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Qilu Hospital of Shandong University: strengthening the construction of "1365" system to improve the treatment ability of emergency and severe cases

Updatetime:2023-01-08 09:18:15 From:Qilu Hospital

Recently, Qilu Hospital of Shandong University has resolutely implemented the national joint prevention and control mechanism and relevant decisions and arrangements of the Shandong provincial party committee and provincial government, and mobilized cadres and staff of the whole hospital with the goal of "protecting health, preventing severe diseases and reducing death" to give full play to the system, team and technical advantages of the diagnosis and treatment of critical and emergency cases in Qilu Hospital. Qilu Hospital will resolutely shoulder the treatment task of emergency and severe cases, and make all-out preparations in all respects, forming the “1365” systematic work layout with Qilu characteristics.
Adhere to the "one goal" principle and realize the integrated treatment of acute and critical diseases
Adhere to the "people first, life first" principle, give full play to the systematic construction foundation and multi-disciplinary comprehensive advantages of the Emergency Medicine of Qilu Hospital, highlight the forward movement of the first aid front, and build a full-chain emergency and critical care system with pre-hospital first aid, in-hospital emergency and intensive care, so as to achieve the goal of " protect health, prevent severe illness, and reduce the illness death".

Adhere to the "three overall plans" to achieve efficient and accurate allocation of diagnosis and treatment resources of emergency and critical diseases
Adhere to the idea that the hospital is a whole, and realize the "three overall plans" according to the needs of emergency and critical treatment, that is, to co-ordinate the medical team, rescue equipment and ward space of the whole hospital, resolutely break the boundaries of disciplines, departments and ward units, strengthen the personnel organization, and do a good job in the expansion and layout of emergency medical resources as a whole. Co-ordinate the beds of the whole hospital, the non-surgical departments of the hospital are all transferred to general internal medicine wards, and doctors on duty in the emergency department can issue hospitalization tickets for all wards, in order to accept all patients in need. Coordinate medical and nursing staff, all doctors are to be uniformly deployed by the hospital. Set up emergency and critical diseases expert guidance workgroup, tracheal intubation emergency support workgroup, and emergency cardio-cerebrovascular interventional therapy workgroup, etc., make sure that all patients with acute and critical diseases can get timely and effective treatment.

Adhere to the "six preparations" to improve the diagnosis and treatment of emergency and critical cases
Strengthen mental preparation. The party committee of the hospital issued a proposal to the grass-roots party organizations, party members, cadres, and medical staff of the hospital, and the Youth League committee to the youth of the hospital to further unify their thinking and reach a consensus on meeting the peak and achieving the success. Establish a full-dimensional health security mechanism for all staff: dynamically monitor employees' health and deal with relevant conditions, issue "pandemic prevention health packages" to all staff, make scientific and dynamic rotation arrangements, and implement subsidies for staff who return to work in advance.
Strengthen the preparation of materials. Establish a material support mechanism in close coordination with suppliers to build a "green channel" for the transportation and deployment of urgently needed materials and equipment. Reasonably plan and reserve warehouses, focusing on the reserves of pandemic protection materials and rescue materials for critically ill patients. Strengthen the dynamic allocation of materials, establish a daily inventory mechanism of key materials, and make dynamic planning and adjustment according to clinical needs.
Strengthen equipment preparation. Compared with the configuration standard of intensive care equipment, and according to the needs of ICU ward expansion, "internal deployment" and "external purchase" should be simultaneously adopted to increase the preparation of related rescue and treatment equipment. At present, the key equipment has been deployed as a whole, and the lacking reserve equipment have been resolved through emergency procurement.
Strengthen drug preparation. Rely on the government support platform to establish a linkage dispatch mechanism of pandemic prevention drugs, and establish a "green channel" for the urgent clinical medication. In order to cope with the peak demand for drugs in severe cases, the reserves of hormones, heparin and human immunoglobulin should be increased in advance. Establish the emergency drug allocation work group and daily drug use follow-up evaluation mechanism, and optimize the 24-hour hospital logistics service mechanism of drugs for the treatment of emergency and critical illnesses.

Strengthen space preparation. Grasp the 3 key links of fever clinic, emergency department and ICU to quickly realize the expansion of treatment space. As of December 30, the number of fever outpatient clinics has been expanded from 4 to 30. Through adding beds in original wards, adding intensive care units, and transforming and upgrading intensive care beds in department’s wards, the total number of intensive care beds has reached nearly 500, accounting for 13.50% of the total number of beds in the hospital, exceeding the "4%" requirements of the state and our province. At the same time, the hospital attaches great importance to the treatment of critically ill pregnant women and sets up a special treatment area covering emergency, operating rooms and intensive care units. Speed up the construction of the emergency complex building in an all-round way, and it is expected that some areas in the new building can be urgently used for critical illness treatment in January 2023.
Strengthen personnel preparation. Select nearly 2000 medical staff with anti-pandemic experience and ICU rotation experience to form the first -, second-and third-line emergency and critical care team. Formulate and implement training programs for emergency and critical care personnel, and organize the emergency team members to carry out bedside critical care training on the spot.

Adhere to the "five guarantees" to optimize the treatment effect of emergency and critical cases
Guarantee the circulation of fever clinic. Keep the fever clinic open 24 hours a day. Equipped fever clinic with health care team, strengthen the training of the medical team in fever clinic, focus on improving the identification of infected patients, disease assessment and emergency management ability. For severe and high-risk patients, use bedside rapid inspection equipment to evaluate important indicators as soon as possible, give oxygen inhalation and other active treatment. At the same time, establish a green channel connecting the emergency department with ICU and accept patients in time according to the progression of diseases.

Guarantee an unimpeded emergency access. Resolutely implement the requirement of "Accept and treat all patients in need", and resolutely accept and treat patients transported from brother hospitals and other areas. Arrange emergency teams scientifically and rationally, organize and mobilize all departments of the hospital to support emergency work, and establish emergency treatment teams to guarantee the normal operation of the emergency system. After optimizing the process and strengthening the team, the emergency department has fully met the requirement of " Accept and treat all patients in need ", and the total number of emergency patients per day has climbed rapidly from more than 350 at the beginning of the month before the pandemic to more than 750 at present.
Guarantee the treatment of critical cases. Fever clinic, Emergency Department and ICU are fully interconnected. Patients need hospitalization at the Emergency Department just had to wait for 24 hours compared with 48 hours previously.  Emergency patients could be admitted to hospital immediately through the "green channel". Establish the critical care system based on each bed, and equipped each bed with personnel, equipment, and materials. Enhance critical care techniques, and set up 3 expert groups treating critically ill patients.
Guarantee a strong logistical support. Organize and dispatch the logistics departments of the whole hospital to provide systematic support for the treatment of emergency and critical cases. Focus on medical oxygen, emergency disinfection and food supply, and establish a 24-hour oxygen supply inspection and scheduling mechanism, medical waste timely disposal mechanism, emergency disinfection dynamic service mechanism and food supply mechanism. Establish a regional emergency oxygen supply mechanism for key areas such as observation rooms and rescue rooms, it is proposed to set up temporary storage points for gas cylinders, increase oxygen supply lines and oxygen cylinders, and further strengthen the guarantee of medical oxygen supply. 
Guarantee the safe operation of the hospital. Rely on the "9+10" pandemic prevention and control responsibility system to strengthen the implementation of responsibilities, regularly and irregularly organize safety inspection, and carry out 24-hour dynamic monitoring of important risk points such as water, electricity, gas, and heating, so as to eliminate the hidden dangers to the minimum extent.
By Sun Yingtao,Xie Yang