key: cord-0898543-1wgiz1ah
authors: Khor, W.S.; Lazenby, D.J.; Campbell, T.; Bedford, J.D.; Winterton, R.I.S.; Wong, J.K.; Reid, A.J.
title: Reorganisation to a local anaesthetic trauma service improves time to treatment during the COVID-19 pandemic – experience from a UK tertiary Plastic Surgery centre
date: 2020-10-24
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2020.10.011
sha: 659f469f3a89c8c42e18be40de86a61988424f40
doc_id: 898543
cord_uid: 1wgiz1ah

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Wythenshawe Hospital, part of Manchester University NHS Foundation Trust, provides tertiaryreferral plastic surgery services to Greater Manchester's 2.8 million population. Our trauma service consists predominantly of hand trauma and complex wound reconstruction undertaking around 2900 emergency procedures annually, with an average 66 hours theatre capacity every week.

Despite this, theatre capacity is frequently insufficient resulting in patients with ambulatory upper limb trauma suffering waiting times longer than advised by national and regional guidelines 1 . It is in this context that we sought to change the delivery of our trauma service, a transformation accelerated by the widespread changes in surgical services as a result of the COVID-19 pandemic of 2020.

In the UK, lockdown measures were imposed on 23 March 2020 2 . Our trauma service was rapidly reorganised with a view to long-term change in order to address the risk of poorer outcome of COVID-19 for patients undergoing general anaesthetic procedures 3 , and due to reduction in availability of redeployed anaesthetists and theatre staff. We established a consultant-led one-stop wide-awake local anaesthetic with no tourniquet (WALANT) service at a peripheral community hospital. Emergency cases requiring anaesthetic support continued to be treated at the regional centre with prioritisation in competition with other surgical specialties.

We sought to compare the demand on the service and compliance with guidelines on time to treatment during the COVID-19 pandemic with the same 10-week period in 2019.

Approval to collect data was granted from the hospital audit department. Data was collected retrospectively for the period of 1 April to 14 June 2019 from electronic patient records for all trauma patients undergoing surgery. Time from injury to treatment was calculated and benchmarked against the regional guidelines based on national guidelines for specific injuries 1 .

These were flexor tendon injuries (4 days), extensor tendon injuries (7 days), nerve injuries (4 days), Critically, this has persisted despite returning to 2019 levels of demand in trauma. We attribute this effect to efficiencies afforded by WALANT 5 and more complex cases have been performed under LA when previously GA had been used; revascularisations (n=4), replantation (n=1), arterial repairs (n=5) and hand fractures (n=32).

Towards the end of lockdown, there was a gradual rise of trauma to normal levels. Week 7 (11 May 2020) coincided with easing of measures to allow people back into work if they could not work from home and 'unlimited' exercise In Week 10 (1 June 2020), the schools started to reopen and the public were allowed to meet different households. The rise in trauma demands correlated with the relaxation of lockdown measures and public activity (r=0.90, Figure 1) . The efficiencies of a one-stop assessment and treatment clinic continue to see cases being treated within a desirable time window despite a return to normalcy. We foresee that our service will continue and encourage other units 

BSSH standards of care in hand trauma | The British Society for Surgery of the Hand

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia