Resource Reallocation during the COVID-19 Pandemic in a Suburban Hospital System: Implications for Outpatient Hip and Knee Arthroplasty

Abstract

The COVID pandemic of 2020 has emerged as a global threat to patients, health care providers, and to the global economy. Owing to this particular novel and highly infectious strain of coronavirus, the rapid community spread and clinical severity of the subsequent respiratory syndrome created a substantial strain on hospitals and health care systems around the world. The rapid surge of patients presenting over a small period for emergent clinical care, admission to the hospital, and intensive care units with many requiring mechanically assisted ventilators for respiratory support demonstrated the potential to overwhelm health care workers, hospitals, and health care systems. The purpose of this article is to describe an effective system for redeployment of health care supplies, resources, and personnel to hospitals within a suburban academic hospital system to optimize the care of COVID patients, while treating orthopedic patients in an equally ideal setting to maximize their surgical and clinical care. This article will provide a particular focus on the current and future role of a specialty hip and knee hospital and its partnering ambulatory surgery center in the context of an outpatient arthroplasty program.

Arthroplasty During COVID-19: Surveillance of AAHKS Members in the First Year of the Pandemic

“…Finally, by definition surgeries performed at an ASC obviate the need for admission to a hospital or post-acute facility, which have been associated with higher rates of COVID-19 infections. These findings suggest that the COVID-19 pandemic may act as another catalyst to the disproportionate growth in outpatient arthroplasty[ 10 ].…”

Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice

“…Following the initial title/abstract screen, 78 articles were assessed for eligibility in the full-text phase. Ultimately, 48 studies met the inclusion and exclusion criteria and were included for analysis [ 1 , 3 , 4 , 5 , 6 , 7 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. All of these studies were categorized as level IV or level V Evidence, representing low-quality studies ( Table 1 ).…”

“…Twenty-five studies documented the impact of COVID-19 on future clinical or operational workflow ( Table 2 ) [ 4 , 5 , 6 , 7 , 10 , 11 , 15 , 18 , 19 , 22 , 24 , 26 , 29 , 30 , 32 , 33 , 35 , 37 , 38 , 41 , 44 , 45 , 49 , 50 ]. Of these, fourteen studies detailed the importance of establishment and updating of an effective COVID-19 screening protocol [ 5 , 6 , 10 , 11 , 18 , 19 , 22 , 24 , 26 , 29 , 32 , 33 , 37 , 38 ]. Themes of these studies included the necessity of COVID-19 reverse transcription polymerase chain reaction (RT-PCR) for all patients, the importance of history and physical for the screening of COVID-19 symptoms, the assumption that all patients will be a carrier for the virus, and the possibility for reinfection.…”

“…Eight studies discussed the importance of outpatient orthopedic surgery practice in the COVID-19 era [ 4 , 5 , 19 , 22 , 35 , 37 , 38 , 49 ]. Meneghini et al noted that outpatient elective surgery would save inpatient hospital beds for COVID-19 patients, but that this alteration would result in the challenge of doing the more complex surgeries with increased blood loss in an outpatient setting with potential limitations including inexperienced staff, insufficient physical space, and inadequate central sterile processing capacity [ 37 ]. Further, O’Connor et al noted that the hours of outpatient surgery would need to be extended to keep up with the backlog in surgical cases and that those necessitating traditional inpatient surgery should be shifted to rapid recovery protocols [ 4 ].…”

COVID-19. An update for orthopedic surgeons

“…With the risks posed by shortage of Personal Protective Equipment (PPE) [13][14][15] non-traditional solutions were developed such as 3D printed face shields, reusable gowns, and protocols for the re-use of PPE [18]. Moreover, the sudden overload of healthcare systems mandated institution of new hospitals as well as changing the bed capacity to increase respiratory care beds; this was coupled with initial reduction and later cancelation of all elective procedures in order to save the available resources and limit spread of the virus [19][20][21][22][23][24][25][26][27]. In the midst of this crisis, the orthopedic surgeon was surely affected: from de-specialization and serving on the frontline, to upgrades from fellow to faculty and reassignment of residents to clinical care rotations [18][19][20][21][22][23][24][25][26][27][28].…”