How is Shanghai coping with the critical care rush? Some hospitals open a new ward every day, and soon the patients are full and have to wait 4 to 5 hours for consultation

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The New Year’s Day holiday in 2023 is very different. The hard battle with Omicron virus has been fought and the major hospitals in Shanghai are struggling to bear it!

Faced with thousands of emergency room visits every day, and the resulting large number of patients rescued and kept in hospital. Hospitals are not only experiencing the “toughest time”, but also starting the “hardest deployment”, and what is even more serious is that the frontline medical staff in emergency medicine are finding that the number of serious cases is increasing, and even greater challenges are coming.

Emergency medicine is too difficult

Even the corridor of the clinic is “stuffed” with patients

“There’s barely enough room for one foot”. In the emergency rooms of major hospitals in Shanghai, this is not an exaggeration.

In Renji Hospital, the daily emergency volume of the East and South areas combined reaches more than 3,300 people, receiving about 240 120 ambulances, with a peak of 269 ambulances a day!

“The number of emergency internal medicine consultation spaces in the East Campus of Renji has been increasing, from four to seven, but there are still too many patients and they still have to wait in line for a longer period of time.” Since mid-December last year, Zhuang Xu has almost lived in the hospital, coordinating emergency medical reinforcements and patient triage day and night.

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“We have more than 30 people in the emergency department, and there are only four or five people left without ‘yang’. Sometimes I really can’t line up seven clinics, and the departments that come to support are difficult, with colleagues running wards and supporting fever clinics.” Zhuang Xu said, recently, although medical care “Yang Kang” has been returning to work, but the number of emergency cases continue to run up. The second area of the emergency clinic was set up in Renji Hospital on the occasion of the New Year’s Eve.

The situation of emergency departments of major hospitals in Shanghai is similar to that of Renji Hospital: the waiting time is generally 4 to 5 hours because of too many patients.

“An emergency doctor opens at 7:30 a.m., and the patient may have registered before 00:00 the day before – overnight! Some patients can’t stay up and go back to sleep and come back in the morning. Patients suffer, and so does the medical care, and new patients keep coming.” Zhuang Xu also witnessed the average age of patients staying in the hospital running upwards every day: 73, 75, 77 …… more than 90 years old, and many centenarians. Among them, there are severe lung inflammation, creatinine soared to more than 900 (111 in normal people), and kidney function has become incomplete.

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In the hospital, even the corridor of the consultation room is “stuffed” with patients. The limited space gives emergency doctors another test. “Emergency resuscitation requires physical space. The corridors are congested, and there are very few places to get down.” Xiong Jianfei, an emergency physician at Renji Hospital who has been working in emergency medicine for more than 20 years, was heartbroken for his colleagues and for the patients.

On the other hand, the number of patients transferred by 120 is increasing every day. In line with the principle of “first save lives, then cure” rescue, Xiong Jianfei an 8-hour shift down, tired eyes can not open. “The “duel” has been half a month, he hopes, “the inflection point came soon.

“Almost every day a new ward is opened soon the patients will be full”

The Shanghai Tenth People’s Hospital, located in the northern Jing’an District, has also taken on the heavy task of emergency care. In the face of the usual ordinary patients, a nurse can take care of one or two dozen patients, but now there are more patients with serious conditions, a variety of conditions, and ordinary patient management is not quite the same, so the medical and nursing manpower is relatively inadequate.

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In order to receive patients in the emergency room in time, from two weeks ago, the inpatient department of the Tenth Hospital has stopped accepting regular outpatients and focused on emergency patients. Li Yingchuan revealed that recently, the number of new inpatients per day is less than sixty to seventy, more than a hundred, “almost every day a new ward is opened, and soon forty to fifty beds are filled with patients.” As of January 1, a total of 17 wards have been activated and nearly 700 patients with severe neocoronavirus infections have been admitted.

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In addition, the Tenth Hospital has set up a hospital-wide consultation system, with a treatment team composed of experts from the Department of Respiratory Medicine, the Department of Emergency Medicine, the Department of Critical Care Medicine and the Department of Geriatrics, as well as the Department of Laboratory Medicine, the Department of Pharmacy and the Department of Equipment, etc., to conduct daily consultations for critically ill patients throughout the hospital at noon to ensure that critically ill patients can be effectively treated according to the principles of diagnosis and treatment, and as of January 1, a total of 125 critically ill patients had been consulted.

“Now the hospital is more crowded, blindly send the patient to the hospital, but may let the patient cross-infected with some bacteria, can more carefully observe the patient before deciding whether to send to the hospital.” Li Yingchuan reminded that if the patient simply has a fever, there is no need to be nervous, but if there is behavior that is different from usual, such as talking in a lower voice, speaking two words to gasp for air, eating becomes difficult, etc., you should consider sending to the hospital for consultation.

Compared to the busy emergency room, the recent outpatient volume of the ten hospitals is less than the same period in previous years. Li Yingchuan said, taking into account the needs of some citizens for screening, the hospital also opened a simple new crown screening clinic to reduce the pressure on the general emergency room, so that patients who really need to be treated in a timely manner. For people whose condition is not urgent, they can go to the outpatient clinic to check indicators of heart muscle damage, do lung CT, etc. There is no need to go to the emergency room.

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Seriously ill patients are on the rise

Treatment and care are more difficult

After arranging the patients in her hand, she quickly scanned the whole scene, including the entrance of the staircase aisle, the entrance of the pharmacy, the entrance of the registration office, the back of the gate, and the laboratory report machine. …… She quickly deduced in her mind how she could find some more gaps in the sea of people and add another bed.

“I don’t know when the next ambulance will come, I’ll arrange it early so the patient can wait a little less.” Cha Xiaoli’s voice was hoarse. In the past three years of fighting the epidemic, she had been in contact with and treated patients with new crowns, but she had never been under such pressure. On the day of the night shift, 43 ambulances drove into the hospital area one after another, more than 100 patients were in the emergency observation room, and hundreds of general emergency patients were still waiting for their numbers to be called ……

What to do? I can only grit my teeth and hold on, because there are patients waiting, to treat!

These days, the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital) has also seen a record number of emergency room visits, with a daily average of more than 2,000 visits. In the past, the orderly emergency hall is now full of stretcher beds. Almost all of them are elderly people, and a blue oxygen tank by the bedside has become the “standard”.

“80%-90% are positive patients, the average age of the emergency medicine department is over 80 years old, and there are many serious cases.” Hu Min, head nurse of the emergency department at Changhai Hospital, speaks with a nasal voice and at a fast pace. She has had migraines for years, more so these past few days, and has to rely on medication to keep the symptoms at bay. Even so, she spends an average of more than 12 hours a day in the hospital.

These days, Hu Min is slightly relieved that the department is recovering rapidly as more and more of her “Yang Kang” colleagues are coming to the hospital, but we are also aware that the peak of critical care visits in Shanghai is beginning to emerge and the challenges are becoming more severe. The elderly have chronic underlying diseases, and with new infections, treatment and care become more challenging.

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In the emergency ward of Tongji Hospital, nearly 90% of the patients are elderly people. 45 beds are for an 82-year-old gentleman who had been suffering from high fever and breathing difficulties for many days when he was brought in by 120. “At that time, the old man’s blood oxygen saturation was only 80, and he was severely hypoxic. The chest CT suggested a large area of inflammation in both lungs, but fortunately it had not yet reached the level of ‘white lung’.” Xiao Wuqiang, deputy chief physician of the Department of Emergency Medicine at Tongji Hospital, remembers that after high-flow oxygen and rehydration treatment, the old man’s oxygen saturation was finally maintained at 90, barely passing the test, and then after four days of treatment, his oxygen saturation is now maintained at more than 95, and he was able to answer fluently when doctors checked in.

As the number of critically ill patients began to increase, Xiao Wuqiang 24-hour standby ready to put into rescue, “this will be a tough battle, buried in the eye to do a good job little by little, I believe the tough times will always pass.”

Hospital-wide collaboration

Every department is trying to “triage” for emergency care

How to triage emergency care? At the end of the year and the beginning of the year, a hospital-wide ward restructuring is underway at Huashan Hospital of Fudan University – everyone is fighting to defend emergency medicine!

In the last week of 2022, Dr. Dong Liang, a respiratory physician at Huashan Hospital, clearly felt that the peak of emergency care was approaching and the number of seriously ill patients was increasing. “We go to the ward at 8 a.m. to turn in and sort out the bed situation. Professor Li Shengqing, head of the respiratory department, will make a treatment plan for critically ill patients, and then I will rush to the emergency room. Now, every morning at 7 a.m., the emergency clinic will make a triage list and each department will receive a wave first; at 3 p.m., the emergency clinic will make another list.” Dong Liang speaks with a wheeze of her own. She remembers that the hospital opened a new ward on Dec. 28 last year, and it was basically full in less than two days. “No way, the 11th floor immediately opened a new ward, a large number of patients need oxygen, we also hope that patients can at least lie down ……”

In Huashan Hospital, various departments will run to the emergency room every day to triage patients: diabetic infection into the endocrinology ward, brain infarction infection into the neurology ward …… some patients do not have underlying disease, but the lung condition is very serious, “pneumonia ward” is for the emergency The “pneumonia ward” is for emergency triage.

This is a hospital-wide collaboration. The treatment team of the ward is not only the infection department, respiratory department and ICU, but also anesthesiologists and surgeons. Among them, there are those who have rushed to Wuhan, and those who have fought in the designated hospital, “all are warriors who have gone through a thousand trials and tribulations”. On this basis, each ward is visited by professors, and the whole hospital forms a multidisciplinary team of experts.

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Nevertheless, the virus did not give the slightest chance to breathe. “Recently, there has been a significant increase in the number of seriously ill patients, who may have had a simple viral pneumonia five days ago and a rapid progression of the disease five days later. What we can do is to make the treatment as forward as possible.”

Dong Liang found that one of the major challenges of this new coronavirus infection is that the disease is very insidious, “some patients even cough and cough sputum are not, just a little chest tightness, but in fact, the disease has been silently aggravated, to the hospital a check has been severely hypoxic. The oxygen saturation of normal people is above 95%, once it gets below 90%, the disease may progress quickly and treatment is tricky.”

The virus “hit” some elderly people, more anxious. “The old man is usually in good health and has always eaten on his own. How did the disease get so bad after this infection ……,” the family mumbled with red eyes.

Dong Liang said that nowadays, they encourage families to accompany them because some elderly people are more panic-stricken inside. But the problem is that many families are “all-young”. A 96-year-old gentleman was admitted to a newly opened pneumonia ward, and his grandchildren hired caregivers to look after him. “I have to go back and forth, and I feel like I’m going to collapse too. The grandchildren are on the verge of tears as they talk.

“To go to work, you have to be in high spirits.”

The most difficult years doctors and patients together “carry”

“Now, there is no difference between the night emergency and the day emergency.” The last day of 2022, Huashan Hospital Baoshan Hospital emergency department Fei Fei Ye was at his post. The emergency clinic, crowded with people.

Fei Fei Ye was mainly responsible for emergency pre-screening. One day, the number calling system was out of order, and more than 100 numbers jumped at once, causing patients to flock to the door of the doctor’s office. “Listen to me, everyone, stay calm.” Ye Fei Fei rushed forward, expecting to spend a lot of energy to maintain order, but to her surprise, the patients really sat down obediently. Some people said to her, “Nurse, you’ve worked hard,” and later some family members did a “back-and-forth” between the doctor’s office and Fei Fei Ye, who was walking back and forth to tell her the progress of the call. “It’s not easy for you guys, it’s not easy for all of us to carry through together.” A patient’s family said so.

“Patients not only understand you, help you, patients will also help each other, help queue for reports, point the way.” Ye Fei Fei lamented that he did not expect that it was the patients who gave him the most touching during the most difficult years.

In the face of illness, doctors and patients often have to fight together. One day, a young man rushed into the emergency room, “My father is dying, can I borrow a wheelchair?” Ye Fei Fei happened to be eating lunch, and another nurse could not run in the pre-screening, so she put down her chopsticks, pushed the wheelchair and ran out the door with the young man.

The more Fei Fei Ye ran, the more breathless she became. It turned out that the patient’s family had parked the car on the road outside the hospital, at least three to five hundred meters from the emergency room. Open the car door, only to see the old man has purple lips, confusion. “You follow what I said, drive.” Ye Fei Fei jumped in the car and began to “manual navigation”, the car from outside the hospital around to the front door of the emergency room, the old man in a wheelchair straight to the resuscitation room. “This is the first time I jumped on a patient’s car, when I thought of saving people, if the wheelchair pushed to the emergency room, the distance of three to five hundred meters for him, may not be able to pass.” The panting Fei Fei Ye realized at this moment that he was wearing only a mask.

On December 31, 2022, at 8:00 p.m., after the day shift, Fei Fei Ye finally returned home. This night, as soon as her eyes closed, she saw herself pre-screening triage and receiving “120” ……January 1, 2023, at 2:00 p.m. Before going to sleep, she set an alarm clock for herself at 6:00 pm. The first day of the new year was also Fei Fei Ye’s first shift, another emergency night shift. “When you go to work, you have to be refreshed.” She said to herself.

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How is Shanghai coping with the peak of serious illness?

News 1+1 focuses on

What is the situation of critical care in Shanghai?

What is the current situation of serious illnesses admitted to hospitals? What are the characteristics of the patients, including age, symptoms, etc.? What kind of characteristics do some critically ill patients exhibit? What are the most important issues that need to be addressed in the treatment of critical illnesses at the moment? Zhong Ming, director of the Department of Critical Care Medicine at Zhongshan Hospital of Fudan University, provides answers.

What is important to do during the critical care concentration period?

Zhong Ming, director of the Department of Critical Care Medicine at Zhongshan Hospital of Fudan University, said that during the intensive care period, first, we still need to actively expand the capacity of critical care, that is, ICU beds and personnel, because each ICU bed is a hope for the life of a critically ill patient, so we try to expand the capacity, so we can bring more hope for life. At the same time, for the professional critical care medical team engaged in the treatment of critical illness, or the critical care medical team coming to the assistance, we should implement the effective methods of treating critical illness that have been proven to be effective on the 9th edition of the new coronary care guidelines. For example, we should rationalize the use of hormones, we should implement adequate lung-protective ventilation strategies and aggressive prone positioning for patients who are on air, and we need to firmly implement anticoagulation, which are already proven strategies, and we need to better grasp the implementation of these treatment principles.

Community hospitals, how to help critical care?

On the one hand, community hospitals at the grassroots level in cities need to take on primary care and help triage tertiary hospitals, leaving more medical resources for patients who need them most, and on the other hand, they need to identify high-risk groups and patients with a tendency to become seriously ill, so that timely referrals can be made without delaying treatment. How can community hospitals cope with the pressure and challenges in the face of peak infections? Xin Yurong, deputy director of operations at Jin Yang Community Health Service Center in Pudong New Area, Shanghai, introduces the current situation.

Is the rate of serious illnesses currently high? Latest data revealed

“The percentage of serious and critical illnesses among infected patients currently admitted to Beijing’s sentinel hospitals is 3 to 4 percent.” Tong Zhaohui, vice president of Beijing Chaoyang Hospital, affiliated with Capital Medical University, which is responsible for the treatment of critically and critically ill patients in the two designated hospitals in Beijing, introduced that most of the patients who come to the hospital are of the common type.

Kang Yan, president of West China Tianfu Hospital of Sichuan University, introduced that in the past three weeks, the ICU of Tianfu Hospital has admitted a total of 46 critically ill patients, occupying about 1% of those with symptomatic infections. In terms of visits, the fever clinic has recently seen about 450 patients per day, of which those requiring admission to hospital occupy roughly 10% of those with symptomatic infections.

“Although the pathogenicity of the Omicron mutant strain has decreased, the absolute number of severe cases cannot be ignored because of the large base of infected patients.” Zhang Wenhong, director of the infection department at Huashan Hospital of Fudan University, said that in a city like Shanghai, where the absolute number of elderly and vulnerable people with underlying conditions is not small, even if the percentage of infections becoming serious illnesses is low, it can put a lot of pressure on hospital resources for serious illnesses.

5 indications to master to turn to serious illness

Be on high alert if 1 appears

Early detection, early diagnosis and early treatment are very important to prevent serious illness and improve the treatment of seriously ill patients. Zhang Boli said, “Many patients mistakenly think they are getting better, and when acute symptoms appear and then sent to the emergency room, the time for treatment has been delayed.” Therefore, early detection of indications of serious illness is very important.

During home recovery from infection with the Omicron strain, how can you tell if your condition is gradually recovering or if there is a tendency to turn serious? Zhang Boli gives five criteria for the transition to severe disease.

Fever that does not subside. In general, fever over 38.5 ℃, after taking antipyretic drugs, but still fever persists for more than 3 days to pay special attention.
Difficulty in breathing, shortness of breath after activity, and relatively fast breathing rate. In general, the respiratory rate of a healthy person is roughly 10-20 times per minute, and if the respiratory rate is more than 30 times per minute, it needs to be a key concern.
Persistent more serious nausea, vomiting, diarrhea and other digestive system diseases.
Poor mental state, indifference, trance, irritability, or unresponsiveness and other manifestations. Be especially alert to the fact that some elderly organisms have been hypoxic without the manifestation of respiratory distress, which is silent hypoxia. If there is an oximeter at home, monitor the finger oxygen saturation, and if it is continuously lower than 93%, send it to the doctor in time. If there is no oximeter, the observation of shortness of breath, panic and poor mental status after activity should also be paid extra attention.
Aggravation of the original underlying disease. For example, the original blood pressure is well controlled, “Yang” after the blood pressure can not be controlled, or the emergence of stubborn angina, blood sugar increased significantly and other problems.

Zhang Boli stressed that the above phenomena may be a sign of serious illness, the emergence of 1 should pay special attention, if more than one at the same time must be promptly sent to the doctor.