Rising to the challenges in frontline surgical care during COVID-19

surgeon selecting instruments

By Mr Guy Martin, Clinical Lecturer, Department of Surgery & Cancer

The COVID-19 pandemic is the biggest health crisis the world has faced in a generation. It has led to an unprecedented reaction from every corner of the globe. 

As a surgeon and clinical academic, I feel privileged to be a part of the response. I remain astounded at the selfless commitment, dedication and quality of care delivered by every person working on the frontline in health and social care. I have also witnessed the impact that COVID-19 has on patients, which extends far beyond the more well-known respiratory aspects of the disease that have been the primary focus. 

Working as a vascular surgeon, I have seen people present a range of problems associated with COVID. Some are related to blood clots, such as a condition called acute limb ischaemia, where there is a sudden lack of blood flow to a limb. Unfortunately, this sometimes requires amputation. 

Nonetheless, broadly speaking our surgical workload has been substantially reduced. All but the most urgent elective surgeries have been cancelled and far fewer patients with acute vascular problems are being referred to us via their GP or A&E. Yet those who do come in to see us are sicker or have been delaying treatment due to the crisis. This, unfortunately, can lead to much poorer outcomes. 

Everyday risks

Looking ahead, surgeons have concerns about how we are going to catch up with all our urgent elective work that has been cancelled. There are questions over how we will be able to do this safely and quickly, given that COVID is likely to be the new normal for many months to come.

Right now, all health workers are dealing with a number of challenges. Shortages of personal protective equipment (PPE) for those working in the NHS has been a well-documented issue in the media. I have been lucky, and have always been able to access the PPE I need. Worryingly, we know this is not the case for many. Significant numbers of healthcare workers are understandably concerned about accessing quality PPE. The burden of placing yourself in high-risk areas, without proper protection is huge.

The issues with PPE don’t stop at shortages. While critical for safety, wearing PPE can cause problems, impairing your senses and ability to effectively communicate, making even the most routine tasks far harder to do well. This is a particular issue in the operating theatre.

It is vital to ensure that healthcare workers’ physical, emotional and mental well-being are also protected. Some of my colleagues have worked every weekend since the crisis began. Others have had to leave their families to protect them. Many, myself included, have lost current or past colleagues and friends to COVID-19. 

A global hub to tackle challenges together

In recognition of the unparalleled challenges facing healthcare systems around the world from the COVID-19 pandemic, we created the PanSurg Collaborative. We are a group of clinicians and academics based at Imperial’s Institute of Global Health Innovation and Department of Surgery and Cancer. 

PanSurg is a global hub for surgeons and other healthcare professionals to share experiences, policy, data and research that will facilitate the delivery of safe and effective care during COVID-19. Importantly, we felt the need for an initiative to help those on the frontline look after and protect each other during the pandemic. 

Traditional clinical research typically focuses on gradual innovation and struggles to deliver changes to practice at pace and scale. At PanSurg we have tried to take a different approach. We want to make a difference in the here and now and have a real impact on patients and staff through progressive learning, new approaches to sharing insights and rapid data generation with industry partners.

We have launched a range of research projects including studies specifically aimed at protecting staff. Our PanSurg Staff and Safety Epidemics (SSAFE) study seeks to examine the safety attitudes, psychological well-being and burnout of frontline healthcare workers in real-time across all phases of the pandemic. 

We hope SSAFE can give us insights into targeted interventions to improve staff wellbeing. Through the survey we’re conducting, we plan to provide evidence for workforce planning and organisational change for healthcare professionals. 

As well as our research projects, PanSurg’s webinar series has been an important way to share experiences and knowledge. Here, we invite experts from across the globe to discuss a range of relevant and current issues, from general areas of concern for health workers to more specific topics. For example, our recent session focused on morale and wellbeing of the workforce, featuring Dr Clare Gerada, medical director of NHS Practitioner Health Programme. 

Protecting staff and patients

I am in awe of those who have had to deal with the full brunt of the crisis and in particular those who are not often recognised for their crucial contribution, such as hospital porters or cleaners. The risks to all of those working in health care are very real, and the COVID-19 pandemic will remain a huge challenge for many months to come. We must seek to raise awareness of the key issues. With PanSurg, we hope to rapidly innovate and generate new evidence to address these. 

We want to share our knowledge freely and widely to deliver the best care to our patients. Crucially, we strive to look after and protect the staff who selflessly provide that care every single day.

Find out more about PanSurg here.

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