Other guidance and resources

Infection control and prevention relevant to T&O

Social distancing, remote consultations and reducing pressure on the NHS

NHS England guidance highlights that the NHS is adopting other measures for ‘social distancing’ and reducing pressures on the NHS:

  • The public are asked to greatly limit visitors to patients, and to consider other ways of keeping in touch such as phone calls.
  • All routine CQC inspections and GIRFT visits are being cancelled.


Personal protection equipment (PPE)

Updated PHE guidance was published on 27th April 2020.

Recommended PPE for healthcare workers by secondary care inpatient clinical setting, NHS and independent sector.

Operating theatre ventilation

BOA Guidance update on Aerosol Generating Procedures (AGPs) published 03 July 2020.

Updated PHE guidance was published on 27th April 2020.

Additional infection control resources

Editorial from Bone and Joint Research journal that details the risks of potential transmission of COVID-19 during surgery from aerosols.

Below are links to guidance documents regarding coronavirus in the trauma and orthopaedic specialty and subspecialties.

NHS England specialty guides:

 

National Guidance relevant to T&O:

  • New guidance regarding adult MSK services
     

    NHS England guidance entitled ‘Primary and community musculoskeletal adult services: Restoration principles’, which is badged by the BOA, was released on 20th August 2020.

    The guidance is intended to support the restoration of services as part of the Third Phase NHS response to the Coronavirus pandemic, as well as reflecting the ambitions of the Long Term Plan. The guidance may be of interest to members as it discusses topics including patient referrals, MSK triage systems and secondary care support for primary care and community services. This guidance is currently being disseminated through various routes to reach regional and local teams.

    NICE has published guidance on ‘Arranging planned care in hospitals and diagnostic services’ (27th July 2020), which covers NHS arrangements for patients needing elective surgery and other planned treatments and procedures (including diagnostics and imaging). There are some significant changes to practice regarding testing, self-isolation prior to surgery and also an emphasis on shared decision making. A short one-page version of the guidance is also available.

  • Elective surgery restart and paediatric patients

    The Royal College of Paediatrics and Child Health has published important new national guidance for the recovery of elective surgery in children, which will be relevant to all those operating on children or involved in COVID-19 restart planning. This guidance has been developed by the following organisations: NHS England, Public Health England, the Royal College of Surgeons of England, Royal College of Anaesthesia, Royal College of Paediatrics and Child Health, the Children’s Surgical Forum, British Association of Paediatric Surgeons, Association of Paediatric Anaesthetists of Great Britain and Ireland, and The Association for Perioperative Practice. 

 

BOA and Specialist Society documents:

BSCOS have compiled a page of resources, from a wide number of organisations, to help during the COVID-19 pandemic. 

BSSH have a resource page for members.

Trauma:

Charnley's Closed Treatment of Common Fractures

The name Charnley is forever linked with hip replacement but Sir John Charnley’s influence on Trauma and Orthopaedics extended well beyond arthroplasty. Before the term ORIF became so widespread in the notes of our fracture patients the mainstay of treatment was non-operative. His book ‘The Closed Treatment of Common Fractures’ was ubiquitous, its blue jacket visible on virtually every surgeon’s bookshelf. It isn’t just a recipe book but is full of explanation and rationale. I copied the simple wooden model he used to demonstrate and teach how to reduce a fracture and still use it to lecture the unwary who do not remember to reverse the mechanism of the injury.

As time has passed the operative treatment of fractures has become commonplace and the confidence and skills required to manage them non-operatively have diminished. Now in the midst of the Coronavirus crisis we must manage our patients without competing for those resources vital for the patients needing respiratory support. We will have to revise and regain some lost skills of non-operative care.

The Sir John Charnley Trust have generously made ‘The Closed Treatment of Common Fractures’ available as open access. It is a great resource both as a repository of the lost skills we may now need and also a chronicle of a period of fracture treatment in the UK. Whilst this book is open access you may feel it appropriate having used it to make a donation to the Charnley Trust.
 

Guidance for casting practice in the current COVID-19 pandemic

The BOA Casting Committee has written these guidelines to help with casting practice during the COVID-19 pandemic. The widespread nature of COVID-19 has led to concern about the safety of cast removal and discussion of the best strategies to adopt during that procedure. During COVID-19 there is also a need to reduce hospital attendances, so home management and fewer clinic visits are preferable where this is possible.
 

Initial COVID Surge

All material and documents below were prepared in March/April 2020 during the earliest stage of the COVID-19 pandemic and have been retained for their ongoing relevance.

Regarding trauma surgery and fracture services

The BOA has published guidance on 24th March 2020, entitled ‘Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic’, which is designed as a series of ‘COVID BOASTs’ and includes sections on management of inpatient, outpatient, paediatric and hand trauma.

Regarding elective surgery

All parts of the UK have issued guidance permitting suspension of non-urgent elective surgery (NHS England letter, Scottish government statement,  Wales announcement). As at the end of March, the BOA understands that most, if not all, non-urgent elective operating has now stopped. In England, the advice read that that this suspension would last at least three months but the full duration will depend on various factors as the pandemic progresses.

Additional delays to their planned surgery, at a time when waiting times have already increased significantly in recent years, will have a huge impact on patients, and the waiting list will undoubtedly grow significantly over the coming weeks and months.

  • We have published some ‘Frequently asked questions’ for patients, which we will keep updated as the coronavirus situation unfolds.
  • We are liaising with the NHS England National Clinical Director for MSK to discuss the handling of elective patients over the coming weeks and months, particularly in terms of interim arrangements for those with worsening or ‘red flag’ symptoms and ensuring there are pathways for urgent elective patients.
  • We are highlighting to NHS England that a ‘recovery plan’ will be needed once elective surgery resumes to handle the extended waiting lists.

For GP, diagnostic and outpatient appointments, providers have been asked to roll out remote consultations ‘as a priority’. ‘Face-to-face appointments should only take place when absolutely necessary.’ One of the early articles for the Transient Journal covers this topic.

Two other useful resources are:

If you have found other helpful resources, do let us know and we can add them.