With the lifting of COVID controls and the teardown of layers of “firewalls” in December 2022, the medical community waged the last battle against COVID-19, which is particularly tough for PUMCH and other medical institutions in China alike for many medical staff members were infected while people’s need for medical services surged.
On December 21, the medical care unit under the Joint Prevention and Control Mechanism of the State Council held a national teleconference. The leadership team of PUMCH conveyed the instructions of the conference to the letter as soon as possible and made specific arrangement at the hospital-level joint prevention and control meeting on the next day, requiring all the staff members to abide by the decisions and arrangements of the CPC Central Committee in both thinking and action, earnestly fulfill each task and do their utmost to provide quality care in the new phase.
In the combat of COVID-19, every second counts. Since November, PUMCHers, with the resolve and grit to face the pandemic head on, have responded to the evolving situation flexibly and actively spotted changes to take precautions. With unified command and concerted efforts, the hospital coordinates regular medical care provision and epidemic prevention and control. Through measures such as expanding the capacity of Internet diagnosis and treatment, fully supporting emergency care, making strategic preparations for critical care, and boosting health science popularization and publicity, PUMCH vigorously steers patients to seek tiered and category-based care to fight the epidemic in a targeted and controlled manner.
PUMCHers put people’s lives above everything else.
Outpatient Services: COVID Internet Diagnosis and Treatment
Since November, the hospital has been providing Internet diagnosis and treatment as an important supplement to offline healthcare. Through publicizing the services to patients and guiding them towards it, encouraging doctors to work from home and referrals between online and offline services, among other measures, the hospital strives to unleash the potential of Internet diagnosis and treatment. However, as Internet care was limited to patients seeking follow-up care within half a year of their initial visit, many first-time or overdue patients were denied access.
On December 11, the National Health Commission issued the “Notice on Providing Proper Internet Medical Services for Combating COVID-19”. This is a timely measure that gives hope to many COVID-19 patients. PUMCH acted on it quickly, with the Department of Outpatient, Information Technology Center, Department of Medical Affairs, Department of Human Resources, Department of Pharmacy and Department of Medical Records, among others, discussing the feasibility of the policy and the implementation steps. The Information Technology Center worked around the clock to develop the system needed, and on December 19, the COVID Internet Diagnosis and Treatment of PUMCH was officially launched.
The online module supports first consultation of COVID-19 cases, diagnosis and treatment for patients with 11 types of COVID-19 symptoms, and services such as medical care and psychological counselling, medication guidance and drug delivery to home for patients with underlying conditions. At the same time, PUMCH encourages all its doctors to, on top of their regular consultations scheduled, voluntarily provide online services for COVID-19 patients during their morning, noon and evening breaks. Internet healthcare goes beyond the time and space restrictions of outpatient services and enables doctors and patients to have less restricting and closer interactions.
A COVID-19 patient commended the services offered to him: “I have used online medical services before, and I find them to be very convenient, even more convenient now with the first consultation offered to COVID-19 patients.”
Emergency Care: Full Support Behind Emergency Care and Fever Clinic
Over the past three years, the Department of Emergency and the fever clinic of PUMCH have never closed a whole day due to the epidemic, thanks to its approach of “fast closing, fast screening, fast disinfection and fast opening”. Since the release of China’s new 20 measures for optimizing COVID response and of the 10 new COVID easing measures, the number of COVID-positive patients visiting the fever clinic has surged. In response, PUMCH adopts the strategy of “the Department of Emergency behind the fever clinic, and the whole hospital behind the Department of Emergency” to alleviate the burden on emergency care and the fever clinic as much as possible.
First, the capacity of the emergency care and fever clinic needs to be expanded rapidly. In mid-November, the hospital leadership already discussed feasible solutions to rapidly expand the capacity of the fever clinic. The Department of Capital Construction, Medical Engineering, Infection Control, Medical Affairs and Emergency, among others, quickly acted: on November 25, the makeshift fever clinic started construction; construction was completed and it was put into use on November 27; on December 9, the repurposing of the Department of Emergency for fever clinic started and on December 19, the repurposed emergency care was put into use. Meanwhile, various disciplines, party branches, departments and offices come to their aid actively and arrange for doctors to work at the fever clinic in batches. A hospital-wide consensus has been established that medical care capacity should be expanded in every way possible.
The patients that the Department of Emergency receives are allocated to different channels.
One channel is inter-hospital referral. The two deputy chief physicians in the Department of Emergency joined the group of experts from core COVID-treating hospitals in the hospital consortium established by the Health Commission of Dongcheng District, Beijing. They work with Beijing Longfu Hospital and Beijing No. 6 Hospital respectively in such ways as providing remote consultation, strengthening special training, smoothing two-way referral channels, and improving the efficiency and continuity of medical services by establishing alignment in tiered healthcare. This approach goes a long way in helping bring quality medical resources to lower levels and expand capacity and steer COVID patients towards tiered medical services.
The other channel is intra-hospital referral. On November 19, PUMCH officially opened its first in-hospital quarantine ward for COVID patients, and subsequently put to use multiple quarantine wards. It has now progressed to the stage of each specialty receiving COVID patients seeking its specialized services. For patients with complex conditions and multisystem involvement, the hospital leadership offers guidance and the Department of Medical Affairs assists in triage.
PUMCHers are deeply aware that saving lives is the inherent duty of medical professionals. Whatever the cause of critical illness, it’s always important to prioritize treatment to save lives, as hospitals are meant to do. The importance of acting faster couldn’t be overemphasized. Resources of the whole hospital are favorably allocated to the emergency care and fever clinic. PUMCHers honor their commitment to “people first, life first” with action in every way and never slack off for a second in their race against time to save lives.
Critical Care: Building a Life Support Platform Featuring Unified Command and Department-specific Decision-making
As early as November 22, ICU submitted a plan to the hospital to prepare for setting up quarantine wards and a taskforce for COVID patients in critical conditions. “We are fully mobilized and ready to act any minute.” MICU, CCU, NICU, the Department of Infectious Diseases, and Department of Respiratory and Critical Care, among others, are all on standby duty.
December 12 saw the peak of infections in Beijing and December 15 the peak of patients to the fever clinic. According to experts, the next week or two will see the peak of patients in critical conditions. The priority of the hospital at the current stage has shifted from “prevention of infection” to “prevention of critical conditions and deaths”.
Whatever the turbulence, PUMCH always stands firmly. PUMCHers take the initiative and act vigorously to make all preparations thoroughly. The top leadership makes arrangements in advance, mid-level leaders take on tasks actively and all staff members make concerted efforts. Training and resource coordination have been stepped up so that PUMCHers will be better-positioned to treat critical conditions and save people’s lives.
First, form a taskforce to treat patients in critical conditions as essential preemptive preparations. The hospital has set up a critical care expert group and organized their consultations for patients in critical conditions, and a system of responsibility for assigned cases has been established so that more targeted guidance can be provided. Each specialty organizes training revolving around the characteristics of its high-risk patients to quickly enhance their capability in treating such patients and improve the hospital’s overall clinical expertise as soon as possible.
Second, ensure the supply of equipment, materials and drugs with the key patient groups and steps in mind. Since mid-November, the quarantine ward of the Department of Emergency, the general wards of various departments, ICU and MICU have been put into use one after another; and the Department of Pediatrics is fully behind NICU, the Department of Obstetrics and Gynecology behind the Obstetrics Center and the Department of Nephrology behind the Hemodialysis Center. The hospital has made painstaking efforts to ensure quality care for patients in acute and critical conditions, for example, coordinating emergency care resources, procuring life support equipment in advance, keeping a good stock of therapeutic drugs and expanding blood supply. In a nutshell, to attend to key patients in key wards, it is essential to think ahead and think deeper.
Third, facilitate the repurposing of wards of each clinical specialty for critical care wards. COVID patients whose conditions worsen will be first treated by the urgent care unit of the Department of Emergency and then transferred to the corresponding care unit; COVID patients with underlying conditions will be treated in the corresponding specialty. All specialties are equipped with critical care beds or their own ICU, able to repurpose their beds for critical care beds within 24 hours when necessary.
An elderly man in his 80s infected with COVID had a femoral neck fracture due to an accidental fall. He was promptly admitted to the Department of Orthopedics and had a hip replacement performed under protected conditions. A number of COVID-positive pregnant women gave birth to healthy babies at PUMCH. A 94-year-old grandma was quickly discharged from the hospital under the careful care of the medical staff and said gratefully when she was leaving: “You are my family, and your company and encouragement are the best medicine for me.”
Science Popularization: Guiding Patients to Seek Care Scientifically
Each person should take primary responsibility for his or her own health. To help the public acquire knowledge about epidemic prevention and control is an important step to cut off the spread of infections and control the epidemic. Over the past three years, a large percentage of people have gained knowledge about virus transmission routes and personal protection, and their health awareness and literacy have improved greatly. When the focus of the hospital shifts to medical treatment, a necessary part of its work is to help the public reduce panic and increase confidence in taming the disease.
PUMCH has made well-planned and step-by-step arrangements for medical science popularization. It pays attention to the news releases of the State Council and Beijing Municipality and reaches out to science experts who provide high-quality science content that it can release as it sees fit; interviews medical experts or asks experts to contribute articles in response to public concerns; produces a batch of well-made short science videos in advance; interacts more with media outlets, takes their questions and provides scientific answers, forming with them a powerful portfolio for science popularization and communication.
On the day of the release of the new 10 measures for easing COVID controls, PUMCH posted “Quarantine at Home, Are You Ready”, which was quickly forwarded by many mainstream media outlets. The “home medical kit” advised by PUMCH rapidly topped the list of Weibo (microblog) Trending Topics. As of December 22, the hospital has released nearly 30 articles, illustrations and short videos on home treatment, medication guidance, protection of vulnerable groups, nutrition and psychology, etc., 7 of which made the top 10 Weibo Trending Topics. The short science popularization videos have often been recommended by Healthy China and Healthy Beijing, both of which are official outlets. Xinhua.com launched the column “This is what PUMCH doctors say”, which further expands the influence of PUMCH’s science popularization efforts and serves as scientific, vigorous and trustworthy “PUMCH family doctors” to readers.
Healthcare workers bear the brunt of this pandemic, but they are indispensable to the provision of healthcare, hence the plight caused by the shortage of healthcare workers in good shape. But the healthcare workers in PUMCH stick to their post unless they are in critical conditions, and every department tailors the response strategy to their respective situations but keeps it aligned with the hospital-level coordinated strategy, all facing the surge in infections head on. A COVID-free spring will eventually come, hopefully just around the corner. As a top player among China’s best hospitals, PUMCH will strive to be the last resort that brings hope to patients, aided by all PUMCHers who will work more vigorously, proactively and creatively.
Written by: Chen Mingyan
Translator: Liu Haiyan
Editor: Wang Yao