‘Overnight, things changed. Suddenly, we were in it’: a qualitative study exploring how surgical teams mitigated risks of COVID-19
Leila Rooshenas,
Jane M Blazeby,
David Jayne,
Natalie S Blencowe,
Anni Skilton,
Marcus Jepson,
Peter Hutchinson,
Sian Cousins,
Daisy Elliott,
Sangeetha Paramasivan,
Jenny L Donovan,
Cynthia Ochieng,
Martin Birchall,
Kerry NL Avery
Affiliations
Leila Rooshenas
1National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
Jane M Blazeby
University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
David Jayne
Addenbrooke`s Hospital, Cambridge, UK
Natalie S Blencowe
3 Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
Anni Skilton
National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
Marcus Jepson
Population Health Sciences, University of Bristol, Bristol, UK
Peter Hutchinson
Royal College of Surgeons, NIHR Research Group on Acquired Brain and Spine Injury, Dept Clinical Neurosciences, University of Cambridge, Cambridge, UK
Sian Cousins
National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
Daisy Elliott
1 National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
Sangeetha Paramasivan
Population Health Sciences, University of Bristol, Bristol, UK
Jenny L Donovan
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
Cynthia Ochieng
National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, UK
Martin Birchall
4Department of Otolaryngology, University College London Hospitals, London, UK
Kerry NL Avery
NIHR Bristol Biomedical Research Centre, Bristol, UK
Objectives COVID-19 presents a risk of infection and transmission for operating theatre teams. Guidelines to protect patients and staff emerged and changed rapidly based on expert opinion and limited evidence. This paper presents the experiences and innovations developed by international surgical teams during the early stages of the pandemic to attempt to mitigate risk.Design In-depth, semistructured interviews were audio recorded, transcribed and analysed thematically using methods of constant comparison.Participants 43 participants, including surgeons from a range of specialties (primarily general surgery, otolaryngology, neurosurgery, cardiothoracic and ophthalmology), anaesthetists and those in nursing roles.Setting The UK, Italy, Spain, the USA, China and New Zealand between March and May 2020.Results Surgical teams sought to mitigate COVID-19 risks by modifying their current practice with an abundance of strategies and innovations. Communication and teamwork played an integral role in how teams adapted, although participants reflected on the challenges of having to improvise in real time. Uncertainties remained about optimal surgical practice and there were significant tensions where teams were forced to balance what was best for patients while contemplating their own safety.Conclusions The perceptions of risks during a pandemic such as COVID-19 can be complex and context dependent. Management of these risks in surgery must be driven by evidence‐based practice resulting from a pragmatic and novel approach to collation of global evidence. The context of surgery has changed dramatically, and surgical teams have developed a plethora of innovations. There is an urgent need for high-quality evidence to inform surgical practice that optimises the safety of both patients and healthcare professionals as the COVID-19 pandemic unfolds.
