Author Archives: Paul Jenkins

Winter Virtual SCOT Meeting 2021

Date: Friday 29/1/2021

Time: Committee & Subspecialty Meetings 10am to 12pm

Main Meeting: 12.15pm to 4.30pm

Location: Zoom Webinar – look out for registration details in January 2021.

Although the team are disappointed to announce that the 2021 Winter SCOT Meeting will take place traditional format, we are please to announce that there will be a Virtual Meeting. We will be joined by invited talks from Bob Handley (BOA President), David Warwick and Ciara Stevenson. There will also be the usual Registrar Research Presentations.

We all hope that the normal meeting will return for 2022.

Look out for Registration details in January 2021!

Summer SCOT Meeting

Date: Friday 28 August 2020

Time: 1pm to 5pm

VISIT MEETING PAGE FOR MORE INFORMATION

Sponsors

Due to COVID-19 the Summer SCOT Meeting has been moved to an e-Conference format. It will cover the topic:

Scottish Orthopaedics in the time of COVID

The keynote speakers are:

  • Professor Jason Leitch, National Clinical Director, Scottish Government
  • Professor Phil Turner, Vice-President, BOA
  • Professor Daniel Porter, Tsinghua University, China

There will also be the usual Registrar Scientific Paper session

To register, click here

Criteria for Urgent Orthopaedic Referrals to GJNH (During COVID-19)

GJNH has received requests to provide orthopaedic revision surgery from other boards, because of the ongoing COVID-19 situation. As part of the GJNH’s mobilisation plan, we are able to support boards in Scotland by accepting urgent orthopaedic referrals. This will be dependent on there being sufficient bed capacity and appropriate staffing and may change dependent on GJNH maintaining COVID-free wards. 

The criteria for this patient group would include:

  • Urgent infected revisions 
  • Peri-prosthetic fractures 
  • Dislocations that cannot be reduced
  • Unstable dislocations
  • Complex cases where delay till after the COVID pandemic would have a severe detrimental impact on patient outcome

It would be useful at this stage to ascertain how many patients boards currently have who may fall into this category so we can try and plan capacity going forward.

The process for referring patients would be a consultant to consultant telephone conversation. This would be followed by a manager to manager conversation.

If calls initially could go to Mr Joe Baines ( Lead Orthopaedic Surgeon)

Also if the boards manager could contact Christine Divers (Deputy Director of National Elective Services)

Version 1

2/4/2020

SCOT COViD-19 Statement (27 March 2020)

As the number of COVID patients across Scotland starts to rise significantly several areas of common concern within trauma and orthopaedics are emerging. Most pertain to maximising the safety of staff and patients in the operating theatre. There is also anxiety about the level of trauma service that can be maintained as this situation progresses.

The concern about the operating environment has been elevated in recent days following the publication of the surgical colleges’ intercollegiate guidelines for surgery during COVID (March 25th). It is possible to interpret the guidelines as saying that all patients undergoing surgery should be tested for COVID and where possible surgery delayed until the result known. Where the surgery could not wait the patient should be treated as presumed COVID positive and full protective equipment used. This position presents practical problems for most sites just now as testing capacity and PPE is not in sufficient supply to meet these recommendations. The collegiate advice is also not consistent with Health Protection Scotland (HPS) or Public Health England (PHE) advice which recommends using full PPE only where COVID is suspected. 

Emerging evidence of potentially high levels of asymptomatic carriers of COVID may make the intercollegiate advice sound sensible but the current intercollegiate statement does not represent a policy change from HPS or PHE. The colleges are now working with these bodies and the CMOs to clarify the position but current advice remains to follow the HPS recommendations on PPE precautions.

The Intercollegiate statement also recommended not using laminar flow. Clarification was sought last night from the BOA which it should be noted did not endorse the intercollegiate statement. The BOA position remains that laminar flow should be used for all patients where available. 

We are in a time when numerous groups are hurriedly producing guidance with the best intentions. Where contradictions appear anxiety and scepticism is inevitable. I thought it might be helpful to see an excerpt from a statement by the Infection Prevention Society issued yesterday:

“The Infection Prevention Society are experts in preventing the transmission of infection in healthcare environments. We fully support and endorse the guidance on the use of personal protective equipment (PPE) for the management of COVID-19 from the joint UK Public Health bodies” “ We are therefore calling on clinical colleagues and specialist societies, whose expertise is not infection prevention, to refrain from creating confusion, anxiety and alarm by contradicting the advice from experts in this field.”

It is hoped and expected that we will soon be in a position where patients and staff can be rapidly and reliably tested for COVID and correct precautions taken. In the meantime we must rely on the best evidence we have and the use of sensible measures to protect our teams while still delivering the service our patients need. 

The Scottish T&O leads have been sharing a great deal of advice and common sense via their Whatsapp group and the following may be helpful:

  • Avoid being in theatre during intubation or extubation (this is the time of highest risk) 
  • Encourage use of regional anaesthesia in place of GA whenever possible
  • Use power tools sparingly and on the lowest revs possible to reduce aerosol spread
  • Use smoke extraction with diathermy if possible
  • Use laminar flow 
  • Surgery should be performed by the most experienced surgeon available
  • Keep theatre staff and traffic to an absolute minimum for all cases

The BOA’s recent BOAST guidelines for COVID are important and useful and contain much of the advice above.

As pressures increase we will be facing redeployment of staff and loss of operating capacity. The BOA and SCOT fully support the position that we must protect a viable trauma service to provide life-saving surgery and avoid life changing morbidity wherever possible. That includes continuing to fix hip fractures if at all possible as we know the consequences of not doing so for most. If services feel that they are in a position where this is threatened then please communicate that via the clinical lead or director to SCOT so that we can understand the scale of the problem nationwide and raise the issues with the Scottish Government and BOA. By the same token, T&O will not shirk contributing to the general effort where our skills can be useful and redeployment not detrimental to the trauma service. 

The Scottish T&O community continues to rise to the huge challenges we face. With solid mutual support and good communication between us we stand the best chance of continuing to deliver the best service we can to our patients. 

Al Murray
Chairman, on behalf of SCOT

Resource Update

SCOT have recently updated the “Resources” section of the website. There is a new section on COViD planning where documents are shared for the use of clinical teams having to urgently redesign services.

There is also a new ACRT section which will include shared resources such as example “Patient Information Leaflets” and other pathways.

SCOT Statement on COViD-19

As Scotland enters the next phase of the COVID-19 response the orthopaedic community has been active in playing its part. We are all now implementing plans to postpone our elective services for all but the most urgent cases and reorganising to ensure we can continue to provide a safe trauma service for the duration of the crisis. 

SCOT has formed communication groups to ensure effective communication between CDs and leads across the country. Through this there has already been very useful sharing of ideas and updates on local situations. The following is a summary of the picture for T&O at the moment:

  • There are discussions about possible regionalisation for vital trauma surgery such as hip fractures but at present health boards need to plan for managing these patients within their own facilities. It is important for us in T&O to ensure that Boards appreciate the vital nature of preserving trauma surgery which provides quick and effective treatment and minimises in-patient stay. 
  • Some centres are reporting difficulty having their T&O teams fitted for protective equipment. There has been an issue with central supply and some delays encountered. Any activity involving an intubated patient who is positive for coronavirus is considered high risk and orthopaedic surgical teams must be given sufficient priority for fitting and supply of protective equipment. The BMA has issued a statement offering support where problems are being encountered. SCOT would also like to hear about these issues.
  • With the postponement of most elective care some teams are looking at providing a clinic service from previously unused sites remote from the main hospitals. For example, NHS Lanarkshire are tasking the ESP workforce to plan and deliver what they can to ensure that urgent referrals and returns can be seen. 
  • Many T&O teams have been asked to plan and provide a minor injuries service to remove this burden from the Emergency Departments. This requires a fair amount of planning and will be a particularly useful area for us all to share information such as protocols for certain conditions or safe use of sedation. 
  • Another useful development adopted by some centres has been planning rotas to cover in-patients and ambulatory trauma but also build in time for teams to work from home for a few days at a time to reduce fatigue and exposure to infection. 

This is a rapidly evolving situation to which orthopaedic services need to respond urgently. Sharing of concerns, problems and above all solutions to the challenges we face will be vital in supporting each other and tackling this unprecedented situation in the best way we can. 

Al Murray

Chairman, on behalf of SCOT

16/3/2020