DOI: https://doi.org/10.21203/rs.3.rs-985711/v1
The COVID-19 pandemic spreads all over the world for its high infectivity. This paper presents the practice in patient care management in a Fangcang shelter hospital(FSH) in Wuhan. Large numbers of mild patients were admitted to fangcang shelter hospitals at the beginning of 2020. The Liaoning National Medical Rescue Team (LNMRT) applied simple electronic management (SEM) mode in patient care management when working in the Wuchang Fangchang Shelter Hospital (WFSH). The medical efficiency was assessed by comparing the median hospitalization time between the patients receiving normal treatment and care (group A) and those receiving the SEM(group B). The median hospitalization time was 14 days for group A and 12 days for group B (p=0.001). As a result, It was more effective to apply SEM in fangcang shelter hospitals.
Hospital information systems (HIS) are widely used in hospitals all over the world. Despite the benefits of HIS, they are not very convenient for practice sometimes. [1–3] Considering the information management in hospitals which requires accuracy and timeliness in some cases, and the difficulty of the system optimization after implementation, it is necessary that some supplement for HIS should be made according to the need in a given situation.[4]
The COVID-19 epidemic broke out in Wuhan City, Hubei Province in December 2019 and spread rapidly. FSHs which is converted from large-scale public venue, is proposed and proven to be an effective way for administering medical care and social isolation.[5] FSHs were built and opened in China for isolation and care of patients with mild symptoms. Days after the opening of the WFSH, the HIS was available which made it more convenient to inquire about patient information, examination results and doctors’ orders. Meanwhile, medical information could also be stored effectively. However, unlike in general hospitals, management of hundreds or even thousands of patients at the same time in the WFSH was really a huge challenge, furthermore, the HIS was not competent for processing the information of a large number of patients simultaneously and it took a long period of time to inquire about the medical information of each patient separately through the HIS.
The LNMRT worked in the WFSH with other medical teams. Based on the application of the HIS, the LNMRT adopted a new electric management mode named SEM in patient treatment and care, which achieved good results. FSHs were built from large-scale public venue such as the Hongshan Gymnasium of Wuchang District, the Wuhan International Exhibition Center of Jianghan District, the Wuhan living Room of Dongxi Lake District and so on. The time required for an FSH construction was only 1-2 days. An FSH could accommodate thousands of patients at the same time. Only patients with mild (with mild clinical symptoms, no pneumonia in pulmonary imaging) or general (with fever, respiratory symptoms, pneumonia in imaging) symptoms were admitted in FSHs (figure 1.). FSHs played an important role in care of patients and reduced the medical burden of local hospitals under COVID-19 pandemic.
1124 patients were treated in WFSH. The ratio of doctors to nurses to patients was 1:7:125 there and it was seriously lower than that in general hospitals. [6–8]. Workload of medical staff in FSHs would be enormous if patient management was carried out according to that in general hospitals. Under the epidemic situation, patients always had psychological problems such as anxiety, fear, sadness, depression and so on. Bad psychological state might lead to inhibition of body immune function and was not conducive for their recovery. [9–12] However, one-to-one psychological counseling might greatly increase workload of medical staff. As a result, group psychological counseling could not only reduce workload of medical staff, but also achieve good results.
Although HIS is widely used, there is not a kind of electronic system designed specifically for FSHs yet. The SEM in this study was formulated by the LNMRT according to the actual work needs and achieved good results.
The SEM consisted of four parts. One was application of office software on medical information recording, storage and processing independent of HIS. The second was electronic transmission of patient identity information. The third was that a specially assigned person was fixed for the computer-work. The last was application of the YY live broadcast for patient emotion management. Before the decision was made, the SEM was first discussed by the LNMRT experts and approved by the team leader finally. As a result, the chief resident was assigned to be responsible for the data archiving and management. Emotion management of patients through the YY live broadcast was carried out by another team member at a fixed time every morning and every evening for 1 hour each time.
The patient information and blood test results were entered into the SEM database. Information transmission between outside and inside the WFSH ward was mainly in form of photos. Some information that could not be collected by photos directly would be recorded on paper and then immediately uploaded to the medical WeChat group. When patient information was uploaded, it was entered into the database by the chief residant right away. And test results were entered into the database in the same afternoon when they could be obtained from the HIS. Then a screening formula was set up to seek out the patients who met the discharge criteria and the test items that the remaining patients needed to have the next day. The screening formula was set up based on the regulation of patient care management of WFSH (figure 1.). The screening formula was discussed before it was adopted by the team experts and finally confirmed by the team leader. The team experts would review the information of the patients who were screened out for discharge. If the screened-out patients did meet the discharge criteria, they would be discharged from WFSH the next day. But if they were not eligible actually, they would still stay in the WFSH ward for further treatment and care. The YY broadcast was carried out by a fixed doctor every morning and every evening, and sometimes the team leader or other team experts would be invited to participate and answer patients’ questions. The diagram of the SEM was showed in figure 2.
Figure 1. the patient care management regulations in WFSH
Figure 2. the simple electronic management mode
After applying the SEM, the collection and management of patient information were convenient and accurate, examination arrangement was also timely and hospitalization time was shortened. The YY broadcast was well received by patients. Their anxieties relieved after communication with doctors through YY and their psychological mood became more stable.
The difference of median length of hospitalization among 544 patients was analyzed, who were divided in to two groups according to medical care management mode that they received. The 289 patients of group A received the normal care management the 255 patients of group B received the SEM. The non-parametric test was used to analyze the difference of the median hospitalization time between the two groups.
The patients’ general information could be seen in Table 1. The median hospitalization time was 14 days for the patients in group A and 12 days for those in group B (figure 3.). There is significant difference between the median hospitalization time of the two groups (p=0.001). The result showed that the patients receiving the SEM (group B) had shorter hospitalization time than group A. The Correlation between the hospitalization time and other factors could be seen in Table 2.
Table 1. baseline data and single factor analysis
|
total |
A group |
B group |
p-value |
|
|---|---|---|---|---|
|
patients(n) |
544 |
289 |
255 |
- |
|
gender(male)(n) |
233[42.8%] |
112[38.8%] |
121[47.5%] |
0.041a |
|
(female)(n) |
311[57.2%] |
177[61.2%] |
134[52.5%] |
|
|
age(years) |
49[39-58] |
50[40-59] |
48[38-57] |
0.045b |
|
Hospitalization time (days) |
13[9-18] |
14[10-19] |
12[8-17] |
0.001b |
| a: pearson chi-square analysis; b: non-parametric test | ||||
|
variables |
hospitalization time |
|
|---|---|---|
|
spearman correlation |
p-value |
|
|
group |
-0.137 |
0.001 |
|
age |
0.083 |
0.053 |
|
gender |
-0.044 |
0.317 |
The SEM greatly improved the efficiency of medical work and guaranteed accuracy of medical data without any omission or missing. Meanwhile, emotion management for patients through YY make contribution to relieve patients' psychological problems on the premise of limited medical resources and served a similar effect as to group psychotherapy which was more effective than one-to-one counseling.
Because all the patients in FSHs had just mild or general symptoms without severe cardiopulmonary diseases, the data of complicated diseases are not compared in the baseline information. The p values of the comparation of gender and age between group A and B were 0.041 and 0.045 respectively. If p<0.05 was used as the cut-off point, there was a significant difference in gender and age between the two groups. If p<0.01 was used, there was no significant difference. However, in further analysis, it can be seen that the average hospitalization time of patients has no significant correlation with gender and age, but only with grouping. Therefore, the result shows that the average hospitalization time is only significantly correlated with the group which represents whether the SEM is applied.
Compared with HIS systems, the SEM has the characteristic of simpler and easier to operate, and it meets the requirement for quick start. However, there are still shortcomings in patients’ information acquisition of the SEM. If information acquisition, storage and management could be integrated in order to reduce the workload of manual operation, it will bring more accurateness and efficiency for medical work. Meanwhile, a simplified management database could be set up in FSHs, and a management mode suitable for FSHs could be used to avoid complexity and improve work efficiency.
FSHs for controlling major public health events such as infectious diseases were different from general hospitals or hospitals built for controlling natural disasters such as earthquake or seaquake, which was reflected in some ways such as medical care management, prevention of infection spreading and psychological management for patients. In the WFSH, the SEM was successfully carried out for its simple and easy operation, fast and high accuracy. The further improvement of the SEM could be in many ways, such as application of direct voice inputting in data acquisition instead of manually filling in forms, establishment of a small local network for data storage in order to share data among a few computers and cope with the need for processing a large amount of data, employment of robots in FSHs to carry out basic care for patients who suffer from infectious diseases, usage of psychological management system for relieving patients' bad psychological mood, an orderly electronic management procedures for medical materials, setting up lists of materials needed to deal with different treatment tasks and building up management database, and so on.
The COVID-19 is highly infectious. After mutation, the virus is even more contagious. However there is still no effective treatment against the COVID-19 infection. Except for specific vaccines, effective and appropriate isolation is maybe the most efficient method to prevent further spread of the infection and indispensable for controlling the pandemic. It is hoped that the SEM for patients treatment and care might play a certain role in the fighting against the COVID-19 pandemic.
Funding: This study was funded by the study of Clinical Treatment and Management Strategy for Emergency Medial Rescue (grant number AF-SOP-07-1. 1-01).
Conflict of Interest: Author Wei Chong declares that he has no conflict of interest. Author Xueyuan Li declares that she has no conflict of interest.
Availability of data and material : all data and materials support the claims and comply with field standards.
Code availability : Not applicable
Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
Consent to participate: Informed consent was obtained from all individual participants included in the study.
Consent for publication: consent for publication was obtained from all the authors and the Ethics Committee.
Authors' contributions : All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by xueyuan li. The first draft of the manuscript was written by xueyuan li and wei chong, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.