Hospital within the Hospital - Renaissance of Elective Surgery Amidst the Pandemic

ABSTRACT

Aim: COVID had an unprecedented effect on the NHS elective surgical care. To overcome the deficit created due to the pandemic, the concept of a 'COVID protected zone' gave birth to the 'hospital within the hospital'. This included 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen and a separated entrance. Of the fundamentals of the model were enhanced infection control and PPE guidance for staff. The aim of our study was to evaluate the recovery of elective activity brought about by this elective centre. Methods: Theatre activity data was collected weekly (7/20 to 1/21) through the business informatics system. This was used to compare the activity achieved during the recovery phase from COVID after the first and subsequent wave. Results: Pre COVID-19, 11 theatres were operating. These managed an average of 263 cases were per week. In the first week of operation of elective centre, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. During the 2nd wave the capacity was reduced to 42% as opposed to 0% during the first wave. This was only possible due to our model elective centre. Conclusion: This model elective centre has enabled elective care to return to above normal levels, with increased efficiencies. This has not only shortened patient waiting times and cleared the back-log but also delivered training to surgical trainees without compromising safety.