# Lessons From the Pandemic for Hand Surgery in Wales

## TL;DR

This study explores how hand surgery departments in Wales adapted during the pandemic and identifies lessons to improve future practices.

## Contribution

The study provides insights into pandemic-driven changes in hand surgery practices and proposes strategies for improved efficiency.

## Key findings

- 100% of respondents changed routine management of elective hand cases during the pandemic.
- 83% modified their approach to managing hand trauma.
- A dedicated hand fracture clinic and ring-fenced day-surgical unit were highlighted as key adaptations.

## Abstract

Aims

In March 2020 the World Health Organisation (WHO) declared the COVID-19 virus a global pandemic. The United Kingdom's National Health Service (NHS) was placed under unprecedented pressure and hospitals were forced to adapt their working practices to continue offering world-leading healthcare.

This project aims to highlight the lessons learnt within hand surgical departments throughout Wales. Using this knowledge, we can consider how these lessons can be implemented in both emergency and elective hand practice.

Methods

A qualitative questionnaire was distributed to hand consultants working across Health Boards within Wales during the pandemic. The questionnaire encompasses the impact of the pandemic on usual practices and what local departmental changes have been implemented in response to patient needs.

Results

Across the Welsh Health Boards, we received 12 of 19 consultant responses achieving a 63% response rate and captured data from five of seven (71%) major health boards. The questionnaire revealed that 100% of respondents changed their routine management of elective cases whilst 83% changed their management of hand trauma. 50% reported the need to issue updated management guidelines to junior doctors. The major highlighted lessons were the importance of a dedicated hand fracture clinic, coupled with a ring-fenced day-surgical unit (offering regional anaesthetic support) to manage trauma and elective patients independently from general trauma.

Conclusion

This qualitative research demonstrates that the pandemic drove the restructuring of many hand departments enabling us to find new, efficient ways of working. We must take these lessons forward to tackle the ever-growing waiting list, increased patient expectations and increasingly complex workloads.