When Wuhan fights the epidemic, how to treat both COVID-19 patients and ordinary patients at the same time?

"Killing in the line of fire is all survival experience"

Written by | Yan Xiaoliu

Source | "Medical Community" public account

During the epidemic in Xi'an, many pregnant women and critically ill patients were rejected by the hospital because of health codes or no nucleic acid results.

According to CCTV News, on January 7, Xi'an, Shaanxi Province, issued a notice on further clarifying the medical procedures for all types of personnel. It is proposed that the 48-hour negative certificate of nucleic acid inspection should not be used as a restriction on entering and leaving the community for medical treatment, transferring patients and receiving treatment. Epidemic prevention and control must not be used as an excuse to delay treatment or prevaricate acutely ill patients.

"Treatment of patients with acute and critical illness must not be delayed or blamed on the grounds of epidemic prevention and control", this sentence appeared in the "Notice on Standardizing the Diagnosis and Treatment Process of Medical Institutions under the Normalization of Epidemic Prevention and Control" issued by the National Health Commission in July 2020, appeared in the No. 25 Notice of the Joint Prevention and Control Mechanism of the State Council in 2021, and appeared in many press conferences on the prevention and control of the new crown pneumonia epidemic in many places.

When it comes to specific operations, how to protect the rights and space of diagnosis and treatment of new crown and various non-new crown patients at the same time?

Time to pull back to January-March 2020, the epidemic in Wuhan is scorching.

During this period, the headquarters of the People's Hospital of Wuhan University (Shouyi Branch) undertook the task of "two-front combat" in the treatment of new coronavirus and non-new coronavirus patients.

The hospital is one of the earliest hospitals in Wuhan to carry out the diagnosis and treatment of new crown pneumonia. From the first case received on December 26, 2019 to March 3, 2020, a total of 1,146 confirmed cases of COVID-19 were admitted. At the same time, the hospital also undertook the diagnosis and treatment of cardiovascular and cerebrovascular diseases, trauma, hemodialysis, pregnant women, children (including newborns), malignant tumors (including malignant blood diseases) and chronic diseases, and treated more than 1,000 ordinary critically ill patients and completed more than 300 emergency surgeries.

Wang Gaohua, president of the People's Hospital of Wuhan University, told Health News that from January 11, 2020, the hospital began to lay out the diagnosis and treatment of non-new crown patients, and gradually explored the working mode of "double triage and double buffer".

Two-level triage to achieve classification management

"Double triage" refers to the triage of fever pre-examination and the triage of COVID-19 pre-examination.

According to this process, in the Shouyi Branch of Wuhan University People's Hospital, as soon as the patient enters the hospital, the first step of fever pre-examination triage is carried out at the pre-examination triage desk. During the initial screening, medical staff take three levels of protection. This includes routine wearing medical protective masks, work hats, protective clothing, gloves, shoe covers, goggles or face shields, etc.

Patients with a body temperature of more than 37.3 °C are always treated in a fever clinic. Other patients with normal body temperature go through the emergency channel and enter the second step of the new crown pre-examination triage.

Li Yaming and others of the Orthopedic Department of the Hospital wrote an article introducing the process of treating orthopedic emergencies under the "double triage" model. The article shows that in the emergency area, after the initial screening of body temperature to exclude new crown pneumonia, orthopedic medical staff take secondary protective measures to conduct a rapid and comprehensive assessment of the patient's breathing, circulation, nerve function and trauma degree, and conduct a physical examination, preliminarily determine the damage to important systems such as the head, chest and abdomen, and prescribe a trauma specialist examination. At the same time, the receiving medical staff issued 4 routine examinations of new crown pneumonia at the first time, including blood routine, chest CT, respiratory pathogen test (throat swab, sputum) and new crown nucleic acid.

If the blood routine and chest CT result are normal, they will be transferred to the designated area, waiting for the results of the other two tests, and will be treated with the disease specialist at the same time.

If the blood count and chest CT results suggest suspected COVID-19, or if the COVID-19 nucleic acid test is positive, the patient will be promptly referred and properly placed.

In particular, if the condition is urgent and the triage and buffer screening of the new crown virus infection is not allowed, the patient will be placed in the negative pressure operating room for emergency surgery. Medical staff implement three levels of protection to ensure the safety of both doctors and patients.

Li Yaming and other articles also emphasize that for critically ill patients, saving lives is the first priority, and rescue is carried out on the spot under three-level protection, and triage is carried out after the vital signs are stable.

Image from Chinese Hospital Management

"Double buffering" achieves partition treatment

In order to prevent the new crown pneumonia from sneaking into the ward, for outpatient emergency patients who have all 4 normal examinations and need to be hospitalized, the Shouyi Branch of Wuhan University People's Hospital has set up a "double buffer" ward with about 120 beds to prevent cross-infection in the hospital.

Patients first enter the first level of buffering in a "double buffer" ward, known as the integrated buffer ward. The designated medical person in charge is in charge, and the physician of the receiving department and the independent nursing unit undertake the relevant diagnosis and treatment work. Personnel duty is taken over by the three-level discipline to which the building belongs.

In addition to the diagnosis and treatment of the patient's existing diseases, the focus is also on the observation of fever and respiratory symptoms, and the review of the new crown nucleic acid (more than 1 day between the previous new crown nucleic acid test).

If the re-examination result is negative, he is quickly admitted to the inpatient ward of each discipline for secondary buffering. If the re-examination result is positive, he will be quickly referred to a designated medical institution for treatment.

The patient's buffer time in the integrated buffering ward is generally 24-48 hours, and the maximum is not more than 72 hours.

Inpatient wards in each discipline are divided into "clean areas" and "buffer zones". The latter is the "secondary buffer", which is a single room reserved for new admissions in the ward, that is, a closed unit, and each bed is isolated by the bed. If there is no fever or respiratory symptoms, after 24-48 hours of transition, they are admitted to a multi-person room in a "clean area".

According to the data of Wuhan University People's Hospital, on the first day of the "double triage, double buffer" model, the hospital screened out 2 cases of new crown patients among the 8 buffer patients admitted. As of March 4, 2020, 10 COVID-19-positive patients were found in the primary buffer zone, accounting for 4.5% of the total number of patients admitted, and 1 suspected patient was found in the secondary buffer zone. 11 people were referred and properly placed in a timely manner. None of the hospital's medical staff have cross-infected.

In 2020, the "double triage, double buffer" model was twice promoted in the province by the Hubei Provincial Covid-19 Epidemic Prevention and Control Headquarters. This model was also written into the Hubei Provincial Government's "Government Work Report (2020)".

Source:

1.Analysis and countermeasures of medical emergency management of new crown pneumonia. China Health Quality Management. Volume 27, Issue 4 (Total No. 155) July 2020

2. Analysis and countermeasures of medical emergency management of new crown pneumonia. Journal of Nursing. 2020,(27)05,76-78. DOI:10.16460/j.issn1008-9969.2020.05.076

3. Establishment and practice of "double triage and double buffer" model for large general hospitals to respond to the novel coronavirus pneumonia epidemic. Hospital Management in China. 2020,(40)03,53-55

Source: Medical community

Editor-in-charge: Zheng Huaju

Proofreader: Zang Hengjia

Plate making: Xue Jiao