Department of Radiation Oncology, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany.
Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
Strahlenther Onkol. 2020 Dec;196(12):1080-1085. doi: 10.1007/s00066-020-01698-6. Epub 2020 Oct 29.
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-CoV‑2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic.
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.
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-CoV‑2 infection in 164 tested radiation oncology service inpatients was observed.
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.
本研究旨在避免取消基本治疗，通过在一家大型大学医院的放射肿瘤学部门实施积极的患者流程管理实践并优化基础设施利用，同时优化基础设施利用和人员工作量，以预防大流行期间患者和医务人员的医院内感染。这家医院靠近德国第一个 SARS-CoV-2 热点地区海因斯贝格，是一个区域 COVID-19 治疗中心。
本研究包括对 2019 年和 2020 年 12 周至 19 周的门诊和住院关键流程、机器占用率和未到诊率进行年度干预分析，以评估主动患者流程管理的效果，同时监测医院内 COVID-19 感染情况。
积极的患者流程管理有助于将首次就诊预约的遵守率保持在 85.5%以上。每日预约减少 10.3%（p=0.004）仍可显著增加下游计划 CT 安排（p=0.00001）和绩效（p=0.0001），从而使 CT 绩效绝对增加 20.1%（p=0.009），同时避免过度预约。每日治疗开始时间显著增加 18.5%（p=0.026）。部分分割和加速治疗显著增加（p=0.0043）。通过严格的检测指南、员工和患者的隔离方案、卫生规范和精确的预约安排，164 名接受测试的放射肿瘤学住院患者未观察到 SARS-CoV-2 感染。
在医疗基础设施能力和资源减少的情况下，控制每位患者的基础设施时间，以及优化治疗评估、规划和照射期间的设施利用和人员工作量，可以帮助提高预约的遵守率和质量管理。避免反复和可预防地接触医疗保健基础设施具有潜在的健康益处，并可能在大流行期间避免交叉感染。在高风险 COVID-19 地区积极进行患者流程管理可以帮助放射肿瘤学家安全地继续和启动治疗，而不是取消和推迟有指征的治疗。
