No time to waste, the impact of the COVID-19 pandemic on hip, knee, and shoulder arthroplasty surgeries in the Netherlands and Denmark

AimsThis study aimed to investigate the estimated change in primary and revision arthroplasty rate in the Netherlands and Denmark for hips, knees, and shoulders during the COVID- 19 pandemic in 2020 (COVID-period). Additional points of focus included the comparison of patient characteristics and hospital type (2019 vs COVID-period), and the estimated loss of quality-adjusted life years (QALYs) and impact on waiting lists.MethodsAll hip, knee, and shoulder arthroplasties (2014 to 2020) from the Dutch Arthroplasty Reg-ister, and hip and knee arthroplasties from the Danish Hip and Knee Arthroplasty Registries, were included. The expected number of arthroplasties per month in 2020 was estimated using Poisson regression, taking into account changes in age and sex distribution of the general Dutch/Danish population over time, calculating observed/expected (O/E) ratios. Country-specific proportions of patient characteristics and hospital type were calculated per indication category (osteoarthritis/other elective/acute). Waiting list outcomes including QALYs were estimated by modelling virtual waiting lists including 0%, 5% and 10% extra capacity.ResultsDuring COVID-period, fewer arthroplasties were performed than expected (Netherlands: 20%;Denmark: 5%), with the lowest O/E in April. In the Netherlands, more acute indica-tions were prioritized, resulting in more American Society of Anesthesiologists grade III to IV patients receiving surgery. In both countries, no other patient prioritization was present. Relatively more arthroplasties were performed in private hospitals. There were no clinically relevant differences in revision arthroplasties between pre- COVID and COVID-period. Esti-mated total health loss depending on extra capacity ranged from: 19,800 to 29,400 QALYs (Netherlands): 1,700 to 2,400 QALYs (Denmark). With no extra capacity it will take > 30 years to deplete the waiting lists.ConclusionThe COVID- 19 pandemic had an enormous negative effect on arthroplasty rates, but more in the Netherlands than Denmark. In the Netherlands, hip and shoulder patients with acute indications were prioritized. Private hospitals filled in part of the capacity gap. QALY loss due to postponed arthroplasty surgeries is considerable.

Introduction

Around the world, the COVID-19 pandemic has prompted radical transformations in health policy and the organisation of health and care services. In many countries, policymakers have rushed to re-organise care services to meet the ‘surge demand’ and ‘waves’ of COVID-19 infection and disease. Such strategies signal important and sweeping changes in the organisation of both ‘COVID’ and ‘non-COVID’ care, whilst asking more fundamental questions about the long-term organisation of care ‘after COVID’. This includes, for example, unprecedented patterns and levels of funding;new ways of governing, managing and leading services;and the reconfiguration of clinical teams and frontline care delivery. In some contexts, COVID-19 has exposed the fragilities and vulnerabilities of long held ways of organising care, especially where services operate at the very brink of resource constraints or at near full capacity. In others, it has shown how services are organised to be more resilient and adaptive to unanticipated pressures and surge demand. This introductory chapter reviews the themes of the edited collection in terms of policy learning, governance in hospital organisations, professions and professionalism, technologies and governmentalities, and organisational responses to COVID-19. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Advanced communication skills: Teaching during a pandemic

Introduction: In the first wave of the COVID-19 pandemic, it was recognised there would be an increased demand on clinicians to provide patients and relatives with bad news. The national ban on hospital visiting rapidly changed the way in which this news would be delivered. In recognition of these new challenges, our team sought to design a teaching course that could be implemented quickly and cost effectively, with the aim of improving clinician's confidence around these difficult skills. Methods: A teaching programme was created using senior geriatric and palliative care clinicians as simulated patients, open to any grade and speciality. Learners were required to break bad news (BBN) without any visual feedback, to simulate skills required when using the telephone. Surveys were collected to determine self -assessed confidence across four domains (Table 1) before, immediately after and 4-20 weeks after the course. Participants were asked to rank their confidence for each skill on a 5 point scale with 1 being very unsure and 5 being very confident. Results: Pre-teaching scores showed an average of 3 (neither confident nor unsure) across all domains. After the course all domains improved, most notably around discussing end of life (EoL) care and discussing information over the phone. Conclusion: This project has highlighted a lack of confidence across all skill levels when it comes to BBN. This confidence is easily improved by a short, cost-effective teaching course. It remains to be seen if this improved confidence translates to better communication with relatives. (Table Presented).