ABSTRACT
Introduction/Aims: The COVID19 pandemic caused a cessation in services during 2020/2021, resulting in long NHS waiting lists and the low availability of hospital beds for elective patients. Before the pandemic, all patients undergoing orthognathic surgery at a tertiary London hospital were managed with in-patient admission and overnight hospital stay. The difficulty with delivery of in-patient elective surgery encouraged review of this level of postoperative care. Previous studies have highlighted the safety of day case orthognathic surgery. Our Aim is to review peri-operative and post-operative complications following orthographic surgery and to determine the safe implementation of orthognathic surgery as a day case in our unit. Material(s) and Method(s): Retrospective 2 years study of all patients who underwent BSSO, Le Fort 1 and bimaxillary osteotomies during the covid-19 pandemic in 2020 to 2021. The electronic notes were reviewed to record complications and post-operative recovery. Data collated include time to mobilisation, analgesia and anti-emetics requirement. Results/Statistics: Out of the 89 patients in this study, no patients experienced emergency airway or haemorrhage concerns. 3 patients (3.37%) required intervention on the ward on the same day as the surgery. Majority of patients were discharged after overnight stay. 7 patients (7.86%) required morphine and 2 patients (2.25%) required anti-emetics. These were largely specific to bimaxillary osteotomy patients. 1 (1.12%) patient required more than 1 night as an inpatient. Conclusions/Clinical Relevance: We conclude that single jaw osteotomy can be safely undertaken as day case surgery, this may aid recovery in elective surgery and may be applied to more units in UK. Copyright © 2022
ABSTRACT
Background: Acute stroke care is constantly evolving and often necessitates rapid change. When COVID-19 struck our community, our team determined that we needed to change our approach to emergent stroke cases without sacrificing efficiency and safety. Our goals with the changes in our hyperacute stroke response pathway (called Code Brain) in our ED was to minimize COVID-19 exposure to our team, reduce PPE usage, and maintain an environment of safety and readiness, all while providing the same high-quality stroke care. Purpose: The purpose of this study was to determine if the changes we made to our Code Brain pathway in the ED effected our door-to-needle time for tissue plasminogen activator (t-PA) administration our door-to-groin puncture (DTG) times, or our CT scan turn-around times (CT TAT) under 45 minutes percentage. Implementation: It was decided that the stroke team RNs would respond to the bedside and a neurology resident or fellow would respond via telemedicine robot at bedside. The stroke team nurse is the safety monitor who ensures proper PPE use. The patient is moved through the Code Brain pathway with the telemedicine robot in tow, assuring constant contact with the patient by the stroke physician and stroke nurse. We implemented our revised Code Brain pathway on March 17, 2020. We retrospectively collected data from November 2019 to July 2020 and extracted our DTN, DTG and CT TAT times for a 4 1/2 month comparison. Results: From November 2019 through March 17, 2020, our DTN median time was 39 minutes, DTG median time was 101 minutes, and CT TAT under 45 minutes was 97%. From March 18, 2020 to July 2020, our DTN median time was 54 minutes, DTG median time was 101 minutes, and CT TAT under 45 minutes was 95%. Variables to consider are the length of time it takes to apply the appropriate PPE for the stroke nurse, obtaining the telemedicine robot from our ED storage area and connectivity issues. Conclusion: Although we radically changed the way we approach our Code Brain patients, our response and treatment times changed only slightly. We will continue to streamline this process for optimal outcomes.
ABSTRACT
The United States declared a national emergency on March 13, 2020, in response to the rapidly spreading COVID-19 pandemic after all 50 states reported laboratory-confirmed cases.1 The demand for ambulatory medical care in the US fell by almost 60% and immunization encounters at Walter Reed National Military Medical Center decreased by 76% as patients became concerned about the risk of coronavirus exposure within a clinic or hospital setting.2 Our vaccination initiatives aimed to increase our pediatric and adult immunization rates through offering two alternative immunization platforms aimed to reduce patient concerns about COVID exposure.