COVID-19’s damage to the general public, the international healthcare system, and the global economy are of morbid concern and the orthopaedic ecosystem has undergone significant secondary collateral damage.
As a result, Emory University’s Department of Orthopaedics has devised a pragmatic, standardized five-part approach to continue orthopaedic training within the confines of patient and provider safety.
- First: minimize exposure by separating the department into two distinct teams (active-duty and remotely working) to carry out in-person duties in two-week intervals, allowing for subsequent isolation and observation for symptoms during the virus’ potential incubation period.
- Second: participate in the ongoing care of urgent orthopaedic issues through in-person surgical encounters and remote telecommunication with faculty for ambulatory patients’ histories, exams, and imaging.
- Third: sustainability, with a two-team system with team-based redundancy that accommodates potential illness and has a healthy team ready to replace the active-duty residents after two weeks.
- Fourth: related to the third, is flexibility in that the two-team system is modular and adaptable to the uncertain timeline, magnitude, and undulations of the pandemic.
- Fifth: preserve departmental leaders, which is a departure from the typical lead-from-the-front surgical mentality in order to protect the experienced decision-makers that will found the emergence from this crisis.
At the forefront of every healthcare worker’s mind is the rapidly evolving, unpredictable, and highly contagious novel coronavirus, and associated COVID-19. The global impact, while still predominantly in the growth phase, is already devastating.
The virulent transmission of the virus has accompanied an exceptional burden on the healthcare system, with unparalleled critical care demands, unmet personal protective equipment (PPE) needs for healthcare workers, a burgeoning mortality rate, and profound interruption of typical day-to-day hospital processes.
While the majority of the orthopaedics is segregated from the emergency and critical care elements of disease management, the indirect impacts of interpersonal distancing, resource re-allocation, and public safety measures have halted a predominantly elective-based practice.
As a result, non-essential care ambulatory and surgical orthopaedic care is postponed indefinitely. The quality of life detriment to the patient population and financial impairment of practices likely cannot be quantified. However, a tertiary onus is being shouldered by orthopaedic training programs. Aside from urgent care, surgical and clinical volume has been reduced to a fraction of the typical learning opportunity volume.
This methodical response to the pandemic optimizes an otherwise exigent depletion of orthopaedic learning opportunities. With the creation of the remotely working resident cohort, a daily, attending-lead video teleconferencing didactic sessions couples with self-directed learning to perpetuate resident engagement.
Further, a revitalized focus on academic investigation, grant-writing, and quality improvement projects is derived from the obligate departure from traditional clinical duties. Sustaining the education and development of the finite timeline of an orthopaedic resident in the face of this pandemic requires a departure from standard operating procedures, but is requisite nonetheless. We hope our approach can guide other departments navigating an overburdened healthcare system battling a macabre international catastrophe. The details of this blueprint can be found at https://journals.lww.com/jbjsjournal/Documents/Schwartz.pdf.
For more information, contact Scott D. Boden, MD.
