Impact of COVID-19 on surgical services in a District General Hospital in the United Kingdom: benefits versus drawbacks

Authors

  • Islam H. El-Abbassy 1Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom 2Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom 3Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Hesham El-Hakim Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom
  • Mei Kei Wong Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom
  • Robert McIntyre Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom

DOI:

https://doi.org/10.18203/2349-2902.isj20210353

Keywords:

COVID-19, Laparoscopic surgery, Open appendicectomy, CT chest, Telemedicine consultation

Abstract

Background: COVID-19 outbreak led to significant changes in health services worldwide. This study aimed to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward.

Methods: Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants.

Results: The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively. In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future.

Conclusions: COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit. 

Author Biographies

Islam H. El-Abbassy, 1Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom 2Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom 3Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

MBBCh, MSc, MRCS, MD

Hesham El-Hakim, Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom

MBBCh, MRCS

Mei Kei Wong, Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom

BMBS

Robert McIntyre, Department of General Surgery, Dr Grays Hospital, NHS Grampian, United Kingdom

BSc(Hons), MD, FRCS (Glasg)

References

World Health Organization (WHO) Naming the coronavirus disease (COVID-19) and the virus that causes it. 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it. Accessed on 5 Oct, 2020.

World Health Organization (WHO) WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020. Accessed on 5 Oct, 2020.

Public Health England. Guidance on social distancing for everyone in the UK. gov.uk. 2020.

Elective procedures and outpatient appointments during COVID 19 outbreak. https://whh.nhs.uk/about-us/news-events-and-features/latest-news/press-statement-elective-procedures-and-outpatient-appointments-during-covid-19-outbreak. Accessed on 5 Oct, 2020.

Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PBS et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg. 2020;107(10):1250-61.

Chopra V, Toner E, Waldhorn R, Washer L. How should U.S. Hospitals prepare for Coronavirus Disease 2019 (COVID-19)? Ann Intern Med. 2020;172(9):621-2.

Guidance for Surgeons working during the pandemic.https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/. Accessed on 05 October 2020.

Javanmard-Emamghissi H, Boyd-Carson H, Hollyman M, Doleman B, Adiamah A, Lund JN et al. The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study. Tech Coloproctol. 2020;1-11.

Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A et al. Safe management of surgical smoke in the age of COVID-19. Br J Surg. 2020;107(11):1406-13.

Patel R, Hainsworth AJ, Devlin K, Patel JH, Karim A. Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital. Ann R Coll Surg Eng. 2020;102:457-62.

Gareth I. Covid-19: NHS outlines services to be prioritized to restart in next six weeks. BMJ. 2020;369:m1793.

Mathur S, Jeremy Ng CF, Koh F, Shuang Ling X, Chin ST, Tan HK. Development of enhanced acute care surgery service in response to the COVID-19 global pandemic. Int j care injured. 2020;51(10):2135-41.

Role of CT chest in screening of COVID 19. https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/clinical-information/role-ct-chest/role-ct-screening-0. Accessed on 5 Oct, 2020.

Hare SS, Rodrigues JCL, Nair A, Jacob J, Upile S, Johnstone A et al. The continuing evolution of COVID-19 imaging pathways in the UK: a British Society of Thoracic Imaging expert reference group update. Clinical Radiol. 2020;75(6):399-404.

Bresadola V, Biddau C, Puggioni A, Tel A, Robiony M, Hodgkinson J et al. General surgery and COVID-19: review of practical recommendations in the first pandemic phase. Surg Today. 2020;1-9.

Callaway M, Harden S, Ramsden W, Beavon M, Drinkwater K, Vanburen T et al. A national UK audit for diagnostic accuracy of preoperative CT chest in emergency and elective surgery during COVID-19 pandemic. Clinical radiol. 2020;75:705-8.

Doglietto F, Vezzoli M, Gheza F, Lussardi GL, Domenicucci M, Vecchiarelli L et al. Factors Associated with Surgical Mortality and Complications Among Patients with and Without Coronavirus Disease 2019 (COVID-19) in Italy. JAMA Surg. 2020;10:1001.

Association of Surgeons of Great Britain and Ireland. Commissioning guide: Emergency general surgery (acute abdominal pain). 2014;1-32.

Armstrong J, Merritt N, Jones S, Scott L, Bütter A. Non-operative management of early, acute appendicitis in children: is it safe and effective? J Pediatr Surg. 2014;49(5):782-5.

Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Notes from the battlefield; 2020. Available from: https:// www.sages.org/notes-from-the- battlefield-march-30-2020/. Accessed 3 April 2020.

Intercollegiate general surgery Guidance on COVID-19 update. https://www.rcsed.ac.uk/news-public-affairs/news/2020/march/intercollegiate-general-surgery-guidance-on-covid-19-update. Accessed on 20 October 2020.

Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T et al. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015;313(23):2340-8.

A Spinelli, G Pellino. COVID-19 pandemic: perspectives on an unfolding crisis. BJS. 2020;107(7):785-7.

Bashshur R, Doarn CR, Frenk JM, Kvedar JC, Woolliscroft JO. Telemedicine and the COVID-19 Pandemic, Lessons for the Future. Telemedicine J E-Health. 2020;26(5):571-3.

NHSX. Covid-19 information governance advice for health and care professionals 2020, 2020. Available: https://www.nhsx.nhs.uk/ key-information-and-tools/information-governance-guidance/healthcare-professionals. Accessed on 29 Mar 2020.

Public and staff survey- Video appointments- Near Me. nearme.scot/views. Accessed on 20 August 2020.

Gilbert AW, Billany JCT, Adam R, Martin L, Tobin R, Bagdai S et al. Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative. BMJ Open Quality. 2020;9:e000985.

Ignatowicz A, Atherton H, Bernstein CJ, Bryce C, Court R, Sturt J et al. Internet videoconferencing for patient-clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digit Health. 2019;5:2055207619845831.

Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S, Hanson P et al. Advantages and limitations of virtual online consultations in an NHS acute trust: the VOCAL mixed-methods study. NIHR J Library. 2018;6.21.

Boggan JC, Shoup JP, Whited JD, Voorhees VE, Gordon AM, Rushton S et al. Effectiveness of acute care remote triage systems: a systematic review. J Gen Intern Med. 2020;35(7):2136-45.

Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html. Accessed on 20 October 2020.

Downloads

Published

2021-01-29

Issue

Section

Original Research Articles