Impact of COVID-19 on Surgical Service Provision, Medical Staffing and Training at a Large Acute NHS Trust in the United Kingdom

Abstract

Introduction:The COVID-19 Pandemic has been widely accepted as a challenging period for the medical community. The impact of the virus posed challenges on the surgical service provisions in the General Surgery department at a large acute NHS trust. The department learnt to adapt to the challenges and changes in the system which can be summarised into 4 phases, ‘Alarm’, ‘Resuscitation’, ‘Stabilisation’ and ‘Adaption’.Materials and Methods: The General Surgical department implemented a ‘Gold Command’, ‘Silver Command’ and ‘Platinum Command’ hierarchal system as a systematic method to make decisions to implement change. To assess the outcomes, electronic records were reviewed for number of NCEPOD cases, emergency laparotomies, elective surgeries that took place over the trust and these were compared at each phase.Results: Between 26/03/20-30/09/20 a total of 1578 surgeries took place, of which 869(55.1%) were emergency operations, from that 152(17.5%) were emergency laparotomies. 709(45.9%) were elective operations, 197(27.8%) performed at the satellite hospitals, 468(66.0%) performed at King George’s hospital and 44(6.2%) at Queen’s Hospital. Conclusion:The BHRUT General Surgery Department has successfully implemented a system to work through the pandemic to minimise its effects on surgical provisions. This template can act as a guide to nationwide hospitals if ever faced again with a similar challenge.

Keywords

• covid19
• general surgery
• management