COVID-19 Screening and Triage Using a Unified Approach to the Management of Relevant Healthcare Workers，Procedure and Goals within a Regional Medical Consortium：a Development from Disorderly to Orderly

doi:10.12114/j.issn.1007-9572.2020.00.545

Abstract

Abstract: Background　It was difficult for primary care to take emergency actions to contain COVID-19 at the beginning of its outbreak，and the management of screening and triage procedure was disorderly. To address the situation，it is critical to make a sound management method for appropriately screening，triage，treat and transfer the patients. Objective　To evaluate the effect of an approach for unified management of COVID-19 screening and triage in members within a regional medical consortium. Methods　This study was carried out in a regional medical consortium with five unified features including unified goal，legal person，information platform，service team and salary scheme. An approach developed by our research group，has been used for unified management（of relevant goals，healthcare workers and procedure） of COVID-19 screening and triage in this consortium led by a tertiary hospital，together with 18 stations of a community health center，and the implementation results between January 25 and April 4，2020 were analyzed. Results　During this period，of the 173 841 cases screened and triaged in the tertiary hospital，440 were triaged to the COVID-19 fever clinic，2 051 to the general fever clinic，271 to the quarantine ward due to suspected COVID-19 symptoms，and 4 were confirmed and referred to the designated hospital. The 18 stations of community heath centers screened and triaged 52 525 cases，including 25 who were triaged to the COVID-19 fever clinic，and 122 to the general fever clinic. There were no missed screening of suspected COVID-19 cases and cross infections within the medical consortium. Conclusion　Our unified management approach has effectively facilitated the development of COVID-19 screening and triage from disorderly to orderly within the regional medical consortium，demonstrating good effects in containing the COVID-19 pandemic.

Key words: COVID-19, Coronavirus infections, Communicable disease control, Medical consortium, Triage management

摘要： 背景　新型冠状病毒肺炎（新冠肺炎）疫情暴发，基层医疗卫生机构紧急应对，初期预检分诊管理混沌无序。如何精准预检分诊流程、正确安排患者就诊和转诊是疫情防控的关键。目的　探索新冠肺炎医共体预检分诊管理模式。方法　于2020-01-25至2020-04-04，通过发挥具有五统一（统一目标、法人、信息平台、服务团队和薪酬方案）特征的医共体内1家三级医院牵头作用，联动社区卫生服务中心18个站点，对新冠肺炎预检分诊进行统一管理，包括统一预检分诊目标、统一和迭代预检分诊人员管理、统一和迭代预检分诊工作流程。结果　医共体内三级医院累计预检分诊173 841例，其中特殊发热门诊患者440例，普通发热门诊患者2 051例，新冠肺炎疑似患者收治隔离区271例，确诊新冠肺炎并转诊患者4例；社区卫生服务中心18个站点累计预检分诊52 525例，其中特殊发热门诊患者25例，普通发热门诊患者122例。期间，医共体内新冠肺炎疑似患者零漏检、交叉感染零发生。结论　医共体三统一预检分诊管理模式有效促进新冠肺炎预检分诊从混沌向有序转化，在疫情防控中发挥重要作用。

关键词: 新型冠状病毒肺炎, 冠状病毒感染, 传染病控制, 医共体, 预检分诊管理

XIONG Ziyu,CHEN Yanfang,ZHANG Yinglan, et al. COVID-19 Screening and Triage Using a Unified Approach to the Management of Relevant Healthcare Workers，Procedure and Goals within a Regional Medical Consortium：a Development from Disorderly to Orderly　[J]. Chinese General Practice, 2020, 23(31): 3912-3916. DOI: 10.12114/j.issn.1007-9572.2020.00.545.
熊紫玉,陈彦芳,张颖兰等. 新型冠状病毒肺炎疫情期间从混沌到有序的医共体三统一预检分诊管理实践[J]. 中国全科医学, 2020, 23(31): 3912-3916. DOI: 10.12114/j.issn.1007-9572.2020.00.545.

References

［1］LI Q，GUAN X H，WU P，et al．Early transmission dynamics in Wuhan，China，of novel coronavirus-infected pneumonia［J］．N Engl J Med，2020，382（13）：1199-1207．
［2］国家卫生健康委．国家卫生健康委办公厅关于印发新型冠状病毒肺炎防控方案（第六版）的通知［EB/OL］．（2020-03-07）
［2020-05-22］．http://www.nhc.gov.cn/xcs/zhengcwj/202003/4856d5b0458141fa9f376853224d41d7.shtml.
［3］GUAN W J，NI Z Y，HU Y，et al．Clinical characteristics of coronavirus disease 2019 in China［J］．N Engl J Med，2020，382（18）：1708-1720．
［4］30省份启动一级响应人员物资加速驰援武汉——全国新型冠状病毒感染的肺炎疫情防控焦点扫描之二［EB/OL］．（2020-01-25）［2020-05-22］．http://www.xinhuanet.com/politics/2020-01/25/c_1125502232.htm.
［5］World Health Organization．Coronavirus disease（COVID-19） situation report-51 ［EB/OL］．（2020-03-11）［2020-05-22］．https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10.
［6］World Health Organization．Coronavirus disease（COVID-19） situation report-167［EB/OL］．（2020-07-05）［2020-07-06］．https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200705-covid-19-sitrep-167.pdf?sfvrsn=17e7e3df_4.
［7］基层卫生健康司．国家卫生健康委办公厅关于基层医疗卫生机构在新冠肺炎疫情防控中分类精准做好工作的通知［EB/OL］．（2020-03-02）［2020-05-22］．http://www.nhc.gov.cn/jws/s7882g/202003/8331518df21448729983580e427046db.shtml.
［8］傅卫，秦江梅，黄二丹，等．新型冠状病毒肺炎疫情下的基层医疗卫生发展策略［J］．中国全科医学，2020，23（10）：1199-1201．DOI：10.12114/j.issn.1007-9572.2020.00.324．
FU W，QIN J M，HUANG E D，et al．Developing strategies for primary healthcare in times of epidemic of COVID-19［J］．Chinese General Practice，2020，23（10）：1199-1201．DOI：10.12114/j.issn.1007-9572.2020.00.324．
［9］杜庆锋，王培席，马文军，等．基于校政协同与医防融合的“全科医学+”医共体的构建与探索［J］．中华全科医学，2019，17（5）：705-708，804．DOI：10.16766/j.cnki.issn.1674-4152.000773.
DU Q F，WANG P X，MA W J，et al．The construction and exploration of "general practice+" medical community based on the cooperation between university and government as well as the integration between treatment and prevention［J］．Chinese Journal of General Practice，2019，17（5）：705-708，804．DOI：10.16766/j.cnki.issn.1674-4152.000773.
［10］医政医管局．关于印发新型冠状病毒肺炎诊疗方案（试行第六版）的通知［EB/OL］．（2020-02-19）［2020-05-22］．http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
［11］国家卫生健康委办公厅．新型冠状病毒感染的肺炎防控中常见医用防护用品使用范围指引（试行）［EB/OL］．（2020-01-27）［2020-05-12］．https://www.cma.org.cn/art/2020/1/27/art_68_32122.html.
［12］医疗机构传染病预检分诊管理办法（卫生部令第41号）
［EB/OL］．（2020-01-16）［2020-05-12］．http://www.xxswjw.gov.cn/page165?article_id=17139.
［13］国家卫生健康委办公厅．国家卫生健康委办公厅关于印发医疗机构内新型冠状病毒感染预防与控制技术指南（第一版）的通知［EB/OL］．（2020-01-22）［2020-05-12］．http://www.gov.cn/zhengce/zhengceku/2020-01/23/content_5471857.htm.
［14］国务院．医疗废物管理条例［S/OL］．［2003-06-16］．http://www.gov.cn/banshi/2005-08/02/content_19238.htm.
［15］明耀辉，米元元，聂涛，等．ICU新型冠状病毒感染防控管理体系的建立及成效［J］．护理学报，2020，27（5）：55-59．
［16］钟淑馨，曹晓翼，蒋艳，等．新型冠状病毒肺炎紧急救治下护理人力资源调配方案实施及效果［J］．中国护理管理，2020，20（2）：226-229．
［17］潜艳，汪晖，刘于，等．新型冠状病毒肺炎疫情下发热门诊护理人员组织与管理［J］．护理学杂志，2020，35（6）：64-66．DOI：10.3870/j.issn.1001-4152.2020.06.064.
［18］周宏珍，雷清梅，朱亚芳，等．混沌理论应用于医院创新管理建设的实践研究［J］．中国医药导报，2016，13（28）：147-151.
［19］SENGA M，PRINGLE K，RAMSAY A，et al．Factors underlying ebola virusinfection among?health workers，Kenema，Sierra Leone，2014—2015［J］．Clin Infect Dis，2016，63（4）：454-459.
［20］楚黎君，王洁，贾玉段，等．新型冠状病毒肺炎定点救治医院医护人员感染防护［J］．护理学报，2020，27（6）：56-60．
［21］汪维刚，方芳．混沌理论对妇产科医生管理和培养的启示［J］．中州大学学报，2014，31（4）：118-120．
WANG W G，FANG F．Enlightenment of chaos theory on the management and training of obstetrics and gynecology doctors［J］．Journal of Zhongzhou University，2014，31（4）：118-120．
［22］苏瑾，徐莉苹，易春涛，等．社区卫生双向转诊在区域性医疗联合体建设中的实践与思考［J］．中国全科医学，2020，23（12）：1541-1546．DOI：10.12114/j.issn.1007-9572.2020.00.197.
SU J，XU L P，YI C T，et al．Reflection on the implementation of community-based bi-directional referrals in the construction of regional medical consortium［J］．Chinese General Practice，2020，23（12）：1541-1546．DOI：10.12114/j.issn.1007-9572.2020.00.197.
［23］陈梦云，林淡珠，许金微，等．发热门诊新型冠状病毒感染预检分诊与疫情防控策略［J］．护理学报，2020，27（6）：39-43．DOI：10.16460/j.issn1008-9969.2020.06.039.
［24］MURADUZZAMAN A K M，KHAN M H，PARVEEN R，et al．Event based surveillance of Middle East Respiratory Syndrome Coronavirus（MERS-CoV） in Bangladesh among pilgrims and travelers from the Middle East：an update for the period 2013—2016［J］．PLoS One，2018，13（1）：e0189914.
［25］周宏珍，雷清梅，朱亚芳．基于混沌理论的医学院素质教育管理实践探析［J］．教育教学论坛，2019，11（33）：14-15．
［26］张秀月，刘乙杉．防控新型冠状病毒肺炎驰援医疗队防护消毒物资的优化配置［J］．中国感染控制杂志，2020，19（3）：250-255．DOI：10.12138/j.issn.1671-9638.20206501.
ZHANG X Y，LIU Y S．Optimal allocation of personal protective equipment and disinfection sup-plies for dispatched medical teams for prevention and control of COVID-19［J］．Chinese Journal of Infection Control，2020，19（3）：250-255．DOI：10.12138/j.issn.1671-9638.20206501.
［27］中国医师协会全科医师分会，中华医学会全科医学分会．紧密型医联体和县域医共体新型冠状病毒肺炎疫情防控指导建议［J］．中国全科医学，2020，23（8）：889-892．DOI：10.12114/j.issn.1007-9572.2020.00.309.
Chinese Medical Doctor Association（CMDA）'s General Practitioners Sub-association，Chinese Society of General Practice.Recommendations guiding compact regional medical consortiums and county-based healthcare networks in the control and prevention of COVID-19 epidemic［J］．Chinese General Practice，2020，23（8）：889-892．DOI：10.12114/j.issn.1007-9572.2020.00.309.

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