ABSTRACT
Starting point and problem: The aim of our research was to identify structures and new forms of collaboration which had become established during the COVID-19 pandemic and possible continuation of which beyond the pandemic might provide additional benefit to everyday clinical practice. Methods: A three-stage survey of 22 experts (senior physicians, hospital hygienists, nurse managers and representatives of hospital management) from six municipal hospitals situated in a hotspot region was used to identify measures pertaining to management of intensive care capacity and patient flows, as well as to the flow of information and data. Those measures were rated using a Likert scale. Results were subsequently structured in the setting of a round table. Results: Over the course of three evaluation stages - which saw high response rates of 82 - 91 % - the 43 initially identified measures were reduced to the 14 which received the highest levels of approval. At the round table, 10 of those 14 most relevant measures were categorised in one of three fields of action: 1) interdisciplinary management of patient flows, 2) flexible human resource (HR) concepts and 3) establishing new communication and information structures. Practical examples were formulated for each of the three fields of action and have in the meantime proven their value in everyday clinical practice. Conclusions: Using a structured decision process combined with holistic reflection on the organisational structure of hospitals, strategies were identified which had proven themselves under duress and which should be implemented in everyday clinical practice outside the setting of the pandemic. The flow of patients, resource management and communication structures can be influenced beneficially by sustained closer interdisciplinary and intersectoral collaboration within a "new clinical routine". The practical examples and recommendations put forward for each of the fields of action could provide an impulse for other healthcare providers to examine their HR concepts and communication strategies as well as their management of care capacities and patient flows, adjusting to the challenges of new everyday realities with interdisciplinary and intersectoral approaches. © 2021 DIOmed Verlags GmbH. All rights reserved.
ABSTRACT
Background. The course of disease in mild and moderate COVID-19 has many implications for mobile patients, such as the risk of spread of the infection, precautions taken, and investigations targeted at preventing transmission. Methods. Three hundred thirty-one adults were hospitalized from January 21 to February 22, 2020, and classified as severe (10%) or critical (4.8%) cases;1.5% died. Two hundred eighty-two (85.2%) mild or moderate cases were admitted to regular wards. Epidemiological, demographic, clinical, chest computed tomography (CT) scan, laboratory, treatment, and outcome data from patient records were analyzed retrospectively. Results. Patients were symptomatic for 9.82 +/- 5.75 (1-37) days. Pulmonary involvement was demonstrated on a chest CT scan in 97.9% of cases. It took 16.81 +/- 8.54 (3-49) days from the appearance of the first symptom until 274 patients tested virus-negative in naso- and oropharyngeal (NP) swabs, blood, urine, and stool, and 234 (83%) patients were asymptomatic for 9.09 +/- 7.82 (1-44) days. Subsequently, 131 patients were discharged. One hundred sixty-nine remained in the hospital;these patients tested virus-free and were clinically asymptomatic because of widespread persisting or increasing pulmonary infiltrates. Hospitalization took 16.24 +/- 7.57 (2-47) days;the time interval from the first symptom to discharge was 21.37 +/- 7.85 (3-52) days. Conclusions. With an asymptomatic phase, disease courses are unexpectedly long until the stage of virus negativity. NP swabs are not reliable in the later stages of COVID-19. Pneumonia outlasts virus-positive tests if sputum is not acquired. Imminent pulmonary fibrosis in high-risk groups demands follow-up examinations. Investigation of promising antiviral agents should heed the specific needs of mild and moderate COVID-19 patients.