Wide-Awake Hand Surgery in Trauma: Optimising Patient Experience and Strategies to Advance Patient Care

Background Our regional hand trauma unit in Greater Manchester underwent significant service reorganisation from predominantly GA to WALANT early in the COVID-19 pandemic. We implemented a variety of strategies to optimise patient care and maintain adherence to national standards. Here, we present a review of these strategies. Method Five domains throughout the patient pathway were explored, with chi-square and student t-testing used to assess significance. Results ‘Time-to-treatment’ compliance with national standards were maintained following reorganisation, with an improvement in compliance for extensor tendon repairs. A pre-operative information leaflet resulted in significant improvements in patient knowledge and anxiety levels. A knowledge-gap in post-operative analgesia administration amongst patients was identified and addressed through a standardised protocol and supplemental written guide to optimally manage peak post-operative pain. Additionally, the shift of our services to our ambulatory unit has resulted in a significant in reduction in our theoretical carbon footprint through reduced patient travel and gaseous anaesthesia use. Conclusions Despite dramatic service reorganisation to a primarily WALANT service, we have demonstrated a multi-faceted approach to optimise the patient journey, whilst upholding compliance with national standards and reducing our overall ecological footprint.