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

• Published in: Postgraduate medical journal Vol. 96; no. 1137; pp. 379 - 383
• Main Authors: Omar, Usama Farghaly, Pei Yein, Tong, Rajaratnam, Vaikunthan
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group 01.07.2020
• Subjects: Betacoronavirus - pathogenicity; Clinical Audit; Coronavirus Infections - epidemiology; Coronavirus Infections - prevention & control; COVID-19; Elective Surgical Procedures - methods; Hand Injuries - surgery; Humans; Infection Control - organization & administration; Microsurgery; Pandemics - prevention & control; Patient Safety; Pneumonia, Viral - epidemiology; Pneumonia, Viral - prevention & control; Practice Guidelines as Topic; Quality Improvement Report; Reconstructive Surgical Procedures - methods; Retrospective Studies; SARS-CoV-2; Singapore - epidemiology; Singapore; hand & wrist; plastic & reconstructive surgery; infection control; limb reconstruction; respiratory infections; infectious diseases
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/postgradmedj-2020-137735

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. 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. 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. 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. 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.