Development and application of quality checklist for the prevention and control of COVID-19 in fever clinic and isolation ward of the general hospital / 浙江大学学报·医学版

To develop a quality control checklist for the prevention and control of coronavirus disease 2019 （COVID-19） in fever clinic and isolation ward of the general hospital and to assess its application. Based on the relevant prevention and control plans and technical guidelines for COVID-19，Delphi method was used to identity items for evaluation，and a quality control checklist for the prevention and control of COVID-19 in the fever clinic and isolation ward was developed in Sir Run Run Shaw Hospital. The checklists included 8 dimensions and 32 items for fever clinic，7 dimensions and 27 items for the isolation ward. The appointed inspectors conducted daily quality control for each shift with this checklist. The expert authority coefficient was 0.88，the mean of the importance of each index in the quality control table was not less than 4.8，and the coefficient of variation was not more than 0.07. During the entire February 2020，8 problems were found and rectified on-the-spot with the application of the checklist. Quality inspection rate was 100% in both isolation wards and fever clinic. The compliance rate and accuracy rate of hand hygiene were 100%; the correct rate of wearing and removing protective equipment increased from 96% to 100%. During the same period，a total of 1915 patients were admitted to the fever clinic，including 191 suspected patients （all were isolated in the hospital，3 were confirmed）. There were no medical staff infected with COVID-19，no cross infection of patients and their families in the hospital. A quality control checklist for the prevention and control of COVID-19 has been developed and applied in the isolation wards and fever clinic，which plays an important role in preventing nosocomial infection.

Application of WeChat platform combined with the flipped classroom in the teaching of fever clinic resident doctors / 中华医学教育探索杂志

Objective:To explore the role of WeChat platform combined with flipped classroom in improving the working ability of resident doctors in the fever clinic.Methods:A total of 118 resident doctors who rotated in the fever clinic of department of emergency medicine were selected as the study subjects, and they were randomized into experimental group and control group, with 59 people in each group. The experimental group used WeChat platform and flipped classroom teaching, and the control group used traditional teaching. The results of theory assessment, operation performance and questionnaire survey were compared between the two groups. SPSS 26.0 statistical software was used for t test and chi-square test. Results:There was no significant difference in theoretical test scores between the experimental group and the control group ( P>0.05). The experimental group scored (91.61±3.01) points and the control group scored (84.52±4.02) points in operational assessment, with significant differences ( t=-10.85, P<0.05). The results of the satisfaction survey showed that there was no significant difference in teaching time distribution between the two groups, and the experimental group was better than the control group in any other aspects. Conclusion:The use of WeChat platform combined with flipped classroom during the COVID-19 epidemic can improve the level of operational skills of the resident doctors to wear or take off the protective clothing and collect nasopharyngeal swabs, help residents to avoid the infections, and improve the level of daily diagnosis and treatment of fever clinic.

Analysis on the current situation of outpatient management in 56 tertiary medical institutions in Anhui Province / 中华医院管理杂志

Objective:To comprehensively understand the current situation of outpatient management in tertiary medical institutions in Anhui Province under the COVID-19 epidemic, and to provide empirical reference for effective prevention and control of the epidemic.Methods:In December 2020, a stratified cluster sampling method was used to investigate and score the current situation of outpatient management in 56 tertiary medical institutions in Anhui Province. The survey content included four dimensions: appointment and triage setting and management, fever clinic setting and management, nosocomial infection prevention and control management, and medical resource storage management. The scoring results were divided into three grades, namely " good" (total score≥90 points), " acceptable" (85≤total score<90 points)and " inadequate" (total score<85 points). SPSS 21.0 software was used for data statistical analysis. Independent sample t-test was used to compare the outpatient setting and management scores of medical institutions, and the proportion of assessment grades was used chi-square inspection.Results:The outpatient setting and management of 56 tertiary medical institutions in Anhui Province were evaluated as good in 36, acceptable in 6 and inadequate in 14. The outpatient setting and management score was(81.55±24.94), including(16.53±2.66)in " appointment and triage setting and management" , (47.62±19.60) in " fever clinic setting and management" , (8.69±1.44)in " nosocomial infection prevention and control management" , and (8.75±3.02) in " medical resource storage management" . The total scores and four dimension scores of 39 general hospitals were higher than those of 17 specialized hospitals, and the differences were significant( P<0.05). Conclusions:The overall situation of outpatient epidemic prevention and control management in tertiary medical institutions in Anhui Province is good, but the construction and control of specialized hospitals need to be further strengthened.

Fever clinic in non-epidemic area during coronavirus disease 2019 outbreak: An analysis of countermeasures / 第二军医大学学报

Objective To analyze the diagnosis and treatment data after the adjustment of various measures in the hospital fever clinic during the coronavirus disease 2019 (COVID-19) outbreak, so as to provide experience for the prevention and control of COVID-19 in non-epidemic areas. Methods We collected the diagnosis and treatment data from the fever clinic of Changhai Hospital of Naval Medical University (Second Military Medical University) in non-epidemic area from Dec. 21, 2019 to Feb. 22, 2020 and Jan. 1 to Mar. 5, 2019, and divided them into four groups: Group A (during the 2020 COVID-19 epidemic), from Jan. 22 to Feb. 22, 2020; group B (before the COVID-19 epidemic), from Dec. 21, 2019 to Jan. 21, 2020; group C (in the same period as group A in 2019), from Feb. 2 to Mar. 5, 2019; and group D (in the same period as group B in 2019), from Jan. 1 to Feb. 1, 2019. Year-on-year and month-on-month comparisons of the above data were conducted. Results The overall situation of the fever clinic around the Spring Festival in 2020 was similar to that of the same period in 2019. The year-on-year comparison results showed that during the COVID-19 epidemic, the number of daily patients in the fever clinic was significantly decreased ([114.3±62.9] cases vs [171.7±37.0] cases), the single consultation time of each physician was prolonged ([11.7±1.8] min vs [6.5±1.3] min), but the average waiting time of patients was decreased ([7.5±0.6] min vs [22.8±1.5] min) (all P<0.05). The month-on-month comparison results indicated that the number of daily patients in the fever clinic was significantly decreased during the COVID-19 epidemic ([114.3±62.9] cases vs [216.3±41.8] cases), the single consultation time of each physician was prolonged [( 11.7±1.8] min vs[ 5.6±0.8] min), but the average waiting time of patients was decreased ([7.5±0.6] min vs [23.3±3.2] min) (all P<0.05). The proportion of computed tomography (CT) examination during the 2020 COVID-19 epidemic was significantly higher than that in the same period of 2019 (7.9%[ 292/3 658] vs 3.7% [206/5 493]). Although the examination time was prolonged due to strengthened protective measures ([12.5±3.8] min vs [10.0±3.2] min) (P<0.05), the time for patients to have the CT examination report was significantly shortened ([10.6±2.5] min vs [58.4±9.6] min) (P<0.01). Conclusion During the COVID-19 epidemic, measures such as adjusting the relevant procedures of the fever clinic and equipping special CT machine in non-epidemic area can reduce the daily consultation time of physicians, improving the diagnosis and treatment efficiency and reducing cross infection.

Analysis of the monitoring data of fever clinic symptoms during the pandemic of new coronavirus pneumonia in Xiangyang City / 公共卫生与预防医学

Objective To analyze the monitoring data of the fever clinic during the epidemic period of COVID-19 in Xiangyang City, and to provide a scientific basis for the government to carry out the prevention and control of new coronavirus pneumonia in the next step. Methods Monitoring data from the "Symptom Monitoring System of Fever Outpatients in Xiangyang City" from February 11, 2020 to March 16, 2020 was obtained. The data combined with the confirmed cases was statistically analyzed. Results A total of 28 296 outpatients with fever were monitored and 38 confirmed cases were found. According to trend chi square test, the visit rate of the fever clinic (Z =629.11，P = 0.000＜0.005 ) decreased gradually from the second week. The analysis of the rate of the fever clinic visits (χ2=2819.54，P=0.000＜0.05 ) and the rate of confirmed cases in different areas ( χ2=7.80，P=0.005＜0.05) indicated that the diagnostic confirmation rate in the urban area was higher, while the rate of visits in counties was higher. The rate of visits to fever clinics (Z=2 261.99, P=0.000<0.008) and the rate of diagnostic confirmation (Z=10.69, P=0.001<0.008) in different age groups showed that the visit rate decreased with the increase of age, while the diagnostic confirmation rate increased with the increase of age. Conclusion The prevention and control of the new coronavirus in Xiangyang City had been effective. It is important to strengthen the screening of patients in fever clinics in key areas (urban areas) and key age groups (children and adolescents) in the next step.

Discussion on the Management of Fever Clinic during the Epidemic Period of Corona Virus Disease 2019 / 中华急诊医学杂志

Objective@#To investigate the role of epidemiological history in the screening of Corona Virus Disease 2019 (COVID-19) in fever clinic, to improve the efficiency in fever clinic and reduce the incidence of cross infection.@*Methods@#This is a retrospective study. Patients who were admitted to the fever clinic in West China Hospital of Sichuan University from January 23th, 2020 to February 11th, 2020 included the study. According to epidemiological history, the patients were divided into epidemiological history group (the experimental group) and no epidemiological history group (the control group). The two groups of patients were admitted and treated separately. The clinical data, NEWS score, etiology results, viral pneumonia showed on CT, time of visit, COVID-19 patient ratio, and admission composition ratio were compared between the two groups. The measurement data were presented as the mean ± standard deviation (SD), and the numeration data were expressed as ratio or constituent ratio. The measurement data of normal distribution between the two groups were compared by independent sample t test. The measurement data of skewed distribution are expressed by the median (interquartile range), and the comparison between the two groups is tested by non-parameter. The differences between enumeration data were assessed by chi-square test. A P<0.05 was considered statistically significant.@*Results@#A total of 2423 patients were included, including 927 patients in the experimental group and 1296 patients in the control group. There were no significant differences in gender, NEWS score and clinical symptoms between the two groups (P> 0.05). The age (35.00 ± 12.80 vs 38.13 ± 15.57 years) , the proportion of fever patients (28.80% vs 32.75%) and waiting time (31.72 vs 58.08 min) of the experimental group were lower than the control group, the difference was statistically significant (P <0.05). The CT examination ratio (37.54% vs 20.39%), viral pneumonia ratio showed on CT (9.77% vs 2.95%), ratio of examined COVID-19 nucleic acid test (85.44% vs 56.75%), and the admission ratio (16.72% vs 9.63%) of the experimental group were higher than the control group, and the differences were statistically significant (P <0.05); There was no significant difference in the positive rates of influenza virus and rhinovirus between the two groups (P> 0.05).@*Conclusion@#It is necessary to adjust the management mode of fever clinic during the Corona Virus Disease 2019, and to manage the patients according to the epidemiological history which can improve the screening efficiency and reduce the risk of cross infection.

Application of risk factor management in nursing of the fever outpatient / 中国实用护理杂志

ObjectiveTo investigate the feasibility of apphcation of risk factors management in nursing of the fever outpatient.Methods145 patients from May to December 2009 admitted to fever clinic was defined as the control group, 157 patients from January to May 2010 admitted to fever clinic were set as the observation group. The control group was given routine nursing, while the observation group adopted risk factor management measures. The management indices of the two groups were compared.ResultsThe patients' recognition score of risk factors of fever clinic was (85.4 ± 2.7)in the observation group, higher than(73.2 ± 3.9)in the control group. Patients' satisfaction degree was 84.7％ in the observation group, higher than 67.6％ in the control group. Rate of risk event of the observation group was 1.3％, lower than 6.2％ in the control group, the incidence of nursing errors was 0.6％ in the observation group, lower than 4.1％ in the control group, rate of patients' complaints of nurses was 1.3％ in the observation group, lower than 5.5％ in the control group.ConclusionsThe implementation of risk factors management in fever clinics can reduce medical accidents, improve nursing quality, so this clinical management mode deserves promotion and application.

Antibiotics in Fever Clinic of Our Hospital / 中华医院感染学杂志

OBJECTIVE To know the use of antibiotics in fever clinic of our hospital,and analyze whether it is reasonable.METHODS The situation was reviewed and analyzed that antibiotics were used for patients in fever clinic during the 4th quarter of 2005 by the doctor registry,original prescriptions,and data records of laboratory.RESULTS There were some unreadable aspects in the choice of antibiotics,the using method,drug combination etc in fever clinic of our hospital.CONCLUSIONS Fever clinic should enhance supervision management of the proper use of antibiotics.

CRP Detection and Endotoxin Inspection in Fever Clinic:Their Clinical Significance / 中华医院感染学杂志

OBJECTIVE To investigate the changes in and clinical significance of C-reactive protein(CRP) and endotoxin in patients who are firstly examined in fever clinic.METHODS To review and study the results of CRP and endotoxin from 81 patients(including 48 patients who were diagnosed as bacterial pneumonia and 33 patients who were diagnosed as a cold) in fever clinic of our hospital in 2005.RESULTS In 81 bacterial infection patients, the analysis indicated the levels of endotoxin between the pneumonia patients and the patients with a cold had significant difference.And the levels in the first group were significantly higher than in the latter one.The levels of CRP had no difference in two groups.CONCLUSIONS The result indicates plasma endotoxin detection helps to determine the early diagnosis of serious infection.It is also of significance to select antibacterial rationally and handle syndrome in time.In fever clinic,the levels of endotoxin may be a method to help diagnosis and treatment.CRP could be help to estimate the bacterial infection or virus infection,but it could not adjudge the seriousness in bacterial infection.