. 2020 May 11:10.2106/JBJS.20.00709. doi: 10.2106/JBJS.20.00709

TABLE VI.

Goals to Unload Other Services that Are Impacted by the Pandemic^*

ED/UCC Orthopaedic-Related Work	Inpatient Orthopaedic-Related Work
Be convenient for MSK patients who are seeking care in these settings Unload ED staff from any touch beyond the MSE Relieve needed ED beds Avoid unnecessary use of PPE Keep the orthopaedic surgery department invested in organizational goals during the pandemic as a surge occurs while orthopaedic surgeons practice within their best competencies Protect orthopaedic surgeons and allied providers, as much as possible, from unnecessary exposure to COVID-19-positive patients as local logistics allow	Communicate with primary care providers to request that they forward patient email/telephone requests for MSK conditions directly to the orthopaedic clinic to facilitate a specialty-specific telephone/video encounter (instead of primary care performing an encounter and then referring to the orthopaedic clinic) Establish a doctor-of-the-day to consolidate face-to-face visits at specific office locations that are not connected to the hospital ED or UCC in order to minimize exposure, and evaluate how many appointments there are in order to allow work-from-home virtual appointments Manage inpatient MSK care through rotations of “on” and “off” teams If vital anesthesia staff are available (many are conscripted to intubation teams in pandemics that are respiratory in nature)³⁵, provision of conscious sedation in orthopaedic department procedure/cast rooms for closed reductions may also unload more acute care settings

ED/UCC Orthopaedic-Related Work

Inpatient Orthopaedic-Related Work

Be convenient for MSK patients who are seeking care in these settings
Unload ED staff from any touch beyond the MSE
Relieve needed ED beds
Avoid unnecessary use of PPE
Keep the orthopaedic surgery department invested in organizational goals during the pandemic as a surge occurs while orthopaedic surgeons practice within their best competencies
Protect orthopaedic surgeons and allied providers, as much as possible, from unnecessary exposure to COVID-19-positive patients as local logistics allow

Communicate with primary care providers to request that they forward patient email/telephone requests for MSK conditions directly to the orthopaedic clinic to facilitate a specialty-specific telephone/video encounter (instead of primary care performing an encounter and then referring to the orthopaedic clinic)
Establish a doctor-of-the-day to consolidate face-to-face visits at specific office locations that are not connected to the hospital ED or UCC in order to minimize exposure, and evaluate how many appointments there are in order to allow work-from-home virtual appointments
Manage inpatient MSK care through rotations of “on” and “off” teams
If vital anesthesia staff are available (many are conscripted to intubation teams in pandemics that are respiratory in nature)³⁵, provision of conscious sedation in orthopaedic department procedure/cast rooms for closed reductions may also unload more acute care settings

ED = emergency department, UCC = urgent care clinic, MSK = musculoskeletal, MSE = medical screening examination, and PPE = personal protective equipment.