COVID-19 und die Onkologie: agiles Patientenmanagement : Reorganisation der radioonkologischen Versorgung am Universitätsklinikum Köln COVID-19 and oncology: agile patient managementReorganization of radiooncologic care at the University Hospital Cologne

An der Klinik und Poliklinik für Strahlentherapie des Universitätsklinikums Köln wurden während der COVID-19 Pandemie Arbeitsabläufe für Kernprozesse der onkologischen Grundversorgung transformiert. Die Klinik liegt in geografischer Nähe zu Heinsberg, der ersten Hostpot-Region in Deutschland. Während der deutschen Hochwasserkatastrophe im Jahr 2021 wurden regionale Behandlungssynergien zur Fortführung extern begonnener Bestrahlungen gebildet. Test- und Quarantänemethoden wurden frühzeitig implementiert, um die primäre onkologische Grundversorgung erfolgreich, effektiv und sicher trotz der fluktuierenden SARS-CoV‑2-Ausbruchsgeschehnisse fortzuführen. Durch aktives Management von Patiententerminen und Therapieabläufen in multiprofessionellen Teams konnten indizierte radioonkologische Diagnostikverfahren und Behandlungen begonnen und fortgesetzt werden, anstatt essenzielle Therapien abzusagen oder zu verzögern. Wir berichten über unsere aktiven Strategien zur Optimierung der Infrastrukturauslastung, Steigerung der Behandlungsqualität, sowie Vermeidung finanzieller Dysbalance in Zeiten reduzierter Behandlungkapazitäten und Ressourcen aufgrund einer globalen sozio-ökonomischen Gesundheitskrise.

Managing patient flows in radiation oncology during the COVID-19 pandemic : Reworking existing treatment designs to prevent infections at a German hot spot area University Hospital.

PURPOSE: The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV­2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS: The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS: Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV­2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION: In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.