key: cord-0894395-wg1o85zq
authors: Westley, Suzanne; Creasy, Henrietta; Shah, Rupali; Shaharan, Shazrinizam; Mistry, Rikki; Awad, Guirgis; Blair, Jame; Cubison, Tania
title: Productively protecting a cohort of vulnerable plastic surgery trainees in the COVID-19 pandemic
date: 2020-05-21
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2020.05.029
sha: 0f06560b292796769dd75004217428cafdc9e7b9
doc_id: 894395
cord_uid: wg1o85zq

nan

Dear Sir, We submit a letter outlining how at The Queen Victoria Hospital we have so far successfully protected a group of vulnerable plastic surgeons while enabling them to continue to make a valuable contribution to the work of the department, specifically the hand trauma team, during the COVID-19 pandemic. We can confirm that the Guide of Authors has been read and all authors of this letter have agreed to their inclusion. The material of this letter is original, and it has been neither published elsewhere nor submitted for publication simultaneously. If accepted, the letter will not be published elsewhere in the same or similar form, in English or in any other language, without written consent of the copyright holder. We do hope this is of interest to the Editors. Kind regards Dear Sir, UK Government guidelines for protection of those who are at increased risk of severe illness from COVID-19 pandemic advise certain groups to stringently follow social distancing measures. Inevitably some health care workers fall into these categories and working in a hospital places them at high risk of exposure to the virus.

Studies have shown human to human transmission from positive COVID-19 patients to health care workers demonstrating that this threat is real 1, 2 and as in other infectious diseases is worse in certain situations such as aerosol generating and airway procedures 3, 4 . There is therefore a part of our workforce that has been out of action reducing available workforce at a time of great need.

In our hospital a group of vulnerable surgical trainees ranging from CT2 to ST8, and also Consultants, have been able to keep working while socially isolating within their usual workplace. In light of COVID-19 our hospital, a regional trauma centre for Burns, Plastic Surgery and Oral and Maxillofacial Surgery, was reorganized to increase capacity for both trauma and cancer work. As part of this a virtual hand trauma service has been set up. The primary aim of the new virtual hand trauma clinic was to allow patients to be triaged in a timely manner while adhering to social distancing guidelines by remotely accessing the clinic from home. Further aims were to reduce time spent in hospital and reduced time between referral and treatment.

In brief, patients referred to our virtual hand trauma clinic from across the region receive a video or telephone consultation using Attend Anywhere software, supported by NHS Digital. Following the virtual consultation patients are then triaged to theatre, further clinic, or discharged. Our group of isolating doctors, plus a pharmacist and trauma coordinator, have been redeployed away from their usual face to face roles and are now working solely in the virtual trauma clinic. They are able to work to provide this service in an isolated part of the hospital named the 'Virtual Nest.' The Nest is not accessible in a 'face to face' manner by non-isolating staff or patients.

This allows a safe 'clean' environment to be maintained. The virtual team is able to participate in morning handover with other areas of the hospital via video conferencing using Webex software. The Nest workspace is large enough to allow social distancing between clinicians and by being on site they benefit from availability of dedicated workspaces with suitable IT equipment and bandwidth.

It is widely recognised that reconfiguration of hospitals and redeployment of staff has meant that training is effectively 'on hold' for many trainees. We have found that a benefit of the new virtual hand trauma clinic is that The structure of the team is akin to the firm structure of days gone by with the benefits that brings in terms of support and mentorship. Patients benefit from having access to a group of knowledgeable trainees, supported by consultants, and a service accessible from their own home. This minimizes footfall within our hospital, exposure to, and spread of COVID-19. Local assessment of our practice is ongoing but we have found that this model has enabled a cohort of vulnerable plastic surgery trainees to successfully continue to work whilst reducing the risk of exposure to COVID-19 and providing gold standard care for patients.

None.

Nothing to disclose.

Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient

Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia

Otorhinolaryngologists and Coronavirus Disease 2019 (COVID-19)

Quantifying the risk of respiratory infection in healthcare workers performing high-risk procedures

Skills fade: a review of the evidence that clinical and professional skills fade during time out of practice, and of how skills fade may be measured or remediated