A high-efficiency hospital emergency-response mode is key to successful treatment of COVID-19 patients in

Background: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and has since rapidly spread throughout China. The mortality rates of novel coronavirus pneumonia (NCP) in severe and critical cases are very high. In this public-health emergency, a high-efficiency administrative emergency-response mode in designated hospitals is needed. Method: As an affiliated hospital of Sun Yat-sen University, ours, the Fifth Affiliated Hospital, is the only one designated for the diagnosis and treatment of COVID-19 in Zhuhai, a mid-sized city. The NCP department, for which the president of the hospital is also the direct administrative lead, was established at an early stage of the epidemic at our hospital. This department includes core members of the pulmonary and critical-care medicine (PCCM) specialist and multidisciplinary team. Rather than adhering to national guidelines on NCP, we have focused on individualized treatment, timely adjustment thereof and management strategies in working with COVID-19 patients based on the professional opinions of a professor of respiratory medicine and an expert group. Results: (1) High working efficiency: As of March 2, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 who were diagnosed with COVID-19. (2) Excellent therapeutic effect: Of the 101 patients hospitalized with confirmed COVID-19, only 1 has died, and the rest were all cured and discharged. No secondary hospital infection, pipeline infection or pressure sores were found in any patient. (3) Finding and confirming person-to-person transmission characteristic of COVID-19 prior to the official press conference: Strengthened protection is key to zero infection among the healthcare providers and medical faculty, as well as to a lower rate of second-generation infectious patients. (4) Timely adjustment of management and treatment strategy prior to guideline updates: The first evidence of digestive-tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of the disease was carried out at our hospital. Conclusions: At our hospital, establishment of an NCP department, which is directly administered by the hospital president and specialized operation guided by a professor of respiratory medicine, has been key to our success in managing and treating COVID-19 patients. Our hospital’s

4 response mode could provide a reference for other hospitals and cities in this epidemic situation.

Contributions To Literature
We can comprehensively recognize the shortcomings and deficiencies of traditional emergencyresponse system in the capacity to recognize new infectious diseases.
The key to our success in managing and treating COVID-19 patients is to establish NCP department with the professional guidance from the PCCM department, and multidisciplinary participation. Our highefficiency hospital emergency-response mode can provide reference for other hospitals and regions.
In the treatment process, on the basis of the national guidelines, the treatment plan should be adjusted for infectious respiratory diseases, meaning that the treatment effects are different too 2 . At the beginning of this new epidemic, the absence or insufficiency of hospital emergency-response plans caused a rapid spread of COVID-19 and high mortality rates in severely ill COVID-19 patients, which has greatly increased the subsequent costs of fighting the epidemic nationwide 3 . Therefore, some effective hospital management models need to be shared, summarized and referenced in order to stop the epidemic as soon as possible and reduce mortality.

Method:
Zhuhai, a mid-sized city in Guangdong Province, has 72 public medical and health institutions, including four tertiary hospitals. The authors' hospital, the Fifth Affiliated Hospital of Sun Yat-sen University, is the only one designated for the diagnosis and treatment of COVID-19 patients in Zhuhai; it is responsible for consultation on and centralized treatment of these patients. When the first patient was admitted on January 17, 2020, our hospital activated an emergency plan for infectious diseases.
It was still employing the traditional emergency-response mode: patients were admitted to the Department of Infectious Diseases, receiving consultation by the PCCM department and instruction from the administrative department (Fig. 1). However, after 4 days, the treatment effect for COVID-19 patients was assessed as poor and the hospital's work efficiency in relation to this disease as low.
The president of the hospital quickly made a new decision. Under his direct administrative leadership and management and with the professional guidance of the PCCM department, the NCP department was established. The Department of Infectious Diseases was given the more peripheral role of handling infection control, severely and critically ill patients received multidisciplinary consultation, the hospital's professor of PCCM decided on a finalized treatment strategy, and the entire hospital was mobilized to serve the NCP department first and foremost and to fight the COVID-19 crisis ( one respiratory intensive-care unit (RICU; for critically ill patients), two treatment areas for severely ill patients, three for non-severe COVID-19 patients, two for suspected cases, one transitional area after performance of nucleic-acid removal testing, and one isolation area before patient discharge.

Excellent therapeutic effect:
Of the 101 hospitalized patients with confirmed COVID-19, 26 severely ill patients had a ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) <300 mmHg, while 10 critically ill patients had a P/F ratio <150 mmHg accompanied by elevated lactate dehydrogenase (LDH) levels. Despite the high rate of severe/critical cases (25.74%) at our hospital, all but one patient were cured and discharged (Fig. 3). The remaining patient died after having been given invasive mechanical ventilation too early due to the NCP department not yet having been established.
Our knowledge and understanding of COVID-19 are continually being supplemented and updated. In the NCP department, the professor from the Department of Respiratory Medicine is directly responsible for the treatment plan, individualizing treatment according to patients' specific conditions rather than sticking to national guidelines; this has been the key to our success in treating 100 of the 101 total patients. The effective implementation of the treatment plan has benefited from the direct leadership and instruction of the hospital president. Moreover, due to strict discharge standards, the relapse rate of patients after discharge is only 0.97%. Moreover, no secondary hospital infection, pipeline infection or pressure sores have been found in severely ill patients (Fig. 3), because 20 doctors, 33 nurses, and adequate protective materials and equipment have been supplied to the RICU.

3.
Finding and confirming person-to-person transmission characteristic of COVID-19 prior to official press conference: We have discovered, confirmed and reported such transmissions before holding an official press conference. Subsequently, the local People's Health Commission and administrative departments in been key to the zero rate of infection among our healthcare providers and medical faculty (Fig. 3). In the NCP department, 300 sets of protective N95 masks and protective suits have been used per day.
In addition, a total of 1500 sets of protective gear, including nine positive-pressure electric suppliedair respirators, have been used in the RICU.

4.
Timely adjustment of management and treatment strategy prior to guideline updates: The first evidence of digestive-tract involvement in COVID-19 was found at our hospital 4 , which improved the discharge process for COVID-19 patients. Discharge standards based on national guidelines consider only elimination of 2019 novel coronavirus (2019-nCoV) from the respiratory tract, but we found that 2019-nCoV remained longer in the digestive tract than in the respiratory tract in some patients. Therefore, we do not permit discharge until 2019-nCoV has been eliminated from both stool and the respiratory tract, which has greatly lowered the rate of relapse. In addition, the earliest clinical trial of chloroquine in the treatment of COVID-19 was carried out in our hospital, which was helpful for the inclusion of chloroquine in the updated guidelines. Meanwhile, we achieved an infection rate of zero among our healthcare providers and medical faculty due to early discovery of person-to-person transmission of COVID-19, sufficient supplies of protective equipment and materials, and governmental financial support. In addition, under the direct leadership of the president, the scientific-research team in the NCP department has responded quickly to problems found in clinical practice. The first evidence of digestive-tract involvement in COVID-19 was found via gastroscopy and colonoscopy at our hospital, which improved the discharge process and lowered the relapse rate in COVID-19 patients. We were also responsible for the earliest application of chloroquine as an anti-viral drug in COVID-19 due to the direct instruction of the hospital president.

Conclusions
In our hospital, establishment of the NCP department, which is directly administered by the hospital's president and guided by a professor of respiratory medicine, has been the key to our success in