Table 4 Key elements summary for improving fractured neck of femur patient outcomes during a pandemic
Patient Pathway | |
• Patients with femoral neck fractures are a highly vulnerable cohort and should be treated as such | |
• In agreement with the worldwide initiative “best practice for surgeons, COVID-19 evidence based review”, all patients should have their temperature checked and a surgical mask provided on admission [35]. | |
• Patients admitted from the Emergency Department (ED) who are awaiting a test result should be isolated in a separate bay until the SARS-CoV-2 status is concluded and unnecessary patient transfers should be prevented. | |
• High index of suspicion is warranted for patients with atypical symptoms due to the high aerosol risk and poor patient outcomes as detailed above [36]. | |
• SARS-CoV-2 status should be checked on a regular basis for long staying inpatients | |
Theatre Pathway | |
• Adaptation of the WHO checklist is recommended, to include the addition of “COVID status” and “PPE check” | |
• Theatres should have negative pressure room ventilation, and aerosol generating tools e.g. oscillating saws should be used only in necessity [37, 38] | |
• One dedicated emergency theatre during peak pandemic time to be expanded to a COVID and Clean theatre where possible | |
• Surgeons should use familiar metalwork and trauma hardware. A COVID-19 pandemic is not the ideal period to trial new surgical components or techniques and presence of additional personnel in theatre e.g. representatives of manufacturers should be avoided. | |
Staffing | |
• Consultant services where possible to reduce patient waiting time or delays to decision making | |
• Minimal personnel in theatre where possible | |
• MDT members including physiotherapy, occupational therapy and orthogeriatric and fracture liaison services must prioritise patients with a fractured neck of femur | |
• Restructuring the teams into: “Operating Team”, “On-call team” and “Clinic team” and a “Reserve Team”. |