• Reference Number: HEY1132/2020
• Departments: Coronavirus - COVID-19, Orthopaedics
• Last Updated: 30 June 2020

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Orthopaedic care

The Coronavirus (COVID-19) pandemic is placing huge demands on the entire NHS and is changing the way we work. This leaflet is to help you understand how your surgical care will be affected.

Delay

It is likely that your planned operation will be delayed, possibly for several months. This is because during the pandemic there has been a major reorganisation of our workforce, bed capacity, intensive care units and Emergency department and is why we have been unable to undertake routine operations. Theatre efficiency has also been reduced by the increased precautions now necessary for all patients. We now have a larger waiting list of patients.

We are prioritising theatre lists so that if you need an operation as an emergency to save life or limb this will not be delayed.

Can there be any complications or risks?

Your consultant will have discussed the risks and benefits of the operation with you, but it is important to understand that there are specific risks during the Coronavirus (COVID-19) pandemic that you must also think about. Coming into hospital will increase your risk of contracting Coronavirus (COVID-19) as you may come into contact with members of staff and / or patients who could be unknowingly carrying the virus.  It is also possible that you are infected, but not yet showing symptoms.  The chance of contracting Coronavirus (COVID-19) around the time of surgery is unknown but probably quite low and is likely to decrease over time.

If you do become infected with Coronavirus (COVID-19) around the time of surgery you have a high chance of serious complications and approximately 20% (1 in 5) chance of death. Some patient groups have a higher and some a lower risk. This is a rapidly changing situation and our advice is based on the current available evidence.

The NHS is now asking all patients who are due to have planned surgery to self-isolate for 14 days before and after surgery, to reduce their risk of contracting Coronavirus (COVID-19).  We are also testing patients for Coronavirus (COVID-19) before surgery. These measures are intended to minimise the risk.

We are also aiming to reduce the risks with the following measures:

• Reducing the number of people in our hospital – our wards are restricting the numbers of visitors to help prevent the spread to vulnerable patients.
• Our staff are provided with Personal Protective Equipment (PPE) to prevent the infection moving from person to person.
• All of our patients admitted as emergencies are tested and we have created safe environments for patients admitted with Coronavirus (COVID-19).
• We have introduced social distancing in areas where we can.
• All our practice follows the current national guidance.

Changes to the process

Before your operation

Most of your consultations will occur by telephone or by letter. The added risks of catching Coronavirus (COVID-19) will be discussed and in some cases this may change your treatment options. Your pre-anaesthetic assessment may be done by telephone.

We will arrange for you to have Coronavirus (COVID-19) testing approximately 72 hours before your operation by taking a nose and throat swab. Your operation will to be postponed if you are unwell or test positive.

In hospital

Your operation may not take place at the hospital site that you were expecting. We are operating on NHS patients at the Spire Hospital, Anlaby as well as Castle Hill Hospital and Hull Royal Infirmary.

Circumstances will be very different in hospital.  Wards will be reorganised to provide areas that are as Coronavirus (COVID-19) free as possible.  Staff will be wearing protective equipment such as surgical masks, visors, aprons, theatre clothing and / or boiler suits to provide added protection from the virus for all patients and staff.

You may not meet your surgeon until the day of your treatment and they might not be the same surgeon you were expecting. They will  be experienced and trained to perform your operation.

Unfortunately, it is unlikely that your family and friends will be able to visit you whilst you are in hospital.

After your operation

We will discharge you as soon as it is safe and your follow-up consultations and physiotherapy will be over the telephone whenever possible.

Individual decision

We recognise that, knowing these additional risks, you may not want to proceed with your operation at this time.  If you decide to delay your treatment, your consultant will inform you of the risks of not proceeding and any alternative treatments that they may be able to offer you.

If you decide not to proceed at this time but still want your operation at a later date, we will note this in our records.  If you decide to continue with your operation, we would like you to take the additional precautions.

At the time of your surgery, if you have symptoms of Coronavirus (COVID-19), or have been in contact with someone else who has symptoms, or your test comes back positive, we will very likely delay your treatment.

Your current options are:

1. Remain on the waiting list as planned (please remember there will be a delay).
2. Postpone the operation for a period of time until it may be safer to operate. We will contact you again in three to four months to update you and confirm if you would like to remain on the waiting list.
3. Cancel your surgery, with the option to be referred back by your doctor in the future if you want to discuss surgery with a specialist again.

Helpful information

Should you have a non-urgent question please contact your consultants secretary through the hospital switchboard (01482) 875875.

For emergencies, please attend the emergency department at HRI

For information on self-help please see the following websites

• https://www.nhs.uk/conditions/arthritis
• https://www.versusarthritis.org/
• https://www.arthritisaction.org.uk/

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.