On January 29, the press conference on the prevention and control of the new crown pneumonia epidemic in Shaanxi Province announced that since the outbreak of the local epidemic in Xi'an city on December 9, 2021, Shaanxi Province has reported a total of 2,080 locally confirmed cases (2,053 in Xi'an, 13 in Yan'an, 13 in Xianyang and 1 in Weinan), all of which have been concentrated in Xi'an for treatment. By 12:00 on January 29, there were only 55 new coronavirus patients left in the hospital, and there were no critically ill patients.
Another piece of good news is that since January 24, Xi'an has been reduced to a low-risk area. This means that the current round of covid-19 in Xi'an has ended.
However, in this round of local epidemics, the Xi'an Health Commission has twice apologized for the "difficulty of medical treatment" for the masses at the press conference, triggering social discussion.
On January 29, He Qinghua, a first-level inspector of the Disease Control Bureau of the National Health Commission, said at a press conference of the joint prevention and control mechanism of the State Council that at present, the local epidemic situation on the mainland is scattered sporadically, but the overall epidemic situation remains stable. What new experiences and lessons has this round of local epidemic brought to epidemic prevention and control? How do you avoid something like this happening again?
Behind the tragic events
The current round of epidemics in Xi'an has become a thing of the past, but the reflection brought to medical institutions has not stopped.
On December 23, 2021, Xi'an implemented a "lockdown" due to the new crown epidemic, and on the 31st, Xi'an adopted the method of setting up a yellow code hospital or a yellow code ward to ensure the special diagnosis and treatment needs of pregnant women, tumor radiotherapy and chemotherapy and other critical diseases of the people in the closed and controlled areas and control areas.
At the same time, the relevant departments issued a notice of suspension of business of non-people's livelihood security business units, and the accompanying consultation platform "Preferential Companion" also took the initiative to suspend offline business, no longer providing services such as queuing for registration, taking medicines, paying fees, and examinations.
Near the unsealing, the phone for help still rings every day. "We will receive some phone calls, hoping that we will pick up and deliver the car to accompany the consultation, and the demand for medicine and consultation is more than usual." On January 20, Lu Lu (pseudonym), who enjoyed preferential treatment, told the health community that they could not do anything, "Our staff must also abide by the prevention and control regulations and isolate at home." Whenever this happens, all he can do is introduce customers to various public official medical channels.
But Lu Lu clearly feels that many patients still need help, "they need someone to help straighten out the post-epidemic medical process, including whether to have nucleic acid, how to do a good job of hospital admission protection, etc."
A number of cases of non-COVID-19 patients experiencing "difficulty in seeking medical treatment" occurred here, causing concern. The day before New Year's Day, on December 31, 2021, a 39-year-old man suddenly suffered chest pain, was rejected by three local hospitals, and eventually died suddenly; a 61-year-old patient with angina died of angina due to inability to receive timely treatment in the hospital; on New Year's Day, a pregnant woman waited at the hospital gate for two hours and then hemorrhaged, resulting in an 8-month-old baby miscarriage.
Raising the "threshold" for epidemic prevention and control during the epidemic, most hospitals in Xi'an will hold 24-hour or 48-hour nucleic acid test certificates as admission passes.
Pregnant women who waited at the hospital gate for two hours and then miscarried were blocked from the hospital gate because the nucleic acid results expired.
Individual and public safety choices
In the early morning of January 6, Xi'an officials reported that this was a liability accident, and the relevant responsible persons of Xi'an High-tech Hospital were dealt with, and the relevant responsible persons of the outpatient department and the medical department were dismissed.
"Be sure to take this as a warning and not refuse to do anything." After the incident, a middle and high-level meeting was held in a second-class public hospital in Xuchang City, Henan Province, when the epidemic situation in Anyang City, which belongs to Xuchang City, had not yet fermented, and on January 8, Anyang found the first two confirmed cases.
"I can't understand why this kind of thing happens." Meng Yuli (pseudonym), a nurse at the hospital's outpatient service center, speculated that the hospital's pre-examination triage personnel may not have made an accurate judgment on the criticality of the pregnant woman's condition, or they may not have understood and implemented the hospital's prevention and control measures. "But for whatever reason, they are at fault."
What are they wrong about?
"This reflects the poor coordination and implementation between epidemic prevention and control and emergency medical treatment." At present, in general, the main task of hospital pre-screening triage staff is to check for new crown pneumonia, and the identification and treatment of acute and critical patients at the pre-screening triage office are different, which often threatens patient safety." Qiu Yonggui, director of the Legal Department and Outpatient Department of the Affiliated Hospital of Nantong University, explained this to the health community.
In Qiu Yonggui's view, this is a dilemma between personal safety and public safety that pre-examination triage staff often encounter. "In fact, there is no contradiction between individual safety and public safety, and when emergency medical treatment and epidemic prevention and control are difficult to coordinate, medical institution staff should have a sense of life first." Medical institutions should have emergency plans to facilitate epidemic prevention and control, as well as to facilitate emergency medical treatment of patients."
He mentioned that if medical personnel do not establish the concept of identifying acute critical illness and emergency medical treatment in the pre-examination triage work, it is contrary to their professional ethics and legal obligations. Pre-screening triage personnel are themselves medical personnel, even in the pre-screening triage position, "saving lives is their legal obligation".
Originating from SARS, the emergence and transformation of pre-screening triage
How to coordinate the relationship between individual safety and public safety is a difficult problem facing the pre-examination triage personnel.
The establishment of the pre-examination triage system originated from the "SARS" in 2003, which began with the former Ministry of Health issued the "Administrative Measures for the Pre-examination and Triage of Infectious Diseases in Medical Institutions" in 2005, which stipulates that general hospitals above the second level should set up an infectious disease department, which is specifically responsible for the triage of infectious diseases in the medical institutions, and medical institutions that do not have an infectious disease department should set up infectious disease triage points.
Since then, large and small triage desks have appeared in the outpatient buildings of medical institutions above the second level.
Because of marriage and children, at the end of 2009, Meng Yuli was transferred from the clinical department to the outpatient service center, responsible for pre-examination triage.
Pre-screening triage process before the new crown pneumonia epidemic Meng Yuli provided the picture
"At that time, there were probably only one or two people a day who came to consult." Recalling the work content at that time, Meng Yuli mentioned that what he did more every day was to help the people who came to the consultation identify children's respiratory infectious diseases such as mumps, chickenpox, hand-foot-and-mouth disease, and then guide them to the relevant departments.
Although this position is not valued, the amount of tasks is not much, and the requirements for the staff are not low, "you must have more than 5 years of nurse experience to do pre-screening triage." Meng Yuli said.
This "idle" day did not last long. In December 2019, the "offensive and defensive war" of the new crown pneumonia epidemic kicked off, and Meng Yuli's pre-examination triage work also began the ultra-long standby of "7 a.m. to 7 in the morning" from this month, "there is no rest at noon, and the two people on duty have to take turns to eat."
Pre-screening triage process after the new crown pneumonia epidemic Meng Yuli provided the picture
According to the pre-examination triage process, visitors to the hospital need to go through two passes: one is to scan the health code, and the other is to measure body temperature (infrared temperature measurement). For patients with fever, the pre-examination triage personnel should retest with a thermometer, conduct circulation adjustments, register relevant information, and finally escort them to the fever clinic according to the designated route.
After a set of processes, Meng Yuli has to "stare" at about 2,000 to 4,000 people every day, and "his eyes are sour at the end of the day."
Because of this process, it is inevitable that there will be queues and congestion at the entrance to the hospital, "patients will complain, basically every day someone argues at the door." Meng Yuli was also helpless, and the security guards and volunteers at the door could only carry out pacifying work at this time.
From unappreciated to critical
After the arrival of the epidemic, the pre-screening triage undertook the task of screening, examining and diverting the new crown pneumonia of the hospital personnel. "They pre-screened visitors for COVID-19 by asking about their epidemiological history, occupational history, symptoms, etc." Qiu Yonggui concluded that when pre-tested as a patient with an infectious disease, a suspected infectious disease patient, and a risk factor for an infectious disease, he will be sorted into designated hospitals and fever clinics for investigation and treatment in accordance with regulations.
Pre-screening triage has also gone from being taken seriously to becoming critical.
Since the outbreak of a new round of the epidemic at the end of 2021, Meng Yuli has to undergo about 10 inspections and assessments a month.
There are also more things that make them worry about what they are afraid of happening. During the pre-examination triage, Meng Yuli once met a patient with a history of living abroad and had been released from all isolation, but the patient's first nucleic acid test result after admission was positive.
"If a patient is diagnosed, our pre-screening triage staff will definitely be held responsible, and the outpatient department will be charged." She said.
Fortunately, the patients were ultimately ruled out of COVID-19 infection.
Pre-screening triagers are under this pressure almost every day.
"If you miss a hospital visitor who is finally diagnosed with an infectious disease, it will bring serious consequences to the hospital and society." An old lady sealed a city and a patient sealed a hospital, and Qiu Yonggui still remembers it vividly.
"Any outbreak of infectious diseases inside and outside the hospital will be traced back to the source, and the pre-screening triage personnel will walk on thin ice." Qiu Yonggui said that in the face of pressure, pre-screening triage personnel should stand at the national epidemic prevention and control level and the principle of life first, and ask for more instructions and reports, rather than mechanically implementing epidemic prevention and control policies.
"Identify both infectious diseases and acute and critical illnesses"
When there is a conflict between emergency medical treatment and epidemic prevention and control, how to coordinate all parties?
On January 6, Sun Chunlan, member of the Political Bureau of the CPC Central Committee and vice premier of the State Council, held a special meeting to point out that the primary responsibility of medical institutions is to provide medical services, so during the epidemic prevention period, patients must not be rejected under any pretext, and classified treatment should be carried out according to the medical needs of different patients.
On the same day, Xi'an Issued the Notice on Further Clarifying the Medical Procedures for All Types of Personnel, stipulating that all kinds of medical institutions shall not use the 48-hour negative nucleic acid test certificate as a restriction on medical treatment, transfer of patients and reception, nor can they prevaricate or refuse to treat patients for any reason.
Source: Nantong University Affiliated Hospital Outpatient Department public number
After the abortion incident of pregnant women in Xi'an, Qiu Yonggui immediately organized a training, with the purpose of allowing the pre-examination triage staff to strengthen another awareness: identifying acute and critical diseases, saving lives, and performing the duties of medical personnel.
The grading criteria for emergency pre-examination triage, as well as the rapid identification and treatment of disease symptoms and populations such as chest pain, stroke, trauma, critically ill pregnant women, critical newborns and children, should all be transmitted to the pre-examination triage personnel.
"In addition to assuming the responsibility of identifying infectious diseases, they must also establish a sense of identifying critical and serious diseases." Qiu Yonggui said that the staff of pre-examination triage should not only identify infectious diseases, but also identify acute and critical diseases, not only to do epidemic prevention and control work, but also to deal with acute and critical diseases in a timely manner.
As Qiu Yonggui said, the abortion of pregnant women in Xi'an is the answer sheet made by society, industry, units and individuals in terms of personal safety and public safety. How to deal with the treatment of critically ill patients in the epidemic prevention and control work is the answer sheet that all medical institutions must hand over.
The abortion of pregnant women in Xi'an is also a confrontation between personal safety and public safety. The result of this confrontation has sounded an alarm bell for all medical institutions: the staff of any post must not forget the responsibility of medical institutions to treat diseases and save people.
Sources | the health community
Written by | Yang Ruijing