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Establishment of Medical Service Protocols in Large Public Hospitals for the Prevention and Control of Coronavirus Disease 2019
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摘要: 新型冠状病毒肺炎疫情的全球暴发给医院应急防控带来严峻挑战。大型公立医院作为应对新型冠状病毒肺炎的主战场，应从门诊、急诊、住院、手术、出院全流程进行把控。预检分诊作为医院的首层关卡，是疫情防控的关键节点，需重点关注并加强相关应对机制的建设，以快速遏制外源性/内源性危险因素；同时落实全员培训与考核，加强互联网诊疗等信息化建设，为医院诊疗工作的有序开展保驾护航。Abstract: Coronavirus disease 2019(COVID-19)poses a challenge to hospitals for the prevention and control of public health emergencies. As the main battlefield of preventing and controlling COVID-19, large public hospitals should develop service protocols of diagnosis and treatment for outpatient, emergency, hospita-lization, surgery, and discharge. The construction of medical protocols should be based on the risk factors of key points and focused on pre-inspection triage and screening, to establish a rapid response mechanism to deal with exogenous and endogenous risk factors. Implementation of all-staff training and assessment, strengthening the information system, and use of medical internet service are important. This study explores the construction of medical protocols in large public hospitals during the pandemic, and provides a reference for the orderly diagnosis and treatment in hospitals during the pandemic.作者贡献：张国杰负责资料收集、初稿撰写；常青、潘慧、周炯、陈倩、孙芳艳、柴文昭、徐梅负责论文修订；吴文铭负责审校。利益冲突 无
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图 1 新型冠状病毒肺炎防控期间门诊、急诊、新入院患者预检和分诊流程
*低、中、高风险地区根据当地卫生行政部门规定执行，一般可根据“健康宝”等信息化手段的智能信息采集来判定患者来源地区和流行病学史；#病情危急患者可走急诊绿色通道，经急诊医师评估，留取急查核酸标本后，进入急诊诊治
表 1 北京协和医院2020年6~10月新型冠状病毒肺炎核酸筛查人数(n)
时间 发热门诊 门急诊 新入院患者及陪护人员 其他应检尽检或愿检尽检人员 住院患者 总计 6月 330 356 1709 7894 207 10 496 7月 672 891 4123 2090 180 7956 8月 922 1260 3995 2687 126 8990 9月 901 1491 4332 2270 132 9126 10月 826 1368 3632 1973 102 7901 合计 3651 5366 17 791 16 914 747 44 469 
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[1] Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia[J]. N Engl J Med, 2020, 382:1199-1207. [2] Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis[J]. Lancet, 2020, 395:1973-1987. [3] 韩传平, 高松, 刘慧, 等.传染病5级预检分诊与医源性感染相关性研究[J].中华医院感染学杂志, 2010, 20:3744-3745. http://www.cnki.com.cn/Article/CJFDTotal-ZHYY201023053.htm [4] 马芬, 张明奎, 高岳林.北京市三级综合医院新型冠状病毒肺炎防控关键环节应急管理实践[J].中国研究型医院, 2019, 7:10-14. -
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