 cases (SHS:19 cases), including 246 unilateral TKR, 43 bilateral TKR, and 45 THR, were performed from May to December 2020. Compared with the same period in 2019, the average hospital length of stays decreased from 5.6 days to 4.4 days and ICU bed care was reduced from 26 to 4 patients. The ICU ALOS was one day. The unplanned readmission rate decreased from 2.1% to 1.2%. With the proper case selection of patient with less medical comorbidities and OSA, the postoperative ICU stay is decreased with a shortened hospital stay and lower URR which may also reflect patients’ worry of hospital acquired infections. The frequent change in operation list management caused by change in operation sessions at different times, and its distribution between TJR and non-TJR cases required a TJR advance practiced nurse to coordinate and communicate with patients through telephones for convenience and to minimize hospital visits. In the future, further development in telecommunication would be the trend. Development of isolated TJR center segregated from acute general hospital can better protect patients especially under pandemic like COVID19.
