Preparing an orthopedic department for COVID-19

Figures & data

Figure 1. Questionnaire evaluating needs-driven educational activities: identification, eligibility of participants and response rate.

Table 1. Needs-driven educational activities offered at the orthopedic department related to the COVID-19 pandemic response in order to prepare for COVID-19, ordered by mean (CI) recommendation on a 7-point Likert scale

Educational activity	Faculty, format, schedule, and objectives	Sequential order (needs-driven)	Duration	Participants (max. 101)	Recommend to colleagues mean (SD)
Full-scale in situ simulation team training	ABCDE approach to the patient with COVID-19, teamwork and communication, correct use of PPE	3	60 min	88	6.8 (0.5)
Use of personal protective equipment (PPE)	Donning and doffing procedures, types of PPE, precautions required regarding contact and aerosols, nursing and medical staff teamwork within the isolation room	1	Multiple courses mixed with simulation	92	6.4 (0.8)
Organizational structure of the COVID-19 department	E.g., distribution of doctors, examinations and tests, interdisciplinary cooperation	2	30 min	63	6.4 (0.8)
Arterial blood gas analysis	Arterial puncture analysis and using the machinery correctly, transport and timeframe for analysis; max. 2 participants/instruction	4	20 min	39	6.2 (1.2)
COVID-19 related deaths	Focus on the COVID-19 guidelines for deaths and the subsequent work practices	4	30 min	86	6.1 (0.9)
Lung physiotherapy	Patient positioning, mobilization, other aspects	1	30 min	85	6.1 (0.9)
Basic oxygen therapy and airway suctioning	Practical skills training	3	10 min	85	5.9 (1.1)
The elderly patient and medical issues	Educator launched discussion on considerations regarding the weakened elderly patient who has COVID-19	2	45 min	84	5.7 (1.1)
Fluid resuscitation and nutrition	Sufficient nutrition and correct use of feeding tubes, fluid restrictions related to COVID-19	2	30 min	81	5.6 (1.2)
Delirium—symptoms and causes	Interventions and confusion and assessment methods (CAM)	4	45 min	59	5.6 (1.3)
Hand hygiene	Additional focus to avoid contact transmission of COVID-19	1	E-learning and video	101	N/A
Following nursing staff at the Departments of Endocrinology and of Respiratory Medicine	Peer-to-peer work observation and teaching Discontinued due to inefficiency	1	7.4 hours	7	N/A

For chronological order please refer to the column sequential order (needs-driven).

Figure 2. Mean results (CI) of the question: “Before/after participating in the educational activities, how comfortable did you feel about: (1) using PPE correctly?, (2) avoiding contracting COVID-19 at work?, (3) providing care to COVID-19 patients?

Table 2. General recommendations for orthopedic departments on how to use competencies and establish needs-driven educational program in order to prepare for unprecedented situations

Prepare • Establish a steering committee to facilitate and support continuous learning activities based on relevant guidelines and the staff’s need and feedback. • Prepare 2–3 educational activities with relevance to protecting employees, i.e., in-situ simulation focusing on use of personal protection equipment and hygiene. Facilitate • Conduct interdisciplinary in-situ simulation. • Adapt simulation scenarios to the needs of the given department/staff. • Conduct ad hoc assessments of educational program to promote needs-driven initiatives. Organize • Establish knowledge-sharing across departments/clusters. • Use competencies and resources wisely. Redistributing orthopedic surgeons to manage minor and major orthopedic injuries in the ED is a minor disruption compared with taking care of medically ill patients suffering from COVID-19. This use of core clinical competencies may be applicable in a large variety of hospitals in Scandinavia and around the world.