Multidisciplinary Management of an Outbreak of COVID-19 on an Orthopaedic Rehabilitation Ward: A Description of Outcomes

ABSTRACT

Introduction: In January 2021, Ireland was undergoing the 'Third Wave' of COVID-19, with almost 2,000 persons hospitalised with COVID-19. Over 50% of all COVID-19-related deaths in the EU have occurred in those aged 80 years and older. The same patient cohort is also at high risk sustaining a fragility fracture, leading to an admission to the orthopaedic rehabilitation ward. This study examines a patient group in whom these two scenarios coincided, describing a patient cohort who having sustained a fragility fracture, later contracted COVID-19. This study aims to describe the characteristics and outcomes of orthopaedic rehabilitation patients with COVID-19 and to examine the response of an orthopaedic rehabilitation ward to an outbreak of COVID-19. Methods: This is a retrospective observational study. Data from 26 hospitalised patients aged over 65 years with COVID-19 at an Irish orthopaedic rehabilitation ward was collected. Symptom profile, degree of COVID-19 severity, Clinical Frailty Scale (CFS), Charleston co-morbidity scores, laboratory and radiological data were reviewed. Individual treatment pathways were recorded for each patient. Infection control records were reviewed to examine the response of the ward to an outbreak of COVID-19. Results: Patient mortality rate was 7.7% (n = 2). Median survivor age was 79.5 years (IQR 70-85.5). Mean CFS and Charleston Co-morbidity scores were 4.15;(SD1.6) and 5.08, respectively. The majority of patients (n = 25, 96%) were categorised as mild COVID-19 cases. Delirium was noted in more than 10% of patients (n = 3, 11.6%). One patient (n = 1, 3.8%) required non-invasive ventilation. In those whose disease was classifies as severe (n = 2, 7.7%), intubation/resuscitation were not deemed appropriate and when they deteriorated, comfort measures were taken. The majority of patients (n = 21, 81%) were able to return home upon discharge. Three patients (11.5%) had increased care needs and required long term care to be arranged. Conclusion: An outbreak of COVID-19 requires a multidisciplinary approach with a focus on not only medical management but also clinical workforce management, patient flow, management of access to the wards and information and communications management. The overall outcomes in this group, including mortality and proportion discharged to long term care, were positive when compared to similar cohorts of elderly hospitalised patients with COVID-19. These outcomes support a multidisciplinary model of care.