【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。