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Single vs Dual-site service reconfiguration during Covid-19 pandemic - A tertiary care centre experience in hip fractures and a Scoping review

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journal contribution
posted on 2022-08-30, 09:40 authored by M Muhammad, S Ayton, S Hejmadi, JS Minhas, N Morgan, AC Peek
Aims and objectives: The Covid-19 pandemic has had an unprecedented effect on surgical practice and healthcare delivery globally. We compared the impact of the care pathways which segregate Covid-19 Positive and Negative patients into two geographically separate sites, on hip fracture patients in our high-volume trauma center in 3 distinct eras - the pre-pandemic period, against the first Covid-19 wave with dual-site service design, as well as the subsequent surge with single-site service delivery. In addition, we sought to invoke similar experiences of centres worldwide through a scoping literature review on the current evidence on “Dual site” reconfigurations in response to Covid-19 pandemic. Methods: We prospectively reviewed our hip fracture patients throughout the two peaks of the pandemic, with different service designs for each, and compared the outcomes with a historic service provision. Further, a comprehensive literature search was conducted using several databases for articles discussing Dual-site service redesign. Results: In our in-house study, there was no statistically significant difference in mortality of hip fracture patients between the 3 periods, as well as their discharge destinations. With dual-site reconfiguration, patients took longer to reach theatre. However, there was much more nosocomial transmission with single-site service, and patients stayed in the hospital longer. 24 articles pertaining to the topic were selected for the scoping review. Most studies favour dual-site service reorganization, and reported beneficial outcomes from the detached care pathways. Conclusion: It is safe to continue urgent as well as non-emergency surgery during the Covid-19 pandemic in a separate, geographically isolated site.

History

Author affiliation

College of Life Sciences, University of Leicester

Version

  • AM (Accepted Manuscript)

Published in

Journal of Clinical Orthopaedics and Trauma

Volume

29

Pagination

101890

Publisher

Elsevier BV

issn

0976-5662

eissn

2213-3445

Acceptance date

2022-04-26

Copyright date

2022

Available date

2023-05-06

Language

eng

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