By pooling staff and patients from three hospitals and introducing strict infection control protocols, the team at Barts Health has safely maintained its programme of curative cancer surgery during the Covid-19 pandemic.
More than 140 breast cancer patients have received urgent operations during the coronavirus pandemic after a radical rethink of how surgery is delivered in East London.
Following a fall in available theatre space and staff shortages owing to the impact of Covid-19, the team at Barts Health NHS merged waiting lists from three hospitals into one to ensure those in greatest need of surgery were seen first, often within a week or two of receiving a cancer diagnosis.
Strict infection control measures have also been put in place to reduce the risk of infection. These include asking those undergoing surgery to self-isolate for two weeks prior to their operation and using full PPE to protect both staff and patients.
Breast cancer surgery is typically performed at three hospitals across the trust – St Bartholomew’s, Whipps Cross and Newham, with teams at each site responsible for its own list of patients, from diagnosis through to recovery and rehabilitation.
When theatre capacity was reduced as a result of surge in Covid-19 patients, the team decided to combine their efforts.
Laura Johnson, a breast surgeon at Barts Health NHS Trust, said: “By working as one big team we avoided a situation whereby there was a backlog of people requiring surgery at one particular hospital.
“Prioritising all patients based on their clinical need meant that, each patient, irrespective of their home site, had equal access to the surgical space available.
“Furthermore, if for any reason someone’s surgery could not take place, we were in a position to quickly and easily offer that slot to the next patient on the list.”
The majority of the breast surgery has taken place at St Bartholomew’s Hospital and in the independent sector performed by Barts Health surgeons under the current NHS agreements, initially at King Edward VII's Hospital in Marylebone and later at the Wellington at St Johns Wood, following the development of dedicated cancer ‘hubs’.
Professor Peter Schmid, clinical director of the breast surgery at St Bartholomew’s Hospital, said: “At a time when many hospitals were cancelling all elective surgery, we sat down and determined that we must continue.
“The matrix that we developed – categorising patients according to cancer risk – meant that we were able to maintain a practically normal service, which is a huge achievement considering the scale of the pandemic.
“Much of our learning from the early stages of the pandemic fed into the establishment of the new hubs, including the rigorous infection control protocols we put in place.”
With a number of colleagues shielding and others self-isolating at home, the team introduced a new rota, with a deputy surgeon allocated for each procedure. It has meant that, over the course of the past eight weeks, not a single theatre session has been lost.
Peter added: “We had to keep the team together and be as flexible as possible.
“We introduced a daily call, where all sites come together to check-in and discuss any problems. It’s allowed us to move fast.”
Laura says merging waiting lists in this way has ensured equal access to surgical space for all patients, so not one patient has been prioritised over another based on location or named consultant surgeon at diagnosis.
“Meeting a patient for the first time on the day of their surgery is an unusual situation, and, under normal circumstances we do all we can to ensure continuity of care. However, the need to work more closely together was necessitated during pandemic, and it’s really broken down barriers between the three sites.
“All cases are discussed in detail in advance as part of the multidisciplinary team (MDT) meeting and decisions are taken with expert input from all professional groups.”
Fellow surgeon Md Zaker Ullah said: “Through the combined efforts of three hospital teams, we were able to continue to provide an excellent standard of care that we are proud of.”
Laura added: “I’d like to pay tribute to everyone involved in keeping the service going – the breast care nurses; the pre-assessment nurses; the junior doctors – we’ve all had to really pull together.
“It’s been a phenomenal effort.”