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Learning from minor injury care restructure during the COVID-19 pandemic: a phenomenological study of orthopaedic clinical leaders
  1. Sophie Gatfield1,
  2. Daniel Yeomans1,
  3. Henry Walton2,
  4. Will Mason1,
  5. Vinay Takwale1
  1. 1 Trauma and Orthopaedics, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
  2. 2 Clinical Workforce Productivity Team, NHS England and NHS Improvement London, London, UK
  1. Correspondence to Sophie Gatfield, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 3NN, UK; sophie.gatfield{at}nhs.net

Abstract

Background During peaks of the COVID-19 pandemic, trauma and orthopaedic departments in England have been asked to support emergency departments by providing first contact care for minor injuries. The subsequent requirement for departmental restructure has resulted in a variety of service pathways across the country. This study aimed to explore the experiences of different clinical teams and identify any consistent themes or reflections, which could be applied to continuous improvement of minor injury care.

Methods Using a phenomenological approach, nine semistructured interviews were conducted with trauma and orthopaedic clinical leads across England whose departments provided support to minor injuries service. Detailed transcripts were then analysed to identify themes for discussion. Interviews were conducted via video conferencing in November 2020 at the end of England’s second national lockdown.

Results Each of the nine orthopaedic departments provided support for minor injuries, six of which involved creating a new unit. Themes included the value of collaborative working between the emergency department and orthopaedic staff across multiple professions and the benefit to patients of early definitive decision making. A common theme was reduced barriers to change during the pandemic. Examples of long-term service improvements triggered by the pandemic focus on pathways to enable consultant to provide early opinions for injured patients.

Conclusions A range of experiences have demonstrated themes in reflection from service leaders. Departments across the country should be encouraged to consider what improvements to their own service may be applied long term. Resource limitations, staff well-being and education must all be considered.

  • secondary care
  • research
  • pathway
  • COVID-19
  • clinical leadership

Data availability statement

All trust data used for contextual information was obtained from publicly available sources. Detailed transcripts of interviews are not available as permission to publicise this information was not sought from participants.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

All trust data used for contextual information was obtained from publicly available sources. Detailed transcripts of interviews are not available as permission to publicise this information was not sought from participants.

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Footnotes

  • Contributors SG is the corresponding author, conducted interviews and drafted the manuscript. DY and HW reviewed summarised transcripts of interviews to agreed themes and reviewed drafted the manuscript. WM recruited participants and edited the manuscript. VT reviewed and edited the manuscript prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.