Introduction
The Covid-19 pandemic has demanded us to rethink our approach to healthcare. Through necessity to minimise disease transmission, the Auckland regional Department of Plastic, Reconstructive and Hand Surgery at Middlemore Hospital has implemented a new model of care for acute patient presentations to the busiest mixed (Adult/Paediatric) emergency department in Australasia. Our adaptations to assessment and treatment of acute cases in response to Covid-19 have cemented our “new normal” service provision. We aimed to evaluate the impact of these changes, with an emphasis on acute waiting times.
Methods
A new model of care was implemented at Middlemore Hospital since January 2020. This manifested as increased support for acute admitting registrars and included set-up of the Plastic and Hand Assessment and Discharge Unit (PHADU). Prospectively maintained emergency department data from the first half of 2020 was evaluated and compared to previous years to determine effect of these implementations.
Results
A total of 2458 patients presented between January to June 2020. The trend of 1/3 plastics to 2/3 hands cases was consistent throughout. Majority (97%) of cases were considered triage 3, 4, or 5. A combined triage waiting time of 101 minutes was observed over this period. An improvement from previous years; 137 and 139 minutes in 2018 and 2019, respectively.
Discussion
Our department typically provides an extremely busy plastic and hand surgery service which manages approximately 5% of the total annual acute caseload for the hospital. The Covid-19 pandemic has most certainly impacted our acute presentations but has also required an adaptation to our service provision, and these changes have become our “new normal”. Overcoming pandemic related obstacles have led to a silver-lining of reduced waiting times for our acute patients.