We considered it important to have representation from both the surgical team performing the operation and the medical team who support the care of patients on the ward. We then planned further cycles of data collection and interventions.Ī QI team consisting of a consultant orthopaedic surgeon and orthogeriatrician, a cohort of junior doctors, IT support staff and additional team members was formed. We published these preliminary results at our local audit meeting highlighting our poor adherence to best practice guidelines regarding COVID-19 and consent. Only 1 of the 37 consent forms mentioned COVID-19 (2.7%) and none mentioned the risk of possible ITU admission (0.0%). Thirty-seven consent forms met our inclusion criteria. In 30 cases, the patient had capacity to make informed decisions about their care, in 7 cases a parent consented on behalf of their child, and in 9 cases the patient lacked capacity. These patients were excluded from our analysis as the consent process is documented in a different format.įorty-six consent forms were analysed. For patients who lacked capacity, consent was completed in the patient’s best interests, after discussion with the next of kin and among the multi-disciplinary team about the best way to proceed. Documenting non-specific ‘infection’ was not accepted. Written consent forms were analysed to determine whether they explicitly mentioned the risk of COVID-19 and sequalae such as ITU admission. 11 It is vital that the risks of surgery and COVID-19 infection are carefully explained and documented during the consent process.Īll orthopaedic trauma procedures over a 4-week period in March 2020 were reviewed, corresponding to the start of the first ‘lockdown’.
10 In a further UK study focused on urgent elective surgery, 1.4% of patients acquired COVID-19 within 30 days of the procedure. 9 A cohort study of 584 patients undergoing emergency surgery in the UK reported an infection rate of 5.1% while in hospital. An early meta-analysis reported that 44% of cases could be attributed to nosocomial infections. The risk of acquiring COVID-19 during a patient’s admission must be considered. 7 International multi-centre collaborative work investigating emergency adult surgical patients reported a risk of in-hospital mortality of 3.6% in those with a negative COVID-19 test compared with 15.5% in patients tested positive for COVID-19.
6 This is supported by the results of a further study of 259 patients with COVID-19, who underwent surgery for hip fractures, which reported higher ITU admissions and longer inpatient stays. 5 An Italian study investigating the surgical management of proximal femoral fractures demonstrated that COVID-19 led to a more complex postoperative course, resulting in a significant increase in deaths in the first 3 postoperative weeks. In trauma patients from a large multi-centre study from the US, COVID-19 was associated with increased complications, length of stay and mortality. The risk of surgery differs according to the COVID-19 status of the patient.
3 Furthermore, alternatives to surgery and the associated risks must be discussed. Best practice for consent requires all risks, independent of severity, should be explained to the patient and all elements should be clearly documented. Informed consent in a patient with the capacity to make decisions about their care is imperative prior to any surgical procedure. We aimed to ensure more than 95% of consent forms documented these additional risks. The aim of this multi-cycle quality improvement project is to assess if patients undergoing surgery for trauma are fully informed of the potential risks of developing COVID-19 and the need for intensive care unit (ITU) support.
#PETER FURGESON BEHOLDER 2 PARTY RECORDING UPDATE#
2 It has been important to update the patient consent process to incorporate the additional risks of surgery. There is a risk of patients contracting SARS-CoV-2 leading to COVID-19 disease while in hospital, and multinational collaborative work demonstrated an increased risk of mortality in patients with confirmed SARS-CoV-2 infection undergoing elective and emergency surgery. Our regional trauma centre continued to provide surgical care for emergency orthopaedic admissions with daily dedicated operating lists. The COVID-19 pandemic resulted in the postponement of elective operating services, diversion of trauma patients to specific hospitals and the redeployment of surgical staff.
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