For the surgeons and staff at Novant Health Orthopedics & Sports Medicine Institute, it seems like a lifetime ago that they were operating – both literally in the OR and in the sense of having a normal routine. But it was just March 23 when all non-time-sensitive procedures were put on hold due to the COVID-19 pandemic.
“And those types of surgeries account for probably 90% of what we do,” said Zack Landry, vice president of Orthopedics & Sports Medicine Institute.
Following guidelines from the American Academy of Orthopaedic Surgery on time-sensitive cases, the team has still been performing the other 10% of its work – operating on trauma patients and on any fractures that can’t wait. “In cases where delaying surgery would cause a more difficult recovery, we’re operating,” Landry said.
“Our surgeons have performed time-sensitive fracture care for our weekend warriors, as well as routine trauma cases,” said Dr. Bryan Edwards, orthopedic surgeon and senior vice president of the Orthopedics & Sports Medicine Institute.
Everyone is eager to return to work. And patients – whose pain from an orthopedic injury or condition may have intensified during these weeks – are more than ready. On May 4, Novant Health will resume non-time-sensitive surgery and procedures across North Carolina.
“To ensure high standards for safety and preserve inpatient bed capacity, we will continue to delay elective procedures requiring more than two nights’ stay at the hospital, such as complex revision joint surgery,” Edwards said. “Surgeries that will resume on May 4 include elective primary hip and knee replacement, arthroscopic sports medicine procedures” and routine hand, foot and ankle procedures.
Easing into a new normal
“Our team is as committed to keeping our orthopedic patients and team safe as we all have been to helping COVID patients improve,” Landry said. “The staff is cautiously opening the doors to the clinic visits and elective surgeries, while keeping safety precautions in place. The return to normal operations will happen gradually.”
Landry said they would start with the simplest procedures first – those that are less resource-intensive and those generally associated with a quick recovery. He also added they would start with patients who are safely able to leave their homes. Patients in high-risk categories and those with complex chronic conditions “may not be among the first elective patients we operate on.”
“As we resume surgery, orthopedic surgery patients will not be in a COVID wing of the hospital,” he continued. “COVID patients will continue to be isolated for everyone’s safety.”
Screening will be imperative. Landry anticipates that patients preparing for surgery will be screened 72 hours in advance of their procedure. If they test positive for COVID, elective surgery will be postponed. Those with a negative test result will isolate themselves to ensure they remain COVID-negative before surgery.
Open … but with safeguards in place
The orthopedic staff hasn’t been idle during these weeks. Some team members were working from home and calling patients to check in on them.
“People are still tearing ACLs,” Landry said. So, most clinics were kept open – just with a reduced staff. And any patient who came to a clinic was screened for COVID at the door. After having their temperature checked, patients were allowed to wait in their cars rather than in a waiting room. A staffer would come to the parking lot or call a cell phone to let them know a doctor was ready to see them.
Landry and Edwards implemented a mitigation plan across all Novant orthopedic clinics to handle a worst-case scenario. They used an “Alpha-Bravo team model.” Half the team members were part of the Alpha company, and they worked one week. The next week, the Bravo company would be on duty. Had a patient come to one of the clinics and tested positive for COVID during an Alpha week, the Alpha team would have been quarantined, and the Bravo team – those who hadn’t been exposed – would’ve taken over.
Still, clinics haven’t been seeing the usual number of patients. People who might typically seek medical attention for an injury are delaying it, Landry said. “There’s a fear of going into a medical facility, first of all. Beyond that, people may be delaying because of the potential uncertainty with a job situation. They may just be waiting to see what their new reality is.”
Landry and Edwards understand this situation, but also want people to know that delaying can exacerbate the problem – worsening symptoms, making for more complicated surgery down the road, a longer recovery. And if people are taking prescription pain medication for longer than intended, there’s a risk of addiction.
An orthopedic surgeon might advise a post-op patient to be slow, steady and careful in recovery. Novant Health’s orthopedic team is taking its own advice.