With an emphasis on continued provision of quality care amid shifting patient management priorities, the Department of Orthopedic Surgery played a pivotal role in NYU Langone Health’s response to coronavirus disease (COVID-19). As faculty, residents, and fellows redeployed to support COVID-19 patient care, the use of telemedicine enabled continuity of quality orthopedic care.
At the COVID-19 Epicenter, Necessary Shifts in Patient Management
As the pandemic took hold in New York City, the discontinuation of elective surgeries by order of the New York State governor and the New York City mayor on March 20, 2020, coincided with a sharp rise in COVID-19 cases presenting at NYU Langone’s hospitals. The evolving situation placed unprecedented pressure on the health system as demand for intensive care unit beds and acute COVID-19 care increased rapidly.
In response, surgeons and clinicians in the Department of Orthopedic Surgery redeployed to COVID-19 care, and NYU Langone Orthopedic Hospital was transformed into a staging site for patients with COVID-19 transferred from Tisch Hospital and Kimmel Pavilion. The department mobilized quickly, with 86 faculty and 80 residents and fellows delivering care in COVID-19 medical units across those centers as well as at NYU Langone Hospital—Brooklyn, NYC Health + Hospitals/Bellevue, Jamaica Hospital Medical Center, and VA NY Harbor Healthcare System. Orthopedic surgeons provided direct care to patients with COVID-19, working side by side with internal medicine colleagues, and participated in “proning teams” to improve respiratory function by turning critically ill, intubated patients. Another 70 faculty members in the Department of Orthopedic Surgery deployed to noncontact activities, such as providing remote emergency department orthopedic consults and serving as a liaison between patients and their families who were unable to visit because of the crisis.
“The fluidity of the situation required us to rethink the standard ways of delivering care, with collaboration fueling ready innovation,” says Joseph D. Zuckerman, MD, the Walter A.L. Thompson Professor of Orthopedic Surgery and chair of the department. “As devastating as this pandemic has been, it also brought out the resilience of our department and our medical center as we quickly pivoted to provide the best care for patients with a novel, often complex, condition.”
To deliver quality care as safely as possible, extensive personal protective equipment (PPE) was acquired, and NYU Langone recruited 1,000 additional nurses to expand existing nursing staff for the benefit of patients with COVID-19. While four of NYU Langone Orthopedic Hospital’s floors were dedicated to clinical care for patients with COVID-19, a fifth floor was devoted to rehabilitation care for those patients.
“After a long hospital stay, patients become deconditioned, so they usually need some kind of therapy before they can return home or be transferred to a long-term care facility,” explains David A. Dibner, MPH, senior vice president, NYU Langone Orthopedic Hospital, musculoskeletal, and Rusk Rehabilitation.
Video Doctor Visits Maintain Continuity of Orthopedic Care
To continue orthopedic care amid shelter-in-place orders, the department turned to video doctor visits. The health system was poised to respond to sudden demand for video visits, having fine-tuned its platform over the past several years, notes Kirk A. Campbell, MD, assistant professor of orthopedic surgery. “We’d already troubleshooted potential issues,” he says.
COVID-19 resulted in a rapid growth of the department’s video visit program. In February 2020, 20 video visits were performed; by April the monthly number had increased to 4,000. All physicians quickly converted to the use of video visits to care for patients when possible, while continuing to care for other patients in person as needed. Video visits extended across the care continuum from intakes to postsurgical physical therapy, yielding ongoing personalized care and progress for patients eager to return to their typical daily activities.
Dr. Campbell has successfully hosted video visits for patients ages 18 to 80 across a wide spectrum of clinical conditions. Pre-pandemic, he led a study randomizing postoperative patients into in-office and video visit groups; the two groups scored the same on the Hospital Consumer Assessment of Healthcare Providers and Systems, but the video visitors saved a significant amount of time.
Although an in-person emphasis is certain to return after the pandemic, the team believes that video visits will continue to play a significant role in tandem to facilitate care where and when it’s needed.
“Throughout the pandemic, and especially during the initial phases, patients have been able to get high-quality care that they need at their fingertips, within the comforts of their homes, offices, or wherever they may be,” says Dr. Campbell. “I think patients will demand continued access to telemedicine.”