The new coronavirus is rightly, and almost entirely, devouring news cycles. But even as COVID-19 swamps our attention and stretches the capacity of our health care institutions, those who might in “normal” times end up at UCHealth hospitals for other reasons are still coming. The SARS-CoV-2 virus hasn’t erased heart attacks, organ failures, cancers, injuries, or other illnesses and chronic conditions that need medical attention. The virus is, rather, an addition to and complicator of the many health problems people have anyway.
A hypothetical example: a 75-year-old woman with a heart condition falls and breaks her hip. She needs emergency orthopedic surgery. An ambulance arrives, destination UCHealth University of Colorado Hospital on the Anschutz Medical Campus. The hospital, like every other hospital in the United States, is increasingly occupied by COVID-19 patients. The patient is in a demographic known to face very high risk should she become infected. The hospital can handle it. But how does the hospital handle it?
Dr. Jason Stoneback, a UCHealth and University of Colorado School of Medicine orthopedic trauma surgeon, took the lead in figuring that out for Orthopedic Trauma. He considered three primary factors. First, people would still be getting hurt – and not only locally. UCH would continue to receive badly injured patients and those with infected, non-healing injuries from hospitals across the region. That’s just how it is at a level-one trauma center with an American Burn Association-verified burn center. UCH can treat patients many other hospitals just can’t.
Second, his team would have to provide care to patients while at the same time doing all they could to protect patients from COVID-19.
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Third, Stoneback and colleagues would have to protect themselves from COVID-19. That would mean being careful about the amount of time orthopedic trauma doctors and nurses spent in inpatient units as well as taking measures to ensure that, should a patient arrive with not only a broken hip but also COVID-19, the UCHealth team could treat the hip without exposure to the disease.
Not business as usual for orthopedic trauma during the coronavirus pandemic
Recognizing the need to open up beds for a possible wave of COVID-19 patients, University of Colorado School of Medicine Department of Orthopedics Chair Dr. Evalina Burger announced on March 15 that surgeries – knee and hip replacements being prime examples – would be delayed across UCHealth. (Four days later, Colorado Gov. Jared Polis halted all elective procedures statewide.) Orthopedics’ move would free up beds and minimize the exposure of orthopedics patients to the coronavirus.
“We were ahead of the curve on that, but we felt that we had to lead,” Stoneback said.
While some UCHealth Orthopedic Traumatology surgeries – certain limb-restoration procedures, for example – may reside at the fringes of “elective,” the majority of the service’s work is urgent, and it continues. To do so safely, Stoneback and colleagues instituted several changes to how they approach their work.
The team’s daily morning meeting – typically a standing-room-only affair involving about 25 doctors, physician assistants and nurse practitioners, nurses, medical students, and others discussing past and upcoming cases – was cancelled until further notice. To the extent possible, social distancing must apply within a hospital’s walls, too.
Across Orthopedics, “patients who absolutely didn’t need to be seen,” as Stoneback put it, were tentatively scheduled for a month later, and the appointments of patients who could be managed remotely were changed from in-clinic visits to telehealth consultations.
Stoneback and colleagues then divided the Orthopedic Trauma team into three separate teams, each led by a UCH orthopedic trauma surgeon: Stoneback, Dr. Melissa Gorman, and Dr. Nicholas Alfonso.
The teams are lean: a surgeon, an advanced-practice provider, and minimal support staff. Each team spends one week onsite at UCH and then works from home the next two weeks, a period that doubles as self-quarantining in case of COVID-19 exposure.
Similarly, one or two providers do inpatient rounds. They do so without the medical students who are normally in tow. At night, an MD orthopedic surgery resident checks in on patients, sees new patients in the hospital and emergency department with the fellowship-trained surgeons on call.
Some operations also continue. In addition to standard procedures to minimize infection risk, every provider in the operating room wears an N95 mask. The anesthesiologist wears a special respirator and protective clothing while intubating the patient, and all others leave the OR temporarily to minimize possible exposure during that process, which can aerosolize virus should the patient be infected.
Taken together, Stoneback says he feels that Orthopedic Trauma patients can feel safe at UCH – and so can those taking care of them.
“It’s about keeping vital services open and how we’re managing it without losing a step,” he says.
Orthopedic Trauma’s readiness applies more broadly, says Robbie Dumond, UCH’s senior director of Trauma Services.
“What we really want to emphasize to people right now is that all of our emergency services at University of Colorado Hospital are there for patients,” Dumond said. “Just because we’re taking care of COVID-19 patients doesn’t mean we’re any less prepared to take care of a person with trauma, stroke, cardiac event or other emergency.”