The COVID-19 pandemic has encouraged vascular departments throughout the world to share their management strategies during this difficult time. The Journal of Vascular Surgery has published numerous accounts1 , 2 of how specific countries have adapted their practices to ensure the best care to our patients during this difficult time. We would like to put forward an Irish response to the pandemic.
Surgery
Elective surgeries have been postponed, thereby limiting patient exposure and burden on anesthetics. In addition, we know that those unknowingly incubating COVID-19 at the time of intubation for surgery have a higher mortality and morbidity.2
In Ireland, we have taken a pragmatic approach to guidelines on who should be operated on3; the decision to intervene is consultant-led and based on threat to limb or life. An endovascular first approach is adopted, limiting the need for general anesthesia and critical care.
Imaging
We have designated a COVID computed tomography scanner. The secondment of a local, previously private hospital has allowed for outsourcing of imaging to a non-COVID facility, for urgent outpatient scans. Our vascular laboratory has followed a similar process.
Outpatient reviews
We have endeavored to continue to consult our outpatients via virtual clinic. From March 13 to April 27, we conducted 802 virtual reviews. Those at risk are offered an in-person clinic review. On average 4 patients attend per clinic, compared with an average of 60 before COVID. All team members have completed a course on telemedicine from Harvard Medicine.4
Education and training
Undergraduate tutorials are offered by videoconferencing. Patients were supplied with tablet devices and educated on videoconferencing so they could participate in medical education.
Postgraduate education, both local and national, is delivered using videoconferencing.
Restructuring of the hospital
The hospital was segregated into a COVID and non-COVID area to limit cross-contamination. Emergency construction work in wards has increased the number of isolation bays.
Multidisciplinary care
An encrypted digital platform (Siilo) allows for multidisciplinary meeting discussion, ensuring that we are still offering the best care.
Normal elective work will be slow to return for fear of a second surge, but with adaptations to our vascular service, we can limit future COVID-19 spread whilst maintaining a reasonable standard of care for our most vulnerable patients.
References
- 1.Ben Abdallah I., on behalf of La Collégiale APHP Early experience in Paris with the impact of the COVID-19 pandemic on vascular surgery. J Vasc Surg. 2020;72:373. doi: 10.1016/j.jvs.2020.04.467. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Mousa A.Y., Broce M. The impact of COVID-19 on vascular training. J Vasc Surg. 2020;72:380–381. doi: 10.1016/j.jvs.2020.04.469. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Lei S., Jiang F., Su W., Chen C., Chen J., Mei W., et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;21:100331. doi: 10.1016/j.eclinm.2020.100331. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.https://cmeregistration.hms.harvard.edu/events/the-telephone-in-clinical-medicine-an-instrument-of-risk-and-opportunity/event-summary-c5f25fb22b304ad0b68be4941cc4abeb.aspx?dvce=1 The telephone & telemedicine in clinical medicine: an instrument of opportunity & risk. Available at: Accessed September 4, 2020.