瑞金医院陆勇主任医师总结新冠疫情期间规范化发热(门)急诊快速安全有效创建的瑞金经验

时间:2020-07-03 来源:上海交通大学医学院附属瑞金医院作者: 点击:3770次

2020年6月,陆勇主任医师在《ANNALS OF TRANSLATIONAL MEDICINE》杂志发表题名为Establishing a standardized FUO emergency department: design and practice in dealing with COVID-19”——创建规范的发热(门)急诊应对呼吸道传染病大流行的研究与实践的研究论文。


瑞金医院放射科陆勇主任医师为论文通讯作者,放射科陈彤彤硕士研究生论文第一作者。

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“不明原因发热”(fever of unknown origin, FUO)常为新发呼吸道传染病首发表现,因此医院发热门诊常成为防控甄别的第一站。COVID-19疫情发生以来,如何在短时期内建立符合规范的发热门诊成为人口密集的中国城市防控的关键。课题组依托精益化管理模式,在短时间内(2周)做到了快速、安全、有效地改造创建规范化发热门诊,简化流程,缩短就诊时间,为新冠疫情期间疑似病例的筛查、留观提供了与医院其他诊疗区域完全隔离的封闭场所。论文围绕通过精益工作流和价值流分析,建立少环节就诊和“零”接触会诊流程、实施三步骤完善发热门诊展开经验总结。本研究表明,通过信息技术植入、场地的局部改造、医护团队的合理配置和防护用品按需计划分配,综合性医疗机构能够在短时间内设立安全的发热门诊并提供24小时筛查和留观服务。


目前,随着分级诊疗制度的实现,发热(门)急诊不仅能在综合医院快速建立,且该经验方法在各级医疗机构也行之有效。本研究的结果表明,在重大呼吸道传染病爆发时,成功创建规范化发热门诊的关键在于快速积极应对并应用精益化管理模式,实现动态调整调配人力物力,利用“互联网+”便捷信息技术协助,既保证了接诊和治疗过程中的安全性,又最大程度节约了医疗资源,避免可能的交叉感染。本研究为各级医院及医疗机构更充分应对突发重大呼吸道传染病及目前疫情防控常态化背景下发热(门)急诊的建立和管理提供可借鉴的经验。


【Abstract】

Background: Since the outbreak of COVID-19 in January, 2020, the fever of unknown origin (FUO) emergency department has become the first station for disease prevention and identification in hospitals. Establishing a standardized FUO emergency department within a short period of time has become the key to preventing and controlling COVID-19 in densely populated Chinese cities.

Methods: Based on the lean management model, the research group established a process of less-link visits, which sees reduced contact between patients and physicians during diagnosis and treatment, and zero-contact consultation through lean workflow and value stream analysis. Three steps were implemented to improve the operations of the FUO emergency department: the rapid establishment of an isolation zone, the refinement of duty and protection configuration, and the use of Internet and technology to establish a full-process follow-up consultation system.

Results: (I) Tests related to COVID-19 screening are all completed in the FUO emergency department; (II) 12 new isolated observation rooms have been built; (III) hospital visiting time, waiting time for consultation, and the time from pre-examination to virus screening has been shortened from 18 to 8 hours, from 2 hours to 10 minutes, and from 34 to 3 hours, respectively; (IV) the transfer distance has been shortened from 450 to 20 m, and the observation time has been shortened from 72 to 26 hours. The median waiting time for image examination has been reduced from 40 to 3 minutes, and the moving distance has been shortened from 800 to 10 m; (V) the diagnosis and treatment process is facilitated by 5G, achieving zero contact between doctors and patients.

Conclusions: Through the implantation of information technology, the local transformation of the site, the rational allocation of medical teams and the planned distribution of protective equipment, in a short period of time, individual medical institutions can set up a safe FUO emergency department to provide 24-hour screening and detention services. Establishing an FUO emergency department with lean management and realizing the management approach of combining daily operation with prevention and control could help China and other countries to handle the outbreak of fulminant infectious diseases.


【中文摘要】

背景:COVID-19疫情发生以来,医院发热门诊成为防控甄别的第一站。如何在短时期内建立符合规范的发热门诊成为人口密集的中国城市防控的关键。

材料与方法:课题组依托精益化管理模式,通过精益工作流和价值流分析,建立少环节就诊和0接触会诊流程。实施三步骤完善发热门诊:快速腾空建立隔离区、精细化值班和防护配置、互联网+技术建立全流程随访会诊系统。

结果:1、COVID-19肺炎相关筛查检测全部在发热门诊区域完成。2、新增12个隔离观察室。3、就诊时间从18小时缩短至8小时;会诊等待时间从2小时缩短为10分钟;发热门诊预检就诊-病毒初筛确认结果时间从34小时缩短为3小时。4、留观转移路径从450米缩短为20米;留观时间从72小时缩短为26小时。影像检查等待时间中位数从40分钟缩短为3分钟;影像检查移动距离从800米缩短为10米。5、建立5G网络覆盖的诊疗,会诊医师与病患0接触,物流0接触,器物表面消毒0接触。

结论:通过信息技术植入、场地的局部改造、医护团队的合理配置和防护用品按需计划分配,综合性医疗机构能够在短时间内设立安全的发热门诊并提供24小时筛查和留观服务。安全的发热门诊将成为应对疑似COVID-19等暴发性呼吸道传染病的第一站。建立精益化管理的发热门诊,实现日常运行与特殊时期防控相结合的管理模式,将是中国和其他国家应对暴发性传染病的可行之道。



作者简介

陆勇  主任医师,硕士生导师,上海交通大学医学院附属瑞金医院放射科,医务一处处长,瑞金医院卢湾分院院长;研究方向:磁共振与人工智能影像诊断。

陈彤彤  硕士研究生,上海交通大学医学院附属瑞金医院放射科;研究方向:影像医学在生物医用材料临床转化中的应用。





原文链接:https://mp.weixin.qq.com/s?__biz=MzIxMTI4MTE5OQ==&mid=2247484800&idx=1&sn=69c977889affff78a347bae3848fbfb6&chksm=9756f1c0a02178d6f89ee88590d9f05e4ec9daee8141c025ad7b3b7398d339945037c5165d05&mpshare=1&scene=1&srcid=&sharer_sharetime=1593745564660&sharer_shareid=f270f35ab147bcae145eb99ad22478d0&key=b6ae2d62a5369f5417da99908aa91a15dd6a80524a672166159506081376cc63333036b7304cb1c01c75bc298acd3f79309c3407c8ceb5e339dceb4f643ac386aa1be63bc961e57633b4dc9104bdec37&ascene=1&uin=MTk0ODQ2MzM0Mg%3D%3D&devicetype=Windows+8.1+x64&version=62090529&lang=zh_CN&exportkey=AfVkCp3hbDaDX057TEUGEMY%3D&pass_ticket=ixIgJ889ZWMjPpIoOcjXm4EQOEuj8OHk3goisesKpMPyDTSJOnD1JeBuGBeudw5D


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