Ward
Patients with surgical indication, coming from the Emergency Department or from spoke hospitals, were hospitalized in our ward. During SARS-CoV-2 spread in Lombardy, most available beds were employed to treat severe complication of COVID-19. Thus, our facilities were reduced and limited.
We hosted patients in two different wards, on to different floors of our hospital. Patients who were considered not infected by SARS-CoV-2, without history of fever, cough, or dyspnea, with normal chest radiography and negative swab, were hospitalized in a 40-bed ward. This environment, also defined as “white zone,” functioned as a normal trauma ward. Every patient and all healthcare staff wore a surgical mask. Clinical evaluation, laboratory tests, and chest radiography were performed on a regular basis and according to any clinical worsening.
Patients with confirmed SARS-CoV-2 infection or who showed suspected clinical course were hospitalized in a special 15-bed “trauma COVID-19” ward. In this setting, healthcare operators were equipped with COVID-19 kit PPE during patients’ assistance.
Clinical features of SARS-CoV-2 infection overcame trauma and orthopaedic surgeons’ medical education; therefore, the ward activity was managed by a heterogeneous medical team, formed by one internist and one orthopaedic surgeon; one infectious disease specialist briefed with the medical team every day, for two hours. In cases of severe respiratory impairment, an ICU specialist was on call and rapidly available. The medical team briefed with the nursing team every day, at 8 a.m., 2 p.m., and 8 p.m. All clinical documentation was locked in the medical office; the informed consent module, after being signed by the patient, was stored in a plastic closed bag. Patients who needed emergency surgical treatment, or with laboratory and radiological findings inconsistent with clinical course, were treated with high suspicion and isolated in a “gray zone,” waiting for a clear diagnosis and distribution in white or red zone.