Learning from minor injury care restructure during the COVID-19 pandemic: a phenomenological study of orthopaedic clinical leaders.

BACKGROUND: During peaks of the COVID-19 pandemic, trauma and orthopaedic departments in England have been asked to support emergency departments by providing first contact care for minor injuries. The subsequent requirement for departmental restructure has resulted in a variety of service pathways across the country. This study aimed to explore the experiences of different clinical teams and identify any consistent themes or reflections, which could be applied to continuous improvement of minor injury care. METHODS: Using a phenomenological approach, nine semistructured interviews were conducted with trauma and orthopaedic clinical leads across England whose departments provided support to minor injuries service. Detailed transcripts were then analysed to identify themes for discussion. Interviews were conducted via video conferencing in November 2020 at the end of England's second national lockdown. RESULTS: Each of the nine orthopaedic departments provided support for minor injuries, six of which involved creating a new unit. Themes included the value of collaborative working between the emergency department and orthopaedic staff across multiple professions and the benefit to patients of early definitive decision making. A common theme was reduced barriers to change during the pandemic. Examples of long-term service improvements triggered by the pandemic focus on pathways to enable consultant to provide early opinions for injured patients. CONCLUSIONS: A range of experiences have demonstrated themes in reflection from service leaders. Departments across the country should be encouraged to consider what improvements to their own service may be applied long term. Resource limitations, staff well-being and education must all be considered.

Emergency medicine response to the COVID-19 pandemic in England: a phenomenological study.

BACKGROUND: The COVID-19 pandemic has stretched EDs globally, with many regions in England challenged by the number of COVID-19 presentations. In order to rapidly share learning to inform future practice, we undertook a thematic review of ED operational experience within England during the pandemic thus far. METHODS: A rapid phenomenological approach using semistructured telephone interviews with ED clinical leads from across England was undertaken between 16 and 22 April 2020. Participants were recruited through purposeful sampling with sample size determined by data saturation. Departments from a wide range of geographic distribution and COVID-19 experience were included. Themes were identified and included if they met one of three criteria: demonstrating a consistency of experience between EDs, demonstrating a conflict of approach between emergency departments or encapsulating a unique solution to a common barrier. RESULTS: Seven clinical leads from type 1 EDs were interviewed. Thematic redundancy was achieved by the sixth interview, and one further interview was performed to confirm. Themes emerged in five categories: departmental reconfiguration, clinical pathways, governance and communication, workforce and personal protective equipment. CONCLUSION: This paper summarises learning and innovation from a cross-section of EDs during the first UK wave of the COVID-19 pandemic. Common themes centred around the importance of flexibility when reacting to an ever-changing clinical challenge, clear leadership and robust methods of communication. Additionally, experience in managing winter pressures helped inform operational decisions, and ED staff demonstrated incredible resilience in demanding working conditions. Subsequent surges of COVID-19 infections may occur within a more challenging context with no guarantee that there will be an associated reduction in A&E attendance or cessation of elective activity. Future operational planning must therefore take this into consideration.

A comprehensive hospital agile preparedness (CHAPs) tool for pandemic preparedness, based on the COVID-19 experience.

COVID-19 presents an unprecedented challenge to hospitals and the systems in which they operate. The primary exponential surge of COVID-19 cases is arguably the most devastating event a hospital will face. In some countries, these surges during the initial outbreak of the disease have resulted in hospitals suffering from significant resource strain, leading to excess patient mortality and negatively impacting staff wellbeing. As experience builds in managing these surges, it has become evident that agile, tailored planning tools are required. The comprehensive hospital agile preparedness (CHAPs) tool provides clinical planners with six key domains to consider that frequently create resource strain during COVID-19; it also allows local planners to identify issues unique to their hospital, system or region. Although this tool has been developed from COVID-19 experiences, it has potential to be modified for a variety of pandemic scenarios according to transmission modes, rates and critical care resource requirements.