COVID-19: Plastic Surgery service guide

May 2020

Scope

This information provides guidance on the management of plastic surgery patients across Eastern locality during the COVID-19 pandemic. The information is based on national guidance.

National guidance:

Clinical guide for the management of patients requiring plastics treatment during the Coronavirus pandemic

2WW referrals

Only patients with suspected sarcoma should be referred via the two-week wait.

Malignant melanoma, squamous cell carcinoma (SCC) and Merkel cell carcinoma should be referred via 2WW to Dermatology for initial management

Please include digital photographs with referrals if possible, to streamline triage (localising image, close up image, with or without dermoscopic image). Patient images are acceptable.

Email: Rde-tr.plastics@nhs.net

Conditions with specific guidance

Trauma referrals

The Plastic Trauma service for adult and children will continue to run as normally. Inpatient trauma and paediatric trauma remain in RD&E. Referral pathways remain the same. Patients will be triaged in the Emergency Department (at present, in later stages of surge, triage may move directly to the MSK unit) and then directed directly to the Musculoskeletal Unit for immediate Plastic Surgery review and management.

Elective referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Face-to-face examination (excluding skin malignancies which should be referred to dermatology) will only be arranged for cases that need urgent assessment. This can include hand patients. From May the Plastics Surgery service is only able to see 24 face-to-face referrals per week (8 urgent non-cancer and 8 sarcoma and 8 Melanoma) and all other outpatient work will need to undertaken through telephone clinics. New referrals will be prioritised for face to face appointments, telephone appointments or deferred to a pending list for conditions that would previously have been listed as routine appointments. This will include referrals where malignancy is not suspected.

Urgent advice

Acute Trauma:

Please call or text the on-call plastic surgeon on 07570 951632. If no response (signal is variable within the hospital) then via switchboard telephone: 01392 411611.

Risk factors for face-to-face review will be decided on case by case basis.

Central nhs.net email addresses or individual nhs.net mail will be used for photographic image transfer between healthcare professionals on an individual case basis.

Mobile messaging may be used to communicate, including commercial applications where there is no practical alternative, or when there is a need to share information quickly (see NHSX advice)

Advice & Guidance/Telemedicine services

Burn referrals will be expected to be through telemedicine system. Derriford Hospital is our local Burns Unit for less severe injuries and more serious injuries to North Bristol NHS Trust Burns Unit

Covid 19 High risk patient advice

High risk patients should still be referred if required. Decision for face-to-face review will be decided case by case basis by Consultant. Use of telemedicine will be prioritised over face-to-face consultation.

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 19-05-2020

 

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