key: cord-1045694-vi51uons authors: Huang, J.; Li, Z.; Qu, X.; Zheng, X.; Tu, C.; Chen, M.; Tan, C.; Liu, J.; Shan, H. title: A high efficient hospital emergency responsive mode is the key of successful treatment of 100 COVID-19 patients in Zhuhai date: 2020-03-17 journal: nan DOI: 10.1101/2020.03.15.20034629 sha: 3277f243472672e079096a21264d3b6a32c98ea2 doc_id: 1045694 cord_uid: vi51uons Background: Since December 2019, Coronavirus Disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout China. The mortality of novel coronavirus pneumonia (NCP) in severe and critical cases is very high. Facing this kind of public health emergency, high efficient administrative emergency responsive mode in designated hospital is needed. Method: As an affiliated hospital of Sun Yat-sen University, our hospital is the only designated one for diagnosis and treatment of COVID-19 in Zhuhai, a medium-sized city. Novel coronavirus pneumonia department, which is administrative led by the president of hospital directly, has been established at early stage of epidemic crisis in my hospital. In NCP department, there are core members of Pulmonary and Critical Care Medicine (PCCM) specialist and multidisciplinary team. Don't stick to national guidelines of NCP, based on professional opinion by respiratory professor and expert group, we focused on individualized treatment and timely adjustment of treatment and management strategies in working about COVID-19 patients. Results: 1. High working efficiency: By Mar 02, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 patients diagnosed with COVID-19. 2. Excellent therapeutic effectAmong 101 hospitalized patients with confirmed COVID-19, all were cured and discharged, except for one death. No secondary hospital infection, no pipeline infection and no pressure sore were found in all patients. 3. Finding and confirming person-to-person transmission characteristic of COVID-19 prior to official release conference: Strengthened protection is key point to zero infection in healthcare group and medical faculty and lower rate of second generation infectious patients. 4. Timely adjustment management and treatment strategy prior to guideline update: The first evidence of digestive tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of COVID-19 has been carried out in our hospital. Conclusions: In our hospital, establishment of NCP department, which is administratively led by the president of hospital directly and specialized conduct by respiratory professor, is the key to success in management and treatment of COVID-19 patients. This hospital emergency responsive mode could provide reference for other hospitals and cities in epidemic situation. As an affiliated hospital of Sun Yat-sen University, our hospital is the only designated one for diagnosis and treatment of COVID-19 in Zhuhai, a medium-sized city. Novel coronavirus pneumonia department, which is administrative led by the president of hospital directly, has been established at early stage of epidemic crisis in my hospital. In NCP department, there are core members of Pulmonary and Critical Care Medicine (PCCM) specialist and multidisciplinary team. Don't stick to national guidelines of NCP, based on professional opinion by respiratory professor and expert group, we focused on individualized treatment and timely adjustment of treatment and management strategies in working about COVID-19 patients. 1. High working efficiency: By Mar 02, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 patients diagnosed with COVID-19. 2. Excellent therapeutic effect：Among 101 hospitalized patients with confirmed COVID-19, all were cured and discharged, except for one death. No secondary hospital infection, no pipeline infection and no pressure sore were found in all patients. 3 . Finding and confirming person-to-person transmission characteristic of COVID-19 prior to official release conference: Strengthened protection is key point to zero infection in healthcare group and medical faculty and lower rate of second generation infectious patients. 4. Timely adjustment management and treatment strategy prior to guideline update: The first evidence of digestive tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of COVID-19 has been carried out in our hospital. In our hospital, establishment of NCP department, which is administratively led by the president of hospital directly and specialized conduct by respiratory professor, is the key to success in management and treatment of COVID-19 patients. This hospital emergency responsive mode could provide reference for other hospitals and cities in epidemic situation. Key words: hospital emergency responsive mode, NCP department, treatment, All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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. There are 72 public medical and health institutions, including 4 tertiary hospitals in Zhuhai, a medium-sized city in Guangdong province. As an affiliated hospital of Sun Yat-sen University, my hospital is the only designated one for diagnosis and treatment of COVID-19 patients in Zhuhai. It's responsible for the consultation and centralized treatment of patients with COVID-19. Since the first patient was admitted on January 17, my hospital started the emergency plan for infectious diseases. The emergency responsive mode was still traditional mode: patients were admitted in infectious department, with help of consultation from PCCM department and instruction from administrative department in hospital (Fig. 1) . But poor treatment effect and low work efficiency had been assessed after four days, a new decision from president of hospital was made quickly. NCP department was established with direct administrative leading and management by president of hospital, and professional guidance by professor and faculty from PCCM. The department of infectious diseases was transferred to the periphery in All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.15.20034629 doi: medRxiv preprint charge of infection control, multidisciplinary consultation was referred for severe and critical patients, final treatment strategy was decided by professor of PCCM, and the whole hospital was mobilized to serve mainly NCP department and fight to COVID-19 crisis (Fig. 2) . Don't stick to national guidelines of NCP, based on professional opinion by respiratory professor and expert groups we focused on individualized treatment and timely adjustment of treatment and management strategies in working about COVID-19 patients. can be isolated and diagnosed in time. Subsequently, total 10 treatment areas (with 162 doctors and 322 nurses) were successively established within one week, which included respiratory intensive care unit (RICU) ( for critical patients), 2 severe patients treatment area, 3 common patients treatment area, 2 suspected cases treatment area, one transitional area after nucleic acid removal, and one isolation area before patients discharge. Among 101 hospitalized patients with confirmed COVID-19, 23 severe patients had P/F ratio less than 300mmHg, 9 critical patients had P/F ratio less than 150mmHg, accompanied by elevated lactate level. Even if higher rate of severe/critical cases(22.78%), all patients were cured and discharged (Fig 3) , except for one death, which had been given invasive mechanical ventilation too early before establishment of NCP department. The knowledge and understood to COVID-19 is constantly All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.15.20034629 doi: medRxiv preprint supplemented and updated. In NCP department, the professor of respiratory department is directly responsible for the treatment plan, making individualized treatment according to the specific situation of patients, rather than sticking to the guidelines, which is the key to the success of the treatment of rest 100 patients. The effective implementation of the treatment plan benefited from the direct leadership and instruction from the president of hospital. Moreover, due to the strict assurance of discharge evidence, the relapse rate of patients after discharge is only 0.97%. Moreover, no secondary hospital infection, no pipeline infection and no pressure sore were found in severe patients (Fig 3) , because 20 doctors and 33 nurses had worked in RICU. prior to official release conference: Finding, confirming and reporting person-to-person transmission characteristic of COVID-19 prior to official release conference in our hospital. And then the local people's Health Commission and local administrative departments in Zhuhai were promptly informed, and a timely response plan and stronger protection were set up. The family and close contacts of confirmed COVID-19 patients were isolated quickly and timely, so that the second generation infectious patients (local residents in Zhuhai) was 16, occupying only 15.53% of all patients. Meanwhile, strengthened protection is also key point to zero infection in healthcare group and medical faculty (Fig 3) . In NCP department, 300 sets of protective N95 masker and protective suits pro day had been used. And total 1500 protective sets and 9 sets of positive pressure electric air supply respirator had been consumed in RICU. 4 . Timely adjustment management and treatment strategy prior to guideline update: The first evidence of digestive tract involvement in COVID-19 has been found in our hospital 4 , which improved discharge process of COVID-19 patients. And the earliest clinical trial of chloroquine in the treatment of COVID-19 had been carried out in our hospital, which was helpful for including of chloroquine in updated guideline. All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the In addition, in NCP department, under the direct leadership of the president, the scientific research team responded quickly to the problems found in clinical practice. The first evidence of digestive tract involvement in COVID-19 was found by gastroscopy and colonoscopy in our hospital, which improved discharge process of COVID-19 patients. And the earliest application of chloroquine as anti-viral drug dues to direct instruction of president of hospital. In our hospital, establishment of NCP department, which is administratively led by the president of hospital directly and specialized conduct by respiratory professor, is the key to success in management and treatment of COVID-19 patients. This hospital emergency responsive mode could provide reference for other hospitals and cities in epidemic situation. All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.15.20034629 doi: medRxiv preprint Public health emergency: social representations among managers of a university hospital Ponder over the novel coronavirus infection epidemic situation Evidence for gastrointestinal infection of SARS-CoV-2 Recommended Modifications and Applications of the Hospital Emergency Incident Command System for Hospital Emergency Management Clinical management and infection control of SARS: lessons learned Gaps remain in China's ability to detect emerging infectious diseases despite advances since the onset of SARS and avian flu. Health Aff (Millwood) All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.15.20034629 doi: medRxiv preprint All data generated or analysed during this study are included in this published article. The authors declare that they have no competing interests. No. Hong Shan and Jing Liu conceived and designed this study and final approval of the version to be published, who were correspondent; Jin Huang and Zhonghe Li performed this study and wrote the manuscript, who contributed equally to this work as first authors; Xiujuan Qu, Xiaobin Zheng and Changli Tu collected and analyzed the data; Meizhu Chen and Cuiyan Tan wrote and embellished this paper. All authors read and approved the final manuscript. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.15.20034629 doi: medRxiv preprint