Managing hand and reconstructive microsurgery service during COVID-19 pandemic: Singapore experience

Postgrad Med J. 2020 Jul;96(1137):379-383. doi: 10.1136/postgradmedj-2020-137735. Epub 2020 Jun 10.

Abstract

Introduction: Managing healthcare service during pandemics and outbreaks is a challenging process. The aim is to keep patient safety as the priority, besides, continuing to provide essential healthcare services.

Methods: Situational audit was performed for the services rendered before and during COVID-19 pandemic and the elevation of the disease alert status, and a retrospective analysis of the attendance and procedures performed in the service.

Results: We present a methodology for performing a situational audit and generating service modification for hand and reconstructive microsurgery unit in a pandemic. There was no significant difference between the number of patients seen at outpatient clinics. However, there was a reduction in the numbers of total surgeries performed, with a 40% drop in the number of elective surgeries performed. There was also a reduction of cases seen in the emergency department hand clinic.

Discussion: COVID-19 pandemic is currently affecting not only the health service but also, other vital services all over the world. The pandemic puts significant challenges to acute surgical services in a hospital system involved in the management of the pandemic. Surgeons need to take proactive and a systematic approach in managing the available resources while maintaining essential surgical services. This paper provides the tools and methodology for doctors to plan their services in a pandemic situation.

Conclusions: It is possible to maintain essential surgical services in a pandemic situation through rapid situational audits and generating localised strategies while considering the constraints imposed during the pandemics while maintaining patient and staff safety.

Keywords: hand & wrist; infection control; infectious diseases; limb reconstruction; plastic & reconstructive surgery; respiratory infections.

MeSH terms

  • Betacoronavirus / pathogenicity*
  • COVID-19
  • Clinical Audit
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / prevention & control*
  • Elective Surgical Procedures / methods*
  • Hand Injuries / surgery*
  • Humans
  • Infection Control / organization & administration*
  • Microsurgery
  • Pandemics / prevention & control*
  • Patient Safety
  • Plastic Surgery Procedures / methods*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / prevention & control*
  • Practice Guidelines as Topic
  • Retrospective Studies
  • SARS-CoV-2
  • Singapore / epidemiology