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| 抗击新型冠状病毒肺炎疫情期间呼吸与危重症医学科门诊独立单元运行模式及其作用 |
| 张景熙,时冬辰,孙沁莹,聂小蒙,陈琳,王冬梅,赵立军,黄怡,白冲 |
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(1. 海军军医大学(第二军医大学)长海医院呼吸与危重症医学科, 上海 200433;
2. 海军军医大学(第二军医大学)长海医院门诊部, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 探讨抗击新型冠状病毒肺炎（COVID-19）疫情期间呼吸与危重症医学科门诊独立单元运行的模式及其作用。方法 自2020年1月31日（春节假期结束后）开始，我院呼吸与危重症医学科门诊采取独立单元运行模式。分别选择2020年1月13日至23日（春节假期前10个工作日）及2020年1月31日至2月12日（春节假期后10个工作日）于我院呼吸与危重症医学科门诊就诊的患者5 377例和702例，同时选择呼吸与危重症医学科门诊独立单元运行前和运行后均工作在该门诊的医护人员10名。比较门诊独立单位运行前和运行后的就诊人数、接诊具有COVID-19流行病学史的患者人数等医疗指标，患者空间密度和医护人员防护情况等感染控制指标，以及医护人员的焦虑倾向等心理状态指标。结果 呼吸与危重症医学科门诊独立单元运行前即春节假期前10 d门诊量为5 377例，同比增长15.31%（2019年同时期为4 663例）；春节假期后10 d的门诊量为702例，较春节假期前10 d减少86.94%，同比下降83.43%（2019年同时期为4 236例）。独立单元运行前和运行后分别接诊具有COVID-19流行病学史的患者25例和0例，差异无统计学意义（χ2=2.26，P>0.05）。门诊患者候诊时间由独立单元运行前的（178.33±36.24）min缩短至运行后的（8.50±3.59）min，差异有统计学意义（t=10.18，P<0.01）。独立单元运行前和运行后急性上呼吸道感染、急性支气管炎的总比例分别为46.61%（2 506/5 377）和34.90%（245/702），差异有统计学意义（χ2=34.9，P<0.01）；独立单元运行后咳嗽原因待查患者比例［2.42%（17/702）］较运行前［5.41%（291/5 377）］下降，差异有统计学意义（χ2=11.54，P<0.01）；独立单元运行前和运行后，慢性阻塞性肺疾病急性加重、支气管哮喘急性发作所占比例差异均无统计学意义（P均>0.05）；独立单元运行后慢性阻塞性肺疾病配药、支气管哮喘配药总比例为29.34%（206/702），较运行前［15.23%（819/5 377）］升高，差异有统计学意义（χ2=88.23，P<0.01）。诊疗区患者人数密度由独立单元运行前的（1.85±0.35）/m2下降至运行后的（0.31±0.08）/m2，差异有统计学意义（t=10.52，P<0.01）。独立单元运行前、运行后医护人员手部卫生规范、戴口罩规范、戴工作帽者分别为7、7、5人和10、10、10人，差异均无统计学意义（P均>0.05）。医护人员焦虑评分由独立单元运行前的（38.33±2.79）分下降为运行后的（33.61±2.38）分，差异有统计学意义（t=4.97，P<0.01）。独立单元运行后医护人员对防护措施的满意度较运行前提高（9人vs 4人），差异有统计学意义（χ2=20.00，P=0.03）。结论 呼吸与危重症医学科门诊独立单元运行模式是COVID-19疫情暴发期间门诊工作的一种可行的优化模式，具有满足门诊患者需求、缩短就诊流程、加强医护人员职业防护的优势，有助于降低交叉感染、提高医院感染控制水平。 |
| 关键词: 新型冠状病毒肺炎 预防和控制 门诊 医院感染控制 心理状态 |
| DOI：10.16781/j.0258-879x.2020.04.0383 |
| 投稿时间：2020-02-21修订日期：2020-04-03 |
| 基金项目:国家自然科学基金（81670016）． |
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| Independent outpatient unit mode and its role in the department of respiratory and critical care medicine during the outbreak of coronavirus disease 2019 |
| ZHANG Jing-xi,SHI Dong-chen,SUN Qin-ying,NIE Xiao-meng,CHEN Lin,WANG Dong-mei,ZHAO Li-jun,HUANG Yi,BAI Chong |
(1. Department of Respiratory and Critical Care Medicine, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Outpatient, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To introduce the independent outpatient unit mode and explore its role in the department of respiratory and critical care medicine during the outbreak of coronavirus disease 2019 (COVID-19). Methods The independent outpatient unit mode of the Department of Respiratory and Critical Care Medicine in Changhai Hospital, Naval Medical University (Second Military Medical University) was started on Jan. 31, 2020 (after the Spring Festival holiday). A total of 5 377 outpatients of this department from Jan. 13, 2020 to Jan. 23, 2020 (10 working days before the Spring Festival holiday) and 702 patients from Jan. 31, 2020 to Feb. 12, 2020 (10 working days after the Spring Festival holiday) were respectively selected. There were 10 doctors and nurses who worked both before and after the operation of independent outpatient unit in our Department. Medical indicators such as the number of outpatients and the number of patients who had a COVID-19 epidemic history, infection control indicators such as spatial density of patients and protection and control of medical staff, and the psychological status of medical staff such as anxiety were compared before and after the operation of the independent outpatient unit. Results The number of outpatients in the Department of Respiratory and Critical Care Medicine was 5 377 before the operation of the independent outpatient unit (10 days before the Spring Festival holiday), which was 15.31% higher than that in the same period of 2019 (4 663). The number of outpatients in the 10 days after the Spring Festival holiday was 702, 86.94% lower than that before the Spring Festival, and 83.43% lower than that in the same period of 2019 (4 236). The number of patients with COVID-19 epidemic history before and after the operation of independent outpatient unit was 25 and 0, respectively (χ2=2.26, P>0.05). The waiting time of outpatients decreased from (178.33±36.24) min before operation to (8.50±3.59) min after operation (t=10.18, P<0.01). The total proportion of acute upper respiratory tract infection and acute bronchitis was 46.61% (2 506/5 377) and 34.90% (245/702), respectively (χ2=34.9, P<0.01). The proportion of cough with unknown reason was 2.42% (17/702), which was significantly lower than the former (5.41% ［291/5 377］) (χ2=11.54, P<0.01). There was no significant difference in the proportion of acute exacerbation of chronic obstructive pulmonary disease and acute attack of asthma before and after the operation of independent outpatient unit (both P>0.05). The proportion of prescribing medicine for chronic obstructive pulmonary disease and bronchial asthma was 29.34% (206/702), which was significantly higher than the former (15.23% ［819/5 377］) (χ2=88.23, P<0.01). The density of patients in the diagnosis and treatment area decreased from (1.85±0.35)/m2 to (0.31±0.08)/m2 (t=10.52, P<0.01). There were 7, 7, 5 and 10, 10, 10 medical staff who followed the standard of hand hygiene and wearing mask and work cap before and after the operation of the independent outpatient unit respectively (all P>0.05). The anxiety score of medical staff decreased from (38.33±2.79) before the operation of independent outpatient unit to (33.61±2.38) (t=4.97, P<0.01). The satisfaction of the medical staff with the protective measures increased after the operation of the independent outpatient unit than before (9 vs 4), and the difference was statistically significant (χ2=20.00, P=0.03). Conclusion The independent outpatient unit mode of the department of respiratory and critical care medicine is a feasible and optimized mode of outpatient service during the outbreak of COVID-19. It could meet the needs of outpatients, shorten the waiting time, and improve the occupational protection of medical staff. It is also helpful to reduce cross infection and improve the level of prevention and control of nosocomial infection. |
| Key words: coronavirus disease 2019 prevention and control outpatient nosocomial infection control psychological status |
