key: cord-0686541-7gsu0xx0 authors: Lal, Hitesh; Sharma, Deepak Kumar; Patralekh, Mohit Kumar; Jain, Vijay Kumar; Maini, Lalit title: Out Patient Department practices in orthopaedics amidst COVID-19: The evolving model date: 2020-05-18 journal: J Clin Orthop Trauma DOI: 10.1016/j.jcot.2020.05.009 sha: ce2cc1ce0e20db70dd3a8871d350662dafe165e9 doc_id: 686541 cord_uid: 7gsu0xx0 Severe Acute Respiratory Syndrome COVID-19 was declared as a pandemic on 11(th) March 2020 by the World Health Organization and consequent lockdown imposed in several areas resulted in a marked reduction in orthopaedic practice. Although some guidelines for patient care in orthopaedic practice have been published, overall, publications focusing exclusively on guidelines on starting orthopaedic outpatient departments (OPD) after the COVID-19 lockdown amidst the on-going pandemic are lacking. We hereby propose the evolving knowledge in changes in OPD management practices for orthopaedic surgeons in the COVID- 19 era. The emphasis on online registration (e-registration) should be given impetus and become the new norm supplemented by telephonic and spot registration for the uneducated patients. The review highlights the safety of patient and orthopaedic surgeons in OPD by screening and maintaining hygiene at various levels. The article also mentions the duties of the help desk, OPD hall supervisor and the new norms of Air Conditioning, ventilation, safe use of elevators, sanitization of OPD premises and biomedical waste disposal. The optimum and safe utilization of human & material resources, DO's and DON'Ts for patients & health staff have also been proposed. The reorganization of plaster room, the precaution during plastering, fracture clinic, dressing and injection room services are discussed as per evolving guidelines. This article will give deep insight into the OPD plan &telemedicine graphically also. The authors suggest updating and downward permeation of existing e-infrastructure of government health services that is up-gradation of existing tertiary level online registration services, a paperless model of OPD Consultation & dispensation. The future updating of Aarogya Setu App (https://mygov.in/aarogya-setu-app/). for convenient online OPD registration and dispensation has been discussed and proposed. This review will help in containing the spread of COVID 19 and build upon the health gains achieved after lockdown. The easy concept of CCCATTT has been introduced, and the OPD Plan has also been suggested. We have endeavoured to holistically detail an orthopaedic OPD setup and its upkeep in COVID-19 pandemic, but since the knowledge of COVID 19 is ever-evolving it needs replenishment by regular education for health staff. India and the rest of the world are going through a difficult, decisive and stressful phase of 42 existence due to novel Severe Acute Respiratory Syndrome-SARS CoV2 (COVID-19) 43 pandemic. [1] [2] [3] In these unprecedented circumstances where COVID-19 pandemic has 44 indiscriminately engulfed the world and as social distancing and limitation are essential tools to 45 contain its spread; the outpatient healthcare model needs rebooting to prevent it from spreading Returning Orthopaedic OPD's functioning to the pre-COVID era: 80 4 In order to gradually return orthopaedic practice to relative normalcy due to COVID 19, 99 First and foremost, the patient should decide that he/she has an orthopaedic problem significantly 100 affecting lifestyle and locomotor function, and is not being relieved by rest. If one is not sure 101 that the orthopaedic problem can be tackled at home or not, there are two options, one is to visit 102 the hospital and the other better way is to contact the concerned telemedicine portal of the 103 particular hospital for consultation. This will reaffirm his decision to visit the hospital in these 104 times. After the decision to visit the hospital has been made, the next step is to register; and the best 194 Here they have to filter patients into three categories. The basic details and an orthopaedic prototype teleconsultation has been depicted in Fig. 4&5 In COVID era, more and more patients will be treated by old-established conservative methods; • Take hygienic bath before and after hospital visit • Wash clothes in bleaching powder solution after returning from hospital • Containment zones and COVID positive patient should attend hospital only in case of emergency and after the quarantine restriction of that area are lifted and that too at designated COVID points of the hospital location of whose is made available by telephonic helpline and website • Patient with symptoms as in Table 1 should go to flu clinic /fever clinic first. Records identified through searching PubMed (13) should however be avoided for emergency care when alternative in-person care is available, and telemedicine consultation should be limited to first aid, lifesaving measure, counseling and advice on referral. Covid-19 and mobile phone hygiene in 596 healthcare settings City of Calgary Guidelines on Safe Elevator Etiquette During COVID-19 Elective Orthopaedic Surgery During the COVID-19 Pandemic Post COVID-19: Planning 604 strategies to resume orthopaedic surgery-challenges and considerations 6) Zone of covid stay as per government notification: Containment /Red/Orange Aarogya Setu Notification at home: Safe/ Not safe 9) Department you want to visit 10) Have you consulted Telemedicine department of the hospital-Date/ Advice 11) History of travel/contact with COVID-19 positive patient/coming from containment zone Any history of severe constant chest pain or pressure, extreme difficulty breathing, severe constant light headedness serious disorientation or unresponsiveness---GO TO EMERGENCY CHILLS sweating/difficulty breathing/new or worsening cough/sore throat/ aching throughout the body/running nose/loss of smell/vomiting/ diarrhoea or symptoms as notified History of diabetes, high blood pressure, cancer, kidney disease or heart ailments Any previous investigation and treatment