24 April 2020
Dear Fellows and Members,
I hope that you, your families and colleagues remain safe and well.
In light of the ongoing disruption to the public health service, surgeons across the country are talking about the criticality of a national plan for the provision of surgical care for semi-urgent and time-dependent conditions where it is clear that patients will be exposed to long-term harm if their surgery is delayed.
We face the quandary of providing safe and high-quality care in the COVID-19 environment and social distancing guidelines will undoubtedly influence the numbers that can safely attend at an outpatient clinic.
RCSI’s National Clinical Programme in Surgery and Trauma and Orthopaedics are leading our efforts in this area. The current ad hoc arrangements provide no oversight or quality assurance of patient care and we have real concerns about the inequity of access and lack of continuity of care for many of these patients.
Next week the National Clinical Programme in Surgery intends to publish a specialty specific guide to surgical prioritisation during the pandemic. The guide will identify the urgent scheduled surgical conditions that require surgical intervention within a two month timeframe, those that can be deferred and alternate treatments that can be considered. In addition to this work, each of the specialty advisors are currently working on a recovery plan which will feed into an overall surgical recovery plan which we will publish in the coming weeks.
Anticipating a phased return to planned surgical services over the coming weeks, the National Clinical Programme in Trauma and Orthopaedics is developing a recovery plan which will recommend that we should commence planned surgery services in either standalone centres such as Cappagh, Croom, SIVUH, and the private hospitals that are currently available to our patients, once protocols for follow up and clinical governance are in place. They are also recommending that our patients are enrolled on the Irish National Orthopaedic Register (INOR), which is currently not operational in the private hospitals.
At the outset of the pandemic, in order to free up facilities and personnel for the COVID-19 surge, a decision was made to consolidate a significant proportion of the trauma workload. In Dublin trauma is being concentrated in three hospitals, the National Orthopaedic Hospital, Cappagh, St Vincent’s University Hospital and Tallaght University Hospital. In the south of the country, SIVUH is managing a lot of trauma and in Waterford some trauma cases are being managed in a private hospital. We anticipate that with the easing of restrictions the trauma burden will increase. We need to continue to consolidate trauma in a small number of hospitals, preserving our acute hospitals capacity to cope with the ongoing demands of COVID care.
The issues surrounding the use of PPE in various surgical procedures remains somewhat controversial, and, as we return to planned operating, cognisance should be given to the PPE that will be required. When making decisions about planned surgery, we have a duty to consider the impact on the national supply of PPE and what other healthcare settings it may be required in.
This week in the National Surgical and Clinical Skills Centre at 26 York Street, RCSI Surgical Affairs continued their assessment of personal respirator PPE for surgeons in practice. Surgeons in high risk specialties where aerosolised procedures put the team at risk, joined the multidisciplinary operating room team to test this PPE during simulated procedures. Anaesthesiologists, operating room nurses and surgical teams from general surgery, ENT and plastic surgery came together to test for possible issues associated with performing laparoscopic and head and neck procedures wearing personal respirator PPE. The team assessed the comfort, fit, team communication and other technical factors essential for performing safe, effective surgery for patients while protecting the operating room team. I will continue to update you on the outcome of this work in my updates.
To ensure we have broad input into our National Surgical Recovery plan, our next two weekly webinars will be devoted to this topic. Next week's webinar will be a discussion around preparing for a phased return to surgical service, with contributions from Prof. Deborah McNamara, Co-Lead of the National Clinical Programme for Surgery, RCSI, Mr David Moore, Co-Lead of the National Clinical Programme in Trauma and Orthopaedics, Mr Paddy Kenny, Co-Lead National Clinical Programme in Trauma and Orthopaedics and Brian Kirirons, President of the College of Anaesthesiology.
You can register for the webinar, which takes place next Wednesday at 6pm GMT, here.
The following week’s webinar will look at the wider perioperative stakeholder group and get their input and thoughts on what needs to be included in our recovery plan.
Many clinicians are now engaging with patients using telecommunication tools and these, of course, may challenge their normal practices. Evidence shows that using good communication skills leads to higher quality care and improved quality of life for patients and those who care for them. The COVID-19 pandemic makes communication both more difficult and more important than ever, particularly for people who are at highest risk of becoming very sick.
In a collaboration with the HSE, the National Healthcare Communication Programme (NHCP) and International Association for Communication in Healthcare (EACH), RCSI has developed and launched a free online course to help clinicians navigate telephone consultations with patients and prepare for potentially difficult conversations about COVID-19 treatment. This activity has been approved for 3 CPD credits.
Materials included in the course were developed based on expert knowledge and information on COVID-19 available at the time of publication and will be updated as the situation evolves and as we receive feedback from users. The materials are also based on content from a suite of NHCP Modules which have been delivered to over 2,000 health and social care professionals across the healthcare services since 2018. RCSI has been providing training in Human Factors to surgeons and emergency physicians in this pioneering programme based in the National Simulation Centre in RCSI. You can find out more here.
The COVID-19 pandemic is having a significant impact on clinical practice for all of us. RCSI recognises that our doctors and surgeons will face many stressful situations during and after this crisis. As you strive to deliver the best possible care for your patients, it is crucial that you look after your own mental and physical wellbeing.
The RCSI Institute of Leadership and Department of Surgical Affairs have compiled a suite of resources aimed at supporting your health and wellbeing dealing with the current COVID-19 crisis. You can access these resources here.
Please take care and stay safe.
Mr Kenneth Mealy, President of RCSI