COVID-19, “lockdown” and achilles tendon ruptures

Introduction The COVID-19 pandemic has affected the types of trauma being operated on by Orthopaedic surgeons. Lifting of restrictions around sports saw a sudden return to play for people after a period of inactivity. Achilles tendon ruptures are associated with these episodic athletes. We hypothesised that easing of “Lockdown” restrictions led to increased presentations of Achilles tendon ruptures vs. the same period in 2019. We conducted a case-control study to investigate. Methods Data from electronic theatre logbooks of all operations performed from 27th March 2020 (Lockdown begins) to 31st July 2020 and 27th March 2019 to 31st July 2019 was collected. All operatively managed Achilles tendon ruptures were included. All other operations were excluded. Results 772 total cases were performed in 2019. There were 17 Achilles tendon ruptures in that period (2.2%). 14 occurred after easing of restrictions. 580 total cases were performed in 2020. There were 13 Achilles tendon ruptures in that period (2.2%). 11 occurred after easing of restrictions and the return of sport. There was a greater incidence of Achilles tendon ruptures in 2019 vs. the equivalent “Lockdown” period in 2020. Conclusion COVID-19 pandemic restrictions and return to play after inactivity does not increase the incidence or rate of Achilles tendon rupture.

Developing intuitive investigation forms

Background/Introduction (a brief statement of purpose or why the study was done). In recent years SNBTS Transfusion Practitioner (TP) numbers have diminished while focus towards a regional way of working was established. While each NHS Scotland (NHSS) Health board has an identified TP, in order to provide resilience to all NHSS Health boards the same TP also covers a wider geographical area often with multiple sites and locations. Consequently, a more remote way of working was getting established. Then in March 2020 SARS-Covid 19 struck! This immediately halted access to clinical areas;and thus in areas where electronic records were not available, halted access to the clinical areas, staff and patients case records. In NHSS TP's and Hospital Transfusion Teams found they were struggling to elicit full and relevant information required to complete incident reviews from multiple sites. While most Hospital Transfusion Teams were using SHOT questionnaires for each relevant event/ reaction they were finding multiple communications were required to gather the smallest piece of information and often senior staff in clinical areas, for example, Charge Nurses, Consultants, Clinical Directors and Managers were overwhelmed and struggling to translate clinical information to incident reviews. The TPs recognised a need to simplify interactions between Transfusion Practitioners investigating clinical reactions and events and the clinical teams caring for the patient to ensure timely, appropriate information gathering and reporting that was time efficient for Transfusion Practitioners and to assist senior staff in clinical areas understand what was required from them. Methods or Study Design (a description of the methods used or work done). The SNBTS Transfusion Team Haemovigilance Working Group applied a Plan-Do-Study-Act (PDSA) test of change cycle following analysis of NHSS Service-Now clinical incident trends available from all NHSS health boards. This identified seven common recurring incident trends (Anti-D, ADU, HSE, ICBT - SRNM, RBRP, WBIT and TRALI/TACO). The group then utilised the information from the relevant SHOT questionnaires in addition to applying an understanding of the clinical thought process to produce bespoke Incident investigation forms, which facilitate straightforward information gathering and review. These are in MS Word format that are easily pre populated prior to sending and are readily attached to incidents in local Risk Management Systems. Results (a summary of the results observed). The SNBTS TT Haemovigilance Group produced nine Incident Investigation Forms. These forms lay out information requests in an intuitive manner for clinical teams to record information and findings. No quantitative data is available yet however qualitatively clinical teams and TP's have found it has greatly simplified the existing process. Conclusions (a statement of the conclusions based on the reported results, including any recommendations). The SNBTS TT Haemovigilance Group found the Incident Investigation forms facilitate straightforward information gathering during review of reactions and events, reducing the requirement for multiple requests from near or remote sites. When the TP job role was first created the TP's were deemed the link between the laboratory and clinical areas often translating one discipline to the other. Nowadays, we find ourselves in a similar situation regarding Haemovigilance and as such these small measures have potential for a collaborative approach where we take Haemovigilance to the wards in place of perceived impositions.

Small changes make a difference

Introduction: In March 2020 SARS-Covid 19 halted access to clinical areas thus direct access to staff and patients handwritten case records. NHS Scotland Transfusion Practitioners (TP) and Hospital Transfusion Teams (HTT) struggled to elicit information to complete incident reviews. Most HTT's were using SHOT questionnaires for each event/reaction and found multiple communications required to gather the smallest piece of information. Often senior staff in clinical areas (e.g. Charge Nurses, Consultants, Clinical Directors and Managers) were overwhelmed and struggling to translate clinical information to incident reviews. To ensure timely, appropriate information gathering and reporting the TPs recognised a need to modify interactions when investigating clinical reactions and events with clinical teams. Method: The SNBTS Transfusion Team Haemovigilance Working Group applied a Plan-Do-Study-Act (PDSA) test of change cycle following analysis of NHSS Service-Now clinical incident trends available from all NHSS health boards. This identified seven common recurring incident trends Anti-D, ADU, HSE, ICBT-SRNM, RBRP, WBIT and TRALI/TACO. The group then utilised the information from the relevant SHOT questionnaires in addition to applying an understanding of the clinical thought process to produce bespoke Incident investigation forms, which facilitate straightforward information gathering and review. These are in MSWord format that are easily pre populated prior to sending and are readily attached to incidents in local Risk Management Systems. Results: The SNBTS TT Haemovigilance Group produced nine Incident Investigation Forms. These forms lay out information requests in an intuitive manner for clinical teams to record information and findings. The group found the Incident Investigation forms facilitate straightforward information gathering during review of reactions and events, reducing the requirement for multiple requests from large, small, near or remote sites. Conclusion: When the TP role was first created, the TP's were deemed the essential link between the laboratory and clinical areas often translating one discipline to the other. Nowadays, we find ourselves in a similar situation. As such small and helpful changes supporting efficient and effective data gathering supports clinical areas, risk management and haemovigilance.