Nurse-led sustainable plastic surgery trauma service transformation: a positive COVID-19 legacy

The aim of this quality improvement was to develop a sustainable nurse-led ‘See and Treat’ service in a regional plastic surgery unit in England for patients requiring plastic surgery under local anaesthetic following traumatic injury. Trauma-related injuries are a substantial part of the workload in the plastic surgery department in question; with people with the most minor injuries requiring surgery under local anaesthetic accounting for 17%. COVID-19 threatened the continuation of any minor surgery service, but the initial crisis-driven response to the pandemic provided the opportunity to develop a new, more effective, nurse-led service for this patient group. The Model for Improvement was used and four ‘Plan, Do, Study, Act’ cycles deployed over an 8-week period, involving 102 patients. Routine quantitative and qualitative data in the form of a semi-structured patient feedback proforma were used to guide the improvement process, optimising the new service design and delivery. The results demonstrated that 98% (n=100) of patients received same-day surgery via the new ‘See and Treat’ service. Staff and patient satisfaction remained high throughout; all patients preferred same-day surgery. No negative unintended consequences, for example, postoperative infections, were identified. One positive unintended consequence was the reduction in carbon footprint achieved by decreasing clinical waste and patient travel. Improvement methodology was successfully used by a nurse-led team to enable the continuation and enhancement of surgical services for trauma patients during COVID-19-driven service disruption. This service transformation has resulted in the retention of the revised service delivery model as the ‘new normal’ approximately 2 years later. The COVID-19 pandemic challenged the resilience of the trauma surgery service but led to a positive long-term legacy that sustainably improved waiting times and patient experience while maintaining safety.