Protocolo de intervenção do Departamento de Ortopedia e Traumatologia de um hospital universitário de alta complexidade para enfrentamento da pandemia de COVID-19

Abstract

Resumo Objetivo Descrever os protocolos implementados para adequar a equipe ortopédica à pandemia de COVID-19 e, secundariamente, avaliar o comportamento de variáveis hospitalares e departamentais frente à implementação das medidas. Métodos Estudo retrospectivo com descrição de três protocolos: 1) Redução do risco de contágio dos pacientes e profissionais de saúde; 2) Adaptação das atividades laborais, acadêmicas e científicas; e 3) Adaptação do tratamento ortopédico frente à pandemia. Foram analisadas variáveis hospitalares e departamentais como: número de pacientes atendidos no pronto-socorro e ambulatórios, pacientes internados, casos suspeitos e confirmados nos pacientes e na equipe ortopédica, mudança das atividades de ensino do modo presencial para videoconferência, e número cirurgias. Foi comparado o período A, de 03 a 16 de março, com o período B, de 17 a 30 de março, que corresponde à implementação dos protocolos. Resultados Houve diminuição do número de pacientes atendidos e do número de pacientes internados. Foram notificados dois suspeitos e um confirmado. Dos integrantes do departamento, 12 foram suspeitos e 6 confirmados. Manteve-se a frequência semanal das aulas e as reuniões clinico-científicas diminuíram de dezpara três. Houve redução no volume de cirurgias. Conclusões O presente estudo demonstrou a viabilidade e a eficiência da rápida implementação de protocolos de intervenção em meio ao cenário de pandemia por COVID-19. Os protocolos focaram na redução do risco de contágio dos pacientes e profissionais de saúde, na adaptação das atividades laborais, acadêmicas e científicas, e na adaptação do tratamento ortopédico. Com sua aplicação, mantiveram-se as atividades assistencial, acadêmica e científica funcionantes, priorizando-se medidas de enfrentamento à COVID-19.

Impact of the Covid-19 Pandemic on Orthopaedic and Trauma Surgery – A Systematic Review of the Current Literature

“…Furthermore, ten studies (6, 7, 9, 19, 23-25, 27, 28, 30) investigated the number of emergency and trauma visits, showing a decrease ranging between 37.7% and 74.2% (7,19). Five studies provided information on the change in the number of elective visits (6,19,20,25,27). The decrease in the number of elective visits ranged between 50.0% and 74.0% (6,19).…”

“…A total of 23 studies presented a comparison of the number of performed orthopaedic and trauma surgeries (6, 11-15, 19, 20, 23-25, 28, 29, 32-41). Of these 14 reported the total number of surgeries (12,13,15,19,23,25,28,32,33,35,(37)(38)(39)41). While most studies (n=13) showed a decrease between 5.4% and 88.8% in the total number of surgeries, an increase of 47.8% was observed in one trial (38).…”

Health workforce surge capacity during the COVID‐19 pandemic and other global respiratory disease outbreaks: A systematic review of health system requirements and responses

“…The studies can be grouped into three categories: those focussing on a simulated influenza outbreak (eight articles, mostly published before 2011) [25][26][27][28][29][30][31][32] ; those assessing temporal effects of the H1N1 pandemic (three articles published between 2011 and 2015) [33][34][35] ; and those assessing effects at the early stages of the COVID-19 pandemic (five articles published in the first half of 2020). [36][37][38][39][40] Three-quarters (75%) of the retained articles covered high-income countries in Europe (five studies), North America (4), and Oceania (3); two (13%) studies covered upper-middle-income countries in South America; one (6%) covered a high-income economy in Asia; and one (6%) used a model population. Only five (31%) of the studies assessed the effects of a specific HRH intervention, notably, training and mobilization of healthcare workers to address pandemic-time health system capacity in a given context; most (63%) of the studies simply simulated increased demand for health workers with varying hypotheses surrounding supply factors, and one (6%) considered different staffing scenarios using inferential statistical modelling.…”

“…36 In a study of an urban reference hospital in Brazil, administrative data were used to track adaptation of work including changes in academic and scientific activities among orthopaedic personnel surrounding the rapid implementation of intervention protocols to address the COVID-19 outbreak. 37 Given short-term reduced demand for surgeries, orthopaedists were trained in the care and management of patients with low-complexity flu syndromes while numbers of clinical-scientific meetings were decreased. The authors contended that the study demonstrated the feasibility of rapid implementation of intervention protocols across hospital departments to meet pandemic-related needs.…”

“…Fewer than one-third of the reviewed studies assessed the effects of a specific HRH intervention, and those that did largely focused on short-term emergency response training and mobilization goals. Among the recommended policy actions included the development of protocols to inform reallocation of resources and task shifting, 37,39 pandemic-adjusted staffing models, 30,32,40 expanded training for in-service workers, [27][28][29]37,38 and engagement of a variety of types of volunteers as a standby pool. 27,39 Such activities were argued to facilitate the rapid implementation of HRH supply enablers to address surge capacity, although the findings from any given study context tended to be of unclear generalizability to different countries and settings.…”