MIL OSI Translation. Region: Russian Federation –
Read the mos.ru article on how a temporary hospital differs from a converted hospital and what doctors do to support patients.
In Moscow, the situation with coronavirus infection is getting more tense every day. The incidence curve is going up, and a thousand people are hospitalized in metropolitan hospitals every day. For the treatment of patients with COVID-19 have already opened temporary hospitals– this will allow timely provision of medical care to residents. One of the complexes operates in the Sokolniki Exhibition and Convention Center. The hospital is assigned to city clinical hospital named after F.I. Inozemtseva…
Over a thousand beds were placed here, modern equipment was installed and a laboratory was deployed. An observational center is located in the pavilions nearby. There are sick people who do not need inpatient care, but cannot be treated at home.
What is the peculiarity of such a complex, how do doctors support patients and what do doctors themselves think about working with COVID-19? These and other questions were answered by the chief physician of the city clinical hospital named after F.I. Inozemtseva Alexander Mitichkin.
– When was the temporary hospital in Sokolniki established? What equipment was installed in it?
– The hospital was deployed in the spring in 35 days on the basis of the Sokolniki exhibition complex. It includes a total of 1200 beds. The beds in the hospital are equipped with everything necessary: an oxygen supply system, personnel call buttons, local light, stands for intravenous infusions. There are separate male and female zones. An observatory has also been opened to receive infected patients without clinical manifestations of the disease.
When we made this complex in the spring, we approached it like a regular hospital. We have forgotten the word “temporary”, so we have met the maximum requirements for providing patients. The diagnostic base is fully functional: you can do x-rays, computed tomography and ultrasound (using stationary or portable devices). There is a full-fledged laboratory, equipping a hospital one. All analyzes can be done in 20-40 minutes. There is no need to carry biomaterial to the main laboratory.
In addition, there are still 18 intensive care beds. We call them that, but in fact they are equipped according to the standard of the intensive care unit. There is a ventilator, mobile ultrasound machines, oxygen supply machines, and an X-ray machine. For every three beds – a nurse’s post, for every six beds – a doctor’s post. In total, there are 516 staff per 550 patients in the hospital, including 70 doctors and 150 nurses.
– It turns out that there are no significant differences from the main building of the hospital?
– Yes, in terms of equipment and availability of medical technologies, the complex fully corresponds to inpatient hospitals. The only thing, everyone saw the picture – this is a common space, not separate wards, but we try to encourage and support our patients as much as possible.
We give everyone hygiene kits and tablets, which are loaded with various films and games. We hope this distracts our patients a little. In addition, we have created small recreation areas with power outlets. There you can sit on sofas with our tablets or with your devices and chat.
– What patients is the hospital designed for?
– We receive patients of moderate severity. All patients, before coming to our hospital, go through outpatient CT centers. There, the degree of damage to the lung tissue is detected. At the minimum, outpatient treatment is prescribed, on average, they are taken to us, in serious condition they are sent to traditional hospitals.
– What path does a sick person take from admission to the hospital to discharge?
– We have kept the traditional technology of medical care. First, patients are admitted to the emergency department. They are examined by a guard nurse, collects objective indicators: body temperature, pressure, blood tests, oxygen saturation, ECG, CT, writes the data to the tablet. The program automatically evaluates the patient’s condition and determines his level of intoxication. If the patient has a high level of intoxication and the risk of complications, then the sister immediately calls a doctor. If there is no such danger, then the patient waits his turn.
Then an electronic medical history is started. In the very department, the patient is met by a nurse. As soon as she enters the patient data into her tablet, information appears automatically in the doctors’ office. The doctor gets acquainted with the data and prescribes additional diagnostics and treatment.
Patients are examined by the attending physician daily. Three times a day, the fasting nurse monitors the indicators of patients, enters them into the system. This is reflected in the medical history, which is seen by the attending physician and manager. They can adjust the treatment if necessary. In addition, we have computed tomography and ECG: they allow us to timely identify the risk of complications.
When the patient begins to recover, we do not wait for his complete recovery. In the hospital, we try to make the conditions more comfortable, but how can you compare our pavilion with a house? Therefore, as soon as the patient can continue treatment on an outpatient basis, we discharge him. At the same time, the patient is taken home by ambulance. The patient is transferred to the clinic, from there the doctor comes and continues the treatment. If there are no conditions for finding a home, then there are observers for this.
– What is the specificity of treating patients with coronavirus infection?
– I must say and, perhaps, reassure our patients: the standard of treatment and diagnosis of COVID-19 is constantly being adjusted based on the latest data obtained from the results of treatment and the release of new drugs.
Recently, the Moscow City Health Department approved a new standard for the diagnosis and treatment of covid infection for both outpatient and inpatient stages. For us, this is an axiom, and on the basis of this, patient management is formed.
Of course, each patient is different. Here, the doctor complements, somehow corrects the treatment, but the basis is the approved standard of patient management.
– How is the work of doctors now different from what it was in the spring?
– Differences in tactics. In the spring, when we took part in the work on COVID-19, it was storm and stress. It was a completely stressful rebuilding on a new track. We have repurposed our beds. It was difficult, but everything had to be done quickly.
The creation of such centers as in Sokolniki or in Krylatskoye allows preserving traditional medical care in Moscow. These are planned hospitalizations and planned operations, this is also saving lives. This is the main idea – we have opened new platforms for mass care for infectious patients without compromising existing hospitals.
– How did you react to the fact that hospitals were re-profiled in the spring?
– Like a doctor. We are all reserve medical officers. There is not a single doctor who is not an officer. We all know what a massive influx of wounded and injured people is. All were trained in the organization and tactics of medical services in emergency situations and various extreme situations. It was an extreme situation, so there were no questions, you start working as you were taught. And our wonderful maxillofacial surgeons, traumatologists, dermatovenerologists brilliantly turned into therapists in a week.
– Does your family support your choice? Some doctors moved to hotels to protect their families.
– We did the right thing. We must thank the city administration, which made it possible to protect families and relatives of the medical staff (not only doctors, also nurses and nurses).
I have grown children, they live their own lives. The two of us, and there was no need for any isolation. However, many have small children, elderly parents, and, of course, it’s great that there was such an opportunity.
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– How do they take care of the safety of the doctors themselves?
– The main difference in autumn is that you probably have never heard at least some hint that there are not enough personal protective equipment: masks, gloves, glasses or something else. Everything is in sufficient quantity and even with a margin.
I go around the department every day, see all new patients, communicate with the staff and strictly demand that everyone comply with safety requirements. Moreover, the main person now is the elder sister of the sanitary inspection. She decides whether to let the same department head into the red zone or not.
In addition, the medical staff is tested weekly. Everyone is already used to this.
– What makes the pandemic experience unique for doctors? How will this affect the health system in the future?
– I think the unique experience was in the spring. As a result, several such temporary hospitals have been created. As a person who has devoted his whole life to healthcare and surgery, it seems to me that such megacities as Moscow and other multi-million dollar cities must have backup sites for such cases. This is necessary so that you do not have to suddenly, abandoning everything, perform a labor feat and create them from scratch.
In the fall, when the command came that “you will open in five days,” we didn’t have to do much. We just washed and disinfected everything. We have all the equipment in place, the staff is prepared, there are preliminary contracts for food, cleaning, maintenance of medical equipment, buildings, structures. Everything is prepared. And we started to work. It should be so.
– Why is it important for all citizens to wear masks and gloves in public places?
– In my opinion, this shows the social responsibility of citizens. If he neglects it, he neglects others. This has already become an element of courtesy: if you care, you wear a mask.
And when people with a runny nose go to work, this is a pseudo labor feat. They help colleagues get to the hospital. This is the most dangerous thing. If there are signs of a disease, you need to call a doctor at home.
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EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.