To ensure proper healthcare to COVID patients, the general affairs unit under the Joint Prevention and Control Mechanism of the State Council issued the “Work Plan of Providing Tiered COVID Healthcare via Consortium”. In response, PUMCH, tapping its advantage as a core hospital, has dispatched personnel to join the COVID expert group modeled after a medical consortium established by the Health Commission of Dongcheng District, Beijing. They are tasked with providing remote consultation, 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 seeking tiered medical services.

To effectively steer COVID patients to seek tiered and category-based medical services, the Health Commission of Dongcheng District, Beijing established COVID expert groups modeled after a medical consortium by region to provide support to community-level healthcare providers. Shi Di and Liu Yecheng, two deputy chief physicians in the Department of Emergency joined the group of experts from core hospitals, working with Beijing Longfu Hospital and Beijing No. 6 Hospital respectively.

Thanks to the solid foundation laid by previous work of the medical consortium, the PUMCH experts and the two hospitals they work with quickly set up a tiered COVID healthcare mechanism and implement it efficiently. First, consultation guidance in the form of telemedicine is provided to partnering hospitals in the medical consortium. Second, a two-way referral system is established, which works by referring COVID patients in acute and critical conditions that the partnering hospitals receive to core hospitals for further care and, once they stabilize, referring them back to the partnering hospital or community health centers; mechanisms of fast track and quick referrals have been put in place for key population groups such as the elderly, which, upon changes in their conditions, will take them directly to core hospitals. Third, professional training is offered to member hospitals of the consortium to improve their ability in early recognition of diseases, evaluation of high-risk factors leading to critical conditions, early identification of critical conditions, providing standardized care, and prevention and control of nosocomial infections.

“I knew she would be in safe hands at PUMCH,” said a family member of an 80-old COVID patient that Shi Di recently received. The elderly also suffered from pulmonary hypertension, pulmonary heart disease, gastrointestinal bleeding, conditions further aggravated by an accidental fall that led to lower limb fracture. Having failed to obtain the care needed at several hospitals, the patient finally came to PUMCH where her conditions stabilized after emergency care. The family were overwhelmed with happiness and relief. It was decided after discussion with the family that the patient would be transferred to Beijing Longfu Hospital for follow-up management.

Beijing No. 6 Hospital is also receiving COVID patients whose conditions have stabilized. “Meanwhile, COVID patients in acute or critical conditions will be transferred to PUMCH and receive proper care according to their respective conditions,” said Liu Yecheng, who added that “the two-way referral system is working well and orderly”.

As early as 2019, the Department of Emergency already explored the continuation of safe and patient-centered area. It dispatched experts to Beijing Longfu Hospital, a member of the consortium, and together they started the joint construction of a medical consortium of emergency care from scratch.  

When patients are referred to lower-level hospitals, the key to patient safety is whether the receiving hospital is capable of proper care to them. At the onset of the consortium construction, the two sides started with “department-to-department” referral. The PUMCH experts dispatched to the partnering hospitals viewed every referral as a great opportunity for the consortium member hospital’s team to get their feet wet and hone their skills. Through painstaking coaching and well-designed and elaborate training, the consortium team members gradually mastered many kinds of complex emergency care techniques and skills. Then the “department-to-department” referral gradually gave way to the “department-to-hospital” referral, a new model of cooperative healthcare enabled by the consortium. With the support of the hospital and assistance of departments, the annual referrals from PUMCH to member hospitals of the consortium now exceed 1,000.

In advancing the tiered COVID healthcare, PUMCH, as a nationally leading public hospital, will vigorously work with lower-level hospitals so that no patient is left behind. It will optimize care-seeking procedures and promote orderly two-way referrals so that patients can be timely diagnosed, transferred and treated.

Shi Di was resuscitating a COVID patient in acute and critical conditions in the emergency room

Liu Yecheng was conducting bedside teaching to doctors of a consortium member hospital in the ICU

Written by: The Publicity Department and the Department of Emergency

Picture courtesy: Shi Di and Liu Yecheng

Translator: Liu Haiyan

Editor: Shi Di and Wang Yao