Yuan Li, Director Of Outpatient Office, Wuhan Union Hospital: Fever Clinic Is Like Battlefield Hospital.

The frontline frontline, the sentinel in the fort, the fever clinic undertook the screening, classification and emergency treatment of the new crown patients. It is the first bastion of the patient's treatment after the outbreak of the new coronavirus.

Up to now, 61 new fever clinics have been set up in Wuhan, the main battlefield of the new crown virus campaign, including Wuhan Union Hospital, the South China Hospital and Wuhan, which is a thermometer for the development of Wuhan's new crown disease. It is a barometer for the implementation of epidemic prevention measures and a battlefield for the delivery of life and death.

February 14th, 2020 Valentine's day, twenty-first Century economic news reporter exclusive interview with Professor Yuan Li, director of outpatient office, Wuhan Union Hospital. The female expert who came from the Department of Endocrinology, after the outbreak of the disease, has commanded and coordinated the work of the outpatient department of the fever clinic by more than 15 hours' work intensity every day, so as to ensure that the fever clinic runs 24 hours a day efficiently, smoothly and safely.

On the one hand, we must ensure that all the instruction tasks issued by the higher authorities should be ensured. On the other hand, we must ensure that the health care workers in the outpatient department of the fever clinic can work safely and safely, and also face the needs of the patients who have been rushing for a long time. Under this sudden serious epidemic situation, the managers who are the special posts are also the witnesses of the outpatient department of the fever clinic, and have suffered from all kinds of pressures and challenges. Some tests? What kind of inner experience have you experienced?

Yuan Li. Data map

Peak hours 24 hours 825 visits

Twenty-first Century: when did you get a job?

Yuan Li: in December 31, 2019, I remember very clearly that at that time, I received a notice from my superiors that I requested the hospital fever clinic to run the patient for 24 hours.

My occupation and position require me to be on standby at any time. After receiving the instruction, the hospital attached great importance to it and arranged several times to arrange the corresponding work. We reorganized the previous three district two channel fever clinic setup, and set up independent space in strict accordance with the management requirements of infectious diseases, so as to avoid cross infection. And quickly coordinate the mobilization of all the staff and equipment in the fever clinic, and set up the emergency work flow and working mechanism of the fever clinic. Soon, the fever clinic system of our hospital runs quickly and efficiently.

Twenty-first Century: did you know the seriousness of the epidemic?

Yuan Li: to be honest, I didn't realize the particularity of the epidemic when I first received the task. Since SARS virus has been attacked in 2003, Wuhan Union Hospital has always had a fever clinic. Every year in winter and spring, the number of patients with fever and fever increases, and the work of fever clinics will become more busy than usual. And soon the Spring Festival is approaching, and we need to prepare for the smooth deployment of the emergency during the Spring Festival. Two fronts and two systems need to run at the same time. It should be said that the tasks on both sides of the time were urgent and important. At that time, even busy, it was customary and did not anticipate the rapid development and seriousness of the epidemic.

Twenty-first Century: when did it start to feel different from the previous epidemic?

Yuan Li: at first I thought it was just a temporary epidemic that was going to be dealt with every year, and it would soon be over. But after 24 hours of fever clinic, we only received more than 50 patients on the first day, but more than 100 in third days, more than 200 to more than 300. A few days later, the number of patients was increasing every day, and the number of fever patients was increasing. According to the admission data, the highest peak in January 22nd reached 24 hours and 825 passengers.

Twenty-first Century: when you see these unusual visits, what measures did you take at that time?

Yuan Li: by the year January 10th, the number of fever clinics has risen to about five hundred people per day. We are beginning to feel that the situation is not right and the epidemic is serious. At that time, with the daily outpatient clinic, the peak of outpatient service reached 15 thousand. In order to prevent cross infection, in the routine routine outpatient inspection, the outpatient office began to increase the requirements and reminders of wearing masks for out-patient medical staff.

It should be on the day of January 18th, at the weekly meeting of the whole hospital, that I first sent out the appeal of all the medical staff in the hospital to wear masks. I hope you can protect yourself and protect the environment of the clinic. January 20th is just Monday. We have posted the reminder signs of "for your health, please wear a mask", "please measure the body temperature before going to the clinic" and so on. All the 4-5 outpatient clinics of the outpatient clinic are closed to only one entry and exit, which ensures the safety of the weather, and carries out infrared body temperature measurement.

The timely adoption of these measures, to a certain extent, avoids the outpatient related infection in hospitals. Fortunately, in my management clinic, no doctor is sure to be infected when he goes out.

Fever clinic is like battlefield hospital.

Twenty-first Century: in the face of more and more patients at that time, how do you and your hospital take measures?

Yuan Li: in the face of more and more febrile patients, the space of the outpatient fever clinic has become very crowded. All the patients are queuing up waiting people all day. The number of patients who need to save the infusion is increasing.

Beginning in mid January, the hospital leaders decided to expand the space for the fever clinic and expand the fever clinic from a local area to a whole floor. The area expanded by more than 5 times, and it really transformed into an independent and complete outpatient area.

After that, we further optimized the process, outpatient intelligent calling procedures, waiting orders, security are in place, and increased a lot of waiting chairs. To do these things is to ensure that the front-line work is well protected, and even if the number of visits reaches its peak, the fever clinic is still in order.

At the same time, the hospital transferred manpower from various specialties to the fever clinic. For more than a month, it can be said that the strength of the whole hospital is to support the fever line and go up in batches and rounds.

After the closure of the city in Wuhan in January 23rd, we could foresee the panic and tension of the people. In order to divert the over pressure of the fever clinic, our outpatient office team immediately worked together with the computer center to work overtime, and rushed to open the Internet free fever consultation clinic before the new year's Eve. In the early stage, doctors in emergency, respiratory, infection and internal medicine were the main doctors. On the first day of the trip, twelve thousand people were consulted, and the second day consultation volume reached more than 20000. In total, more than 400 doctors in our hospital volunteered to sign up for online consultation, and later opened online psychological counseling clinic, which became the largest online fever consultation platform in Hubei province at that time.

Twenty-first Century: did the patients on the Internet inquiring at that time appear to be symptomatic patients?

Yuan Li: many are panic strained people. For example, patients are anxious to ask more than a dozen of our medical staff on the Internet platform. The same problem is that they can't eat at home, can't sleep, and feel that every air in the breath is poisonous. Our guidance to him is to dredge his panic and tension and protect himself by popularizing scientific knowledge. Of course, a small number of patients are those with fever and respiratory symptoms. This allows our medical staff to learn and exchange experiences on the Internet.

Twenty-first Century: which of the online and offline outpatient pressures will be greater?

Yuan Li: the pressure on the line is certainly greater. The fever clinic under the line feels like a battlefield. It is very appropriate to compare the fever clinic at that time to a war hospital. The first thing that a fever patient can think of in a serious epidemic situation is to fight for help, that is, fighting frontiers in the forefront of treating patients with fever. That is the front line of the front line.

At 2 o'clock in the night, the state of the front line is still a cry for help: "hurry up, go up!" Mask to oxygen! " "Hurry up! Rescue! The patient's blood pressure is gone! " "Quick and quick, 120 sent another patient to recover and recover immediately."

At that time, patients with blood oxygen saturation below 70 were everywhere. Our young nurses, taking off their white coats and even a delicate little girl, are also the precious daughters of their families. At this time, they wear heavy protective clothing and carry oxygen cylinders that are higher than themselves. This busy rescue scene has nothing to do with a battlefield hospital two.

There are 120 infusion places per day, and there are no more than 24 vacancies for infusion patients. There are always so many patients. The average daily transfusion rate of nurses is 500-600.

Twenty-first Century: can these measures meet the needs of outpatients at this time?

Yuan Li: I couldn't satisfy it at that time. I remember when the most stressful time, the beds of all the patients in the hospital were all full. The beds of all the heating designated hospitals in the city were full. At this time, the fever clinic hall was overcrowded, and everywhere lay in the critically ill patients who were badly in need of rescue. Even 120 of the patients who needed cardiopulmonary resuscitation had no oxygen supply, because all the equipment was exhausted even with oxygen cylinders. But at this point, if the patient does not give oxygen, it will be directly life threatening. We must help. There is no way. Only emergency patients are sent to the emergency department for emergency resuscitation.

It can be said that this tense scene is constantly staged, as the head of the door office, often in the fever clinic and emergency department to coordinate treatment. The pressure is really big, can only insist on sticking to insist, is a principle of death, we must do our best to cure. The bottom line is that we can not die without help. We can only do all we can, but we can not stop patients from dying. Many of them are critically ill and critically ill patients.

The young man could not hold back for 6 hours.

Twenty-first Century: for these patients, there is a need for a systematic operation mechanism. How does the hospital's system work?

Yuan Li: first of all, personnel protection. Indeed, as the epidemic becomes more and more severe, the front line is getting longer and longer. In order to ensure the smooth operation of the fever clinic, the hospital has dispatched many medical personnel in different departments. Emergency, respiratory, infection, critical care medicine, and many departments of internal medicine have been almost transferred. Some surgical departments, tumors, anesthesiology, rehabilitation and other departments have transferred many people to the fever line. At the same time, a wheel break mechanism was established. Go to work for two weeks in a row, rest and rest, so that the health and mental health of medical staff can be restored and buffered, and adjusted according to the actual situation.

The second is the protection of protective equipment. For a time, our protective materials were scarce. After knowing the situation, we could only adjust the duty time. At first, doctors took classes every 3 hours, and after 3 hours of rest, they went on to the next shift. This is a humanized arrangement from a human physiological point of view. However, in this way, two hours of 3 hours per class will take 6 hours, and two protective clothing will be needed. Once the protective equipment was very tight, in order to save, there was no way to become a continuous 6 hours a day.

As a manager, we can often go to the scene to solve problems at first, but later we are not allowed to go there, just to save some protective clothing. In addition, we also try to classify the protective materials. The front-line medical staff should treat patients, especially those who need close contact with all kinds of examinations, especially for high-risk throat swabs or intubation, so the level of protective materials is high. Other personnel enter the scene, such as management and security personnel, the level of protective equipment is lower, so that we can save a little bit, so as to protect first-line medical personnel's protective equipment.

Twenty-first Century: does it feel bad to work 6 hours a day?

Yuan Li: the front-line medical staff are really very difficult, 6 hours in a tight air tight protective equipment, do not eat or drink, do not sleep. Some young women, and the physiological cycle, even young men sometimes can't hold back.

Some people in the WeChat group laughed at using diapers and urine receptors. I know this kind of ridicule is tears and helpless. Because people in a sober physiological state, even diapers can not be solved, but no need to insist on diapers.

Twenty-first Century: how can doctors ensure the professionalism of the doctors transferred elsewhere?

Yuan Li: advance training. When we deploy personnel, we need to have a basic understanding of outpatient doctors in various specialist programs, such as departments, age, name, specialty content, and professional age, etc.

Every doctor has to start training about a week before going to the clinic. We have compiled a set of first-hand knowledge manuals for fever clinics, such as diagnosis and treatment process, protection requirements and precautions, fever knowledge, guidelines and programs for prevention and treatment of new crown pneumonia, and a practical prevention and control plan compiled by our own hospital experts. We have learned from the hospital network and WeChat group for reference.

For example, how to classify patients, mild, severe, confirmed, suspected, progress, improvement, how to deal with different patients. In addition, including how to protect the scene, and how to wear protective clothing, how to remove, disinfection and so on which steps. That is, we think all the knowledge needed to go to the front line is in it, and the content is very detailed.

"You are our hope."

Twenty-first Century: the impact of medical staff infection on everyone should be great. How did you deal with it at this time? How do medical staff worry about psychological counseling?

Yuan Li: at the beginning of the epidemic, the whole society, including the medical staff themselves, did not know the seriousness of the epidemic. At that time, some patients were not fever or mild symptoms, or were infected, but also in the incubation period because of other diseases to specialist treatment, and many hospitals are still working normally. In fact, some patients may have been exposed, and some medical staff have also been infected.

However, at present, every medical staff can not escape. There is no choice but to be strong. This is a professional requirement. From the first day of wearing white coats, we must be ready at all times.

As a management department, appeasing medical personnel should start from two aspects. The first is material guarantee, the second is psychological comfort. Without material protection, doctors are running naked and the psychological pressure will be greater.

With the severe development of the epidemic, many of our young doctors have not experienced such scenes. They are also afraid, nervous and aggrieved. In order for them to work comfortably in the front line, the general logistics of hospitals is very powerful. It is difficult to ensure that the first-line protective materials are in place, and the security guards are stationed in the fever clinic for 24 hours.

At the same time, I also encourage them to strengthen their confidence. "History has chosen us. After a few years, we recall this past. In a hundred years, we are not deserters, we are fighters." "If we do this, history will remember that our efforts are worth it." "We are the hope of the sick."

With adequate protection and firm confidence, in fact, the number of medical staff on the front line of fever is much less than that of other regional medical staff.

Twenty-first Century: how many patients have you received since the opening of the fever clinic?

Yuan Li: up to now, the total number of patients receiving fever under the line has reached over 17000. On line, in addition to the free fever clinic, there are also free psychological counseling clinics, and our online specialist clinic has reached more than 70 thousand. Now many doctors in the hospital are attending this platform.

Twenty-first Century: do you feel a lot of pressure in coordinating these processes?

Yuan Li: the pressure is really great, but in this position, I have to be responsible and responsible. All the designated tasks that our superior needs us to accomplish is to be seized and unshirkable.

In addition, we need to ensure smooth and smooth operation of all front-line lines, and enable front-line doctors to feel secure and put down their burden to work. When faced with difficulties and contradictions, I can not solve some hard conditions except that some important decisions must be reported. Others, I think, should be digested here, and I can no longer pass the pressure on frontline staff and superiors.

Once a patient said to me, "you can't fall, you are our hope." This remark has a great impact on me.

Who is not afraid, and who is not afraid? But not only for the safety of ourselves and our families, but for our patients who are hopeful, neither physically nor spiritually, we can not fall down. So, in my heart, the most important thing I say to myself is "to hold on, we must hold on!"

Twenty-first Century: when did you begin to feel that there was a change in the number of outpatient visits?

Yuan Li: after the online inquiry on the Internet after the Spring Festival, the number of out-patient services slowly came down, and then remained at about 500 per day for a long time. Since February 8th, Wuhan has set up a shelter hospital, where the fire god mountain and Raytheon hill hospital have been opened.

Now we have three days in a row. The number of visits is about 200. We can say that the most difficult days have passed, and we have persevered.

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