Hospitals around the world have been forced to adjust in the wake of the COVID-19 pandemic. This as no different for Atrium Health Musculoskeletal Institute (MSKI), which brings orthopedics, sports medicine and spine care under one umbrella. This state-of-the-art specialty center, which has been recognized as one of the best in the nation by U.S. News & World Report, had to dramatically scale back the surgeries performed to only the most essential.
But on May 4, Atrium Health’s Carolinas Medical Center (CMC) and Atrium Health Mercy two Musculoskeletal Institute locations initiated Phase 1 of MSKI's elective surgeries, setting the musculoskeletal care team on the gradual path back to normal. Here, Claude "T." Moorman III, MD, president of Atrium Health's Musculoskeletal Institute walks us through the “COVID-Safe” protocols MSKI has implemented in order to make this possible.
Elective surgeries go on hold
“On March 14, the edict came down from the governor,” explains Dr. Moorman. “We stopped all elective surgeries and did only essential surgeries, which encompasses the emergency surgeries we do.” This includes fractures, incisions, infections, and other injuries that require immediate attention.
“For people who may have been in chronic pain for a while, it was a bit hard to know that these elective surgeries were being put on hold,” says Dr. Moorman. “But given these unique circumstances, people have been very understanding and patient.”
While elective surgeries were paused during March and April, MSKI had to prepare for a potential surge of COVID-19 patients in the hospital and adjust their care accordingly. This meant sequestering the trauma team at CMC's F.H. “Sammy” Ross Jr. Trauma Center, who often work hand-in-hand with the teams at MSKI and dividing them into smaller groups. These trauma groups limited in-person interaction so that there wouldn’t be cross-contamination in the event of infection.
The tiered approach begins
After nearly two months of no elective surgeries, it was time to start resuming these surgeries safely. One key to this process would be patient tiering, which meant starting surgeries for a specific subset of patients first, then moving onto another subset, and so on.
These first “Tier 1” patients to go into surgery would be individuals without comorbidities, meaning they were low-risk for complications. By and large, these people needed only straightforward procedures and could be in and out of the hospital in under 24 hours.
“Everything that can be done virtually is done virtually,” explains Dr. Moorman. “For our Tier 1 patients, that means doing preoperative appointments virtually. That’s just one way we’re taking every step and using every technology we can to protect our patients and our staff.”
The weeks of May 4 and May 11 were dedicated to Tier 1 patients, of MSKI’s normal patient volume. And just a few short weeks later, they began operating on Tier 3 patients.
“Approaching June, we’re now approaching 80% of pre-COVID volumes,” says Dr. Moorman. “As many patients have been sidelined due to COVID restrictions, we will be staffing up in anticipation of doing 110-120% of normal volumes for the second half of the year.”
Putting patient safety first
Patient tiering is only the first part of MSKI’s five-point “COVID-Safe” plan. These protocols ensure patients are safe and protected from infection when they enter the hospital. Here are the other four parts of the “COVID-Safe” plan that MSKI implemented:
- Patient testing: Utilizing an innovative antigen testing plan that was a first for any hospital in the region, each surgical patient is tested 48 hours before their surgery on an outpatient drive-by basis. If the patient tests positive, their surgery is delayed, and they’re quarantined. That way MSKI teammates can be sure that anyone coming in for surgery is negative for COVID-19.
- Personal protective equipment (PPE) and signage. N95 masks, which are tighter-fitting and designed to filter out an estimated 95% of airborne particles, must be used by hospital staff in order to mitigate the spread of infection. Atrium Health even received some support from Hendricks Motorsports, the NASCAR racing team, who used 3D printing to create face shields for Atrium Health doctors and nurses who need additional protection. Additionally, new facility signage and floor markers have been placed to reinforce best practices of social distancing.
- Isolation of COVID-positive patients: Isolating COVID-positive patients away from other patients is key to stopping the spread of COVID-19.“For instance, at Mercy Hospital, where we do musculoskeletal surgery, we’ll transfer any positive patients out of Mercy and have separate spaces for elective surgeries that are away from the ER,” explains Dr. Moorman.
- Teammate screening: History checks are run on teammates every day prior to entering the facilities for their next shift, along with temperature checks and the consistent distribution of PPE.
MSKI looks ahead
Musculoskeletal Institute performs around 200 surgeries on a typical day. Today MSKI is performing around 160 surgeries per day, bringing us closer and closer to normal volume.
“I’m very proud of our team and system for getting that close to normal volume so quickly,” says Dr. Moorman. There’s still work to do, though, and Dr. Moorman hopes that in a few weeks the hospital will operate at above 100% volume — maybe at as high as 120% volume — in order to get to the backlog of surgeries that had to be put on hold.
While Dr. Moorman understands patients’ possible hesitation about going to the hospital right now, he wants them to know that everything that can be done is being done to minimize risk — and that Atrium Health is uniquely positioned to respond to this moment.
“It starts with a fabulous health system,” says Dr. Moorman. “Atrium Health is an industry leader. We have great equipment, we recruit the best and brightest, and we have great relationships with other hospitals in the region. Right now, we’re leveraging all of our excellence to keep patients safe.”
Learn more about Atrium Health Musculoskeletal Institute.
For more on Atrium Health's COVID-Safe approach, visit AtriumHealth.org/Safe
