Guest: Zhao Yuanyuan, vice president of the First Hospital of Hebei Medical University
Knowledge points:
1. How do different organizational behaviors affect the effect of sensor control?
2. How to do a good job of infection control in emergency situations?
3. How to test for nucleic acid?
The current round of domestic epidemic has recently added thousands of new cases of new coronary pneumonia every day. At present, our understanding of the epidemic prevention and control situation is not in place, and the implementation of hospital infection prevention and control in medical institutions is still not in place.
One or two major infection control strategies
Hospital infection control is nothing more than two states: emergency state and normalization.
1. Emergency state sensor control strategy: 1+3+7
1+3+7
A system, that is, the establishment of an emergency command system, the secretary, the president as the commander-in-chief;
Three sets of mechanisms, namely the one-day two-session system, the party general branch responsibility system and the dynamic adjustment system, any mechanism is not set in stone, and the infection control strategy should be dynamically adjusted according to the overall epidemic situation;
Seven special classes, that is, the establishment of seven special working groups headed by the vice president: comprehensive coordination group, medical treatment and student management group, nucleic acid testing and information support group, manpower allocation team, logistics support group, publicity and medical support group, nucleic acid collection team.
New organizational model
Infection control is not a departmental matter, it requires the hospital to coordinate the organization as a whole, and different organizational behaviors will have different effects. With one hand holding an umbrella and the other working, the infection control during the epidemic period should not only do a good job in epidemic prevention and control, but also ensure daily medical treatment.
So, how does the emergency command system change the sensing control work through organizational behavior? Business functional departments are horizontally connected and managed according to system groups.
For example, the above 7 special working groups are set up, of which the formation of nucleic acid collection groups is very important, but unfortunately many hospitals do not have them.
After the arrival of the epidemic, why do many hospitals have "shut down" and patients cannot be hospitalized? Because these hospitals no longer have the energy to care for non-COVID-19 patients.
In the emergency state, the hospital needs to continuously draw personnel to collect nucleic acids, if this part of the work is still responsible for the usual nursing or business president, the hospital will not have the energy to do normal medical treatment work, and the daily medical treatment efficiency of all many hospitals will decline.
The hospital must let the vice president in charge of medical treatment free up energy to pay attention to the daily medical treatment of the hospital.
In our hospital, even in the most serious period of the epidemic, daily medical treatment work has not been affected, the number of surgeries and hospitalizations is still the same as usual, and the income of medical staff has not been affected.
The same is true of other groups, with hospital management transferred according to organizational behavior, and the entire organization is flattened.
Not everything has to go to the medical office or the infection control department.
In addition, the hospital set up a 28-person hospital infection prevention and control inspection team, compared with 8 items and 20 inspection lists, carried out gridded, full coverage, no dead ends supervision and inspection, divided into areas, and each area carried out hospital sense supervision every day.
2. Normalized infection control strategy: 1+3+7+N
A system: a system under normalization is to set up an epidemic prevention and control office with the secretary and the president as the director, all work is coordinated by the office, and combined with the daily division of labor, there are 8 special working groups under it;
Three-level inspection: hospital-level inspection, hospital infection prevention and control group inspection, section-level self-inspection;
Seven passes: nucleic acid testing, fever observation, pre-examination triage, education and training, safety protection, disinfection and isolation, outpatient ward, of which pre-examination triage - emergency department - fever clinic - observation ward integrated design, emergency department fever patients are treated in the fever clinic, emergency department, observation ward jointly set up an emergency critical care team;
N guarantees: daily health monitoring, full risk investigation, emergency drills and other measures, according to the changes in the epidemic situation, dynamic adjustment.
Second, two tips for improving efficiency
The more critical the state, the more important the process.
1. Shorten the nucleic acid detection time
Construction of independent testing sites for fever clinics
Is there a nucleic acid testing laboratory in the fever clinic? Absolutely.
In this way, closed-loop management can be realized, nucleic acid test results are reported within 1 hour, the internal circulation of fever diagnosis is accelerated, the patient's detention time is shortened, and the risk of hospitalization is correspondingly reduced.
Sort out the nucleic acid testing process
Achieve nucleic acid test results for patients to be hospitalized (accompanying care) within 2 hours.
Fragment acquisition
Adjust the outpatient nucleic acid collection site, and the outpatient nucleic acid is adjusted from centralized collection to sub-area, which is collected nearby.
Established a special class for specimen delivery - nucleic acid testing
Specimen delivery - nucleic acid detection special class cycle at the major sampling points, collected once every 5 minutes, sent to the laboratory, to accelerate the treatment of critically ill patients.
2. Rational use of buffer wards and wards
In the emergency state, the buffer ward is activated, and the entire ward is vacated for the treatment of patients with an epidemiological history that has not excluded new crown, and patients with critical and severe disease without nucleic acid results.
After rescuing and treating patients in the buffer ward, the patients are transferred to the buffer ward so that other wards can concentrate on daily medical treatment.
The buffer ward can be continuously set up, and under normal conditions, patients who need to be hospitalized without nucleic acid results can be admitted, critically ill patients with nucleic acid-free results can be treated in emergency conditions, and patients with fever of unknown cause during hospitalization in any state can be admitted.
Third, the three development directions of infection control
Hospital infection control is not one-size-fits-all, let alone become the shackles of medical staff, but scientific, precise and innovative.
1. Scientific control
Three same defenses: internal and external defense, doctors and patients, and character defense
Three-proof fusion:
"Civil air defense" based on standardized behavior and strengthening control,
"Technical defense" based on upgrading skills and optimizing processes,
"Instrument Defense" Based on Technological Innovation and Scientific Use
Three letters of equal emphasis:
"Blocking" strategy based on source control,
Risk assessment + "gridded" "containment" strategy,
A "closed" strategy that fully protects full closed-loop management
2. Precise prevention and control
Keen risk recognition ability: Someone must be responsible for paying attention to the epidemic dynamics at home and abroad in real time, focusing on the epidemic dynamics in the province, and judging the risk impact on hospitals
Rapid risk control capability: classify the risk level of the hospital, dynamically adjust the cleaning and disinfection measures and protection level
Scientific risk-bearing ability: master epidemic prevention and control policies, dynamically adjust the hospital prevention and control system, and guide the safe admission and treatment of patients in clinical practice
3. Innovative sensor control
Technically, realize the informatization of infection control, such as VR to assist ward visits, the installation of monitoring equipment in the hospital infection department to remotely monitor the fever clinic wearing and taking off protective equipment, etc.;
From the organizational management model, break the convention, reshape a set of organizations, and respond to the emergency state or normal situation of infection control.
Quality control, medical affairs, nursing, hospital sense, clinical pharmacy, ward management center and other business functional departments are horizontally connected to improve efficiency; and according to the system group management, such as the combination of internal medicine group, surgical group, outpatient medical technology group, etc.; and finally weekly joint office, the problem analysis and rectification, tracking.
Source | The health community
Author | Yang Ruijing