Emergency Responses to Covid-19 Outbreak: Experiences and Lessons from a General Hospital in Nanjing, China

Abstract

Background: The novel coronavirus 2019 (SARS-CoV-2) has caused wide dissemination across the world. Global health systems are facing the unprecedented challenges. Here we shared the experiences and lessons in emergency responses and management from our hospital, a government-assigned regional anti-Covid-19 general hospital in Nanjing, Jiangsu Province, China.

Methods: Our periodic strategies in dealing with Covid-19 were described in detail. An administrative response including the establishment of Emergency Leadership Committee that was in full charge of management was established. Modifications of infrastructure including the Fever Clinic, inpatient ward, outpatient clinic and operation room were carried out. Special arrangements for outpatient services, hospitalization and surgeries were introduced. Medical personnel training and patient educations were performed. Initiations of Covid-19 researches and application of information technology were introduced.

Findings: Since January 16, three cases have been confirmed in our hospital and no healthcare-associated infection was found. During the epidemics, 6.46% staffs suffered depression, 9.87% had anxiety, and 98% were satisfied with the infection control policy. Shortages in staffs and medical consumables, and limitation in space were the obstacles we encountered.

Interpretation: As the cost of in-hospital transmission is unbearable, our experiences and lessons suggested that prompt actions should be taken immediately to decrease or eliminate potential in-hospital transmission. Experience shared herein may be useful for those facilities that are and may encounter Covid-19.

Keywords: Covid-19; Emergency response; Hospital management; Infection prevention and control.

Fig. 1

Three major phases of hospital emergency management. The first confirmed case in Jiangsu Province was reported on January 22 in Suzhou (red arrowhead), and the first patient in Nanjing was documented on the following day (blue arrowhead)

Fig. 2

The organizational structure of the board

Fig. 3

The illustration of the infrastructure modifications. The internal building in the figure indicates the building for in-patient in internal medicine unit

Fig. 4

The flowchart showing the screening procedure in the outpatient clinic

Fig. 5

Screening procedures for hospitalization and surgery. * Special scenarios such as other infectious diseases causing fevers and CT abnormalities should be considered

Fig. 6

Interim admission during the epidemic. A Regular clinical services were available in Phase I and decreased due to the clinical restrictions in Phase II, then gradually increased in Phase III. B Surgeries maintained in Phase I, while urgent surgeries continued throughout three phases. C Patient volume reached a high level in Emergency (day 7, January 22) and Fever Clinic (day 5, January 20) during Phase I and gradually decreased in Phases II and III. In A and B, the curve reached bottom several times during Phases I and II. This was caused by the shut down of the regular clinic and surgery during weekends

Fig. 7

The comparison of the daily PPE consumption between epidemic and regular periods in a year-over-year manner. The increased demands for all categories were apparent