key: cord-0933745-dr97dd7g
authors: Malhotra, Rajesh; Gautam, Deepak; George, Jaiben
title: Orthopaedic resident management during the COVID-19 pandemic – AIIMS model
date: 2020-05-13
journal: J Clin Orthop Trauma
DOI: 10.1016/j.jcot.2020.05.001
sha: ae75ece166050809c748c542b3b46cca2acedbf8
doc_id: 933745
cord_uid: dr97dd7g

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The novel coronavirus disease (COVID-19) pandemic has led to suspension of non-essential health services in most hospitals leading to an unequal distribution of workload. Many patients who availed health services through routine care are directed to emergency department. As a result, emergency department residents and staff are being overburdened while the workload on other departments like Orthopaedics has seen a sharp decline.

Therefore, it becomes important to efficiently utilize the hospital staff to provide patient care, and protect the health workers from COVID-19 and burnout. In this viewpoint, we would like to discuss our strategy in using the Orthopaedic resident workforce at All India Institute of Medical Sciences, New Delhi, during COVID-19.

In addition to the cancellation of routine surgeries like joint replacements, sports surgeries and spine surgeries, the decrease in trauma surgeries as a result of reduction in road traffic accidents has led to a significant drop in the volume of surgeries performed by our department. This substantial reduction in the surgeries, and the resulting decline in admitted patients has led to decreased resident requirement. At present, majority of our surgeries are either for oncology patients or for those who experience low energy fractures such as hip fractures. As a result, only one or two operating teams are required per day. Therefore, our residents have been divided into multiple small teams who are assigned duties on a rotational basis (Figure 1) . Each team comprises of senior and junior level residents so that 1-2 operating rooms can be run efficiently every day without overcrowding in the operating rooms. The same team is also sufficient enough to manage patients in ward and emergency department. Apart from this working team, residents in other teams are advised to stay home though they are available 24X7. Methods have been detailed to regroup the (General surgery) residents into teams to minimize patient contact and prevent transmission between the teams 4 . However, the regrouping strategies described by the aforementioned authors do not mention about decreasing the overall resident workforce, and do not involve specific teams for COVID-19 duty. We believe that having a separate team which is involved only in COVID-19 duty prevents transmission between residents, and also protects transmission to orthopaedic patients. Although a national level lockdown at a relatively early stage might have slowed the transmission in India, considering its density of population, an explosive rise in cases post lockdown cannot be ruled out and warrants escalation of preparations. Therefore, we have redistributed residents in a manner that 50% of the residents can be allocated for COVID-19 duty at any time without compromising the orthopaedic care, and safety of patients.

Residents form the major workforce in most teaching hospitals, and take care of both COVID-19 positive and normal patients. However, residency is also a training period, and hospitals have an obligation to continue their educational activities. As part of social distancing measures, lectures, journal clubs, thesis presentations, etc. were suspended.

However, we continue to have all our department educational activities through online portals as they were scheduled. Multiple online portals are available which enable live lectures and promote interactions between the participants. These are easy to use and can be implemented anywhere without much technical expertise.

At present, we do not have a universal screening of our patients, and it is possible that some of the orthopaedic patients might be asymptomatic carriers. Moreover, COVID-19 has been reported among a few healthcare workers at AIIMS. Therefore, residents are at risk of contracting COVID-19 even while performing their normal duties. To protect our residents, we have provided N-95 masks to all our residents for use at hospitals even when not seeing a confirmed COVID-19 patient. Additionally, all residents have been provided hydroxychloroquine tablets as the ICMR guidelines have advocated its use for prophylaxis among healthcare workers 5 .

In summary, we are trying our best to progress in patient care, teaching, and research even during these challenging times ( Table 1) . Although we hope the current situation to end soon, it is important for orthopaedic departments to find new ways to continue their routine activities instead of waiting for the pandemic to be over. We hope that our experience will provide valuable guidance to other orthopaedic departmentsin managing their residents, and in continuing patient care and learning.

Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19

What's Important: Redeployment of the

Emergency Restructuring of a General Surgery Residency Program during the Coronavirus Disease 2019 Pandemic: The University of Washington Experience

Advisory on the use of Hydroxychloroquine prophylaxis for SARSCov2