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The impact of the COVID-19 lockdown on orthopaedic emergency presentations in a remote and rural population
Ahmed S Elhalawany1, James Beastall1, Gerard Cousins1
1Trauma and Orthopaedics, Raigmore Hospital, NHS Highlands, Scotland, UK.
Insights
The UK COVID-19 lockdown significantly reduced orthopaedic emergency department visits. Fractures in elderly patients and minor surgeries became the focus, suggesting a need for minor operating theatres near emergency departments.
Area of Science:
- Orthopaedic Surgery
- Emergency Medicine
- Public Health
Background:
- COVID-19 pandemic necessitated public health measures like lockdowns.
- Managing healthcare services, including orthopaedic emergencies, posed challenges during the pandemic.
- Remote geographical areas faced unique challenges in healthcare provision during lockdown.
Purpose of the Study:
- To analyze the impact of the UK lockdown on orthopaedic emergency department presentations.
- To compare the rate, distribution, and type of orthopaedic emergencies before and during the lockdown.
- To inform strategies for maintaining patient and staff safety in orthopaedic services during crises.
Main Methods:
- Retrospective study comparing orthopaedic emergency data from March 23 to May 5, 2020 (lockdown) with the same period in 2019.
- Data collected from Raigmore Hospital's Emergency Department (ED) Information System (EDIS), ward, and theatre records.
- Included local and tertiary referrals from the UK Highlands.
Main Results:
- Total ED attendances decreased by 58.6% during lockdown (1,978 in 2020 vs. 4,777 in 2019).
- Orthopaedic presentations reduced by 57.4% (736 in 2020 vs. 1,729 in 2019).
- A proportional increase in minor surgical procedures (56.4%) compared to major procedures (43.6%) was observed during lockdown.
Conclusions:
- The COVID-19 lockdown led to a significant decrease in orthopaedic emergency attendances.
- A shift towards a higher proportion of fractures in elderly patients and minor surgical procedures occurred.
- The findings suggest the need for accessible minor operating theatres in or near emergency departments for future crises.
Aims:
COVID-19 remains the major focus of healthcare provision. Managing orthopaedic emergencies effectively, while at the same time protecting patients and staff, remains a challenge. We explore how the UK lockdown affected the rate, distribution, and type of orthopaedic emergency department (ED) presentations, using the same period in 2019 as reference. This article discusses considerations for the ED and trauma wards to help to maintain the safety of patients and healthcare providers with an emphasis on more remote geography.
Methods:
The study was conducted from 23 March 2020 to 5 May 2020 during the full lockdown period (2020 group) and compared to the same time frame in 2019 (2019 group). Included are all patients who attended the ED at Raigmore Hospital during this period from both the local area and tertiary referral from throughout the UK Highlands. Data was collected and analyzed through the ED Information System (EDIS) as well as ward and theatre records.
Results:
A total of 1,978 patients presented to the ED during the lockdown period, compared to 4,777 patients in the same timeframe in 2019; a reduction of 58.6%. Orthopaedic presentations in 2020 and 2019 were 736 (37.2%) and 1,729 (36.2%) respectively, representing a 57.4% reduction. During the lockdown, 43.6% of operations were major procedures (n = 48) and 56.4% were minor procedures (n = 62), representing a significant proportional shift.
Conclusion:
During the COVID- 19 lockdown period there was a significant reduction in ED attendances and orthopaedic presentations compared to 2019. We also observed that there was a proportional increase in fractures in elderly patients and in minor injuries requiring surgery. These represented the majority of the orthopaedic workload during the lockdown period of 2020. Given this shift towards smaller surgical procedures, we suggest that access to a minor operating theatre in or close to ED would be desirable in the event of a second wave or future crisis.
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