Shanghai's grassroots community hospitals: some hospitals have square cabin CT in place, residents can take lung films at home

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There is still a lot of pressure on hospitals as well as imaging centers to treat the disease. If a young person is positive to negative and has no obvious symptoms, he or she can go to the hospital for a CT examination of the chest without having to worry about white lung. “Including our center at this stage also temporarily open only lung CT examination, to focus medical resources on the identification of critically ill patients with new coronavirus infection as a priority.”

On the afternoon of Jan. 13, a “box-type” square chamber CT produced by United Imaging Medical was put into use in the open space outside Anting Town Community Health Service Center in Jiading District, Shanghai.

This is the epitome of Shanghai’s grassroots community hospitals actively “fighting” for the new crown. Shen Zhiping, director of Anting Town Community Health Service Center, mentioned in an interview that in the past week, the entrance of the hospital’s radiology outpatient room was full of patients waiting for CT, “especially in the past two days, the scanning volume was as high as 60 to 70 cases a day”.

At the scene, citizen Auntie Wang is waiting for CT examination with her family. “Before also need to go to the big hospital queue for film, time-consuming and labor-intensive, in the family doctor’s introduction only to know that the original in the doorstep of the community hospital can do, indeed much more convenient.”

However, Shen Zhiping also told reporters that the pressure on hospitals and imaging centers is still relatively high. She suggested that if young people after the positive turn negative and no obvious symptoms, they can not have to worry about white lung and go to the hospital for chest CT examination. “Including our center at this stage also temporarily open only lung CT examination, to focus medical resources on the identification of critically ill patients with neocoronavirus infection as a priority.”

The most urgent demand for CT and ultrasound equipment in grassroots community hospitals

Shen Zhiping introduced that Anting Town Community Health Service Center mainly serves the health management of about 200,000 people in the district, with a total of about 170 medical and nursing staff, carrying out departments including general medicine, gynecology, pediatrics, dentistry, maternal and child health care. At present, the center has a daily outpatient volume of nearly 1,500 people. Most of the people who come to the center are those who are in the early stage of new crown or still have some symptoms that are difficult to be relieved after recovering from the new crown, and the medical and nursing staffs mainly provide treatment and rehabilitation guidance by means of medication, Chinese medicine and infusion.

Shen Zhiping, director of Anting Town Community Health Service Center, was interviewed by the reporter

For some time, with the optimization and adjustment of the epidemic prevention and control policy, it has been pointed out that community health service centers should give full play to the role of graded treatment to relieve the pressure of treating new coronavirus infected patients in secondary and tertiary hospitals. The community health service center in Anting Town has also expanded its capacity and increased its capability, actively responding to the demand for medical services such as oxygen therapy, infusion, medication and nebulization, giving full play to the role of the community health service center to move forward and continuously improving the community medical treatment capability.

According to Shen Zhiping, the Anting Center has recently started to improve its own medical treatment capacity in three main ways. Firstly, the hospital has set up 80 new family beds in the Fangtai branch center, which will serve the residents in the district during the period of infection with the new crown and also help the residents in the rehabilitation and recovery period of the new crown.

Secondly, the hospital has also actively expanded the fever clinic during the peak of the current epidemic. The stockpile of small molecule drugs and antipyretic and analgesic drugs for new crown has been strengthened, and the rehydration space, oxygen therapy space and nebulization treatment area have also been expanded to meet the needs of the residents in the district. “Due to the climbing rate of disease infections, the daily rehydration volume of our center has surged from the original single digits to nearly 150, while also greatly relieving the pressure of rehydration in the higher-level hospitals, allowing them to focus on treating critically ill patients.” Shen Zhiping said.

Finally, with the support of the higher authorities, Anting Town Community Health Service Center also ordered the square chamber CT and completed the installation, commissioning and use of the equipment within three or four days.

“Before the installation of CT equipment, our center mainly used DR equipment to take pictures, which not only had high shooting requirements but also easily caused the phenomenon of missed diagnosis, so we usually suggested patients to go to higher hospitals for CT examinations again before.” Shen Zhiping said, “After the square cabin CT is in place, our center is also able to detect some serious patients from daily tests and refer them to higher hospitals at the first time, effectively diverting the treatment pressure of higher hospitals.”

On January 16, Zhang Qiang, chairman and co-CEO of Liangying Medical, said in an interview with reporters that from the perspective of the current actual demand, scenarios such as emergency prevention and control of acute respiratory infectious diseases, mainly new crown pneumonia infection, and emergency triage of major public health emergencies, mainly traffic accidents and natural disasters, are the core applications of primary community healthcare. Therefore, from the functional level of the equipment, the demand for CT and ultrasound equipment is relatively most urgent in primary community medicine, and the above-mentioned equipment (square cabin CT) can basically meet the demand for filming at the grassroots level.

However, it should be noted that in the current framework of medical association, community hospitals generally lack qualified radiologists. At present, all films taken by Anting Town Community Health Service Center also need to be uploaded to the higher level Anting Hospital. Since the amount of films taken by the secondary hospital itself is not small, coupled with the need to consult reports from several community hospitals, the amount of remote diagnosis has increased dramatically, which has caused considerable pressure on the higher level hospital for treatment. Liang Kaiyi, director of the radiology department of Renji Hospital Jiading Branch, said in a previous interview with the media that originally there were three doctors in the hospital’s imaging center to undertake remote diagnostic services every day, but recently it is necessary to invest at least five to six people to meet the demand for treatment of residents.

Shen Zhiping also pointed out that the pressure on the hospital as well as the imaging center for treatment is still relatively high, and young people can come for chest CT exams without having to worry about white lung if they are positive to negative and have no obvious symptoms. “Including our center at this stage also temporarily open only lung CT examination, to focus medical resources on the identification of critically ill patients with new coronavirus infection as a priority.”

Patients come for CT up to 60 to 70 cases per day

On the afternoon of January 13, when the reporter came to Anting Township Community Health Service Center, he saw that the “box-type” square cabin CT produced by Liangying Medical (SH688271, stock price 183.18 yuan, market value 151 billion yuan) had been put into use in the open space outside the hospital. Shen Zhiping introduced, nearly a week, the hospital radiology department outpatient room door is full of patients waiting to do CT, “the past two days, especially more, a day scan volume of up to 60 to 70 cases”.

Auntie Wang, a citizen waiting at the scene, told reporters that her family has been infected with the new crown for some time, although it has turned negative two days ago, but the symptoms of coughing and shortness of breath have not been good, she decided to help her family to the community hospital to do a checkup.

Auntie Wang said that their queuing time was not very long, as long as the checklist was opened at the doctor, and they only waited about half an hour for the CT to the square cabin. In addition, the CT shooting process is also very fast, from the time the patient enters the CT chamber to the completion of the shooting, it can be completed in three minutes. “Before, I still need to go to the big hospital to queue for the film, which is time-consuming and labor-intensive. After listening to the family doctor’s introduction, I realized that it can be done at the community hospital in front of my home, which is really much more convenient.”

Medical care is helping patients to perform CT scan

Zhang Qiang also introduced to the reporter that, relying on the Shanghai Jiading-Liangying Regional Imaging Center, the technician will upload the image to the radiology department of Anting Hospital for reading and issuing the diagnosis result through the remote diagnosis platform of Liangying Medical after the film is taken. Under normal circumstances, it takes about 20 minutes (diagnostic results) to return. Through this model, community hospitals do not need to allocate diagnostic doctors, which saves community hospitals’ expenses and greatly relieves the pressure on higher-level hospitals.

According to the information provided by UNI Medical, the Shanghai Jiading-UNI Regional Imaging Center is currently centered on Nanxiang Hospital, Anting Hospital, District Central Hospital and Jiangqiao Hospital, connecting 18 community hospitals, 4 secondary hospitals and 1 tertiary hospital in the district, and is able to serve 1.6 million permanent residents in the district.

Zhang Qiang said, relying on the hospital’s square cabin CT equipped with AI navigation system, can automatically complete the positioning, scanning and other processes, significantly improving scanning efficiency and reducing the risk of cross-infection.

In addition, previously, for community hospitals, it was difficult to determine “what kind of patients should stay in the community hospital and what kind of patients should be referred to higher levels,” but the square cabin CT is equipped with the new coronavirus infection intelligent auxiliary analysis system, which can automatically indicate whether they are critical patients. Even before opening the image, the system can tell the technologist (analysis results). After opening the image, you can also see the key quantitative indicators derived by the AI based on the patient’s CT image, which largely improves the efficiency of the community health service center as the first line of defense for screening at the grassroots level and speeds up the process of referring critical patients to higher levels.

New crown treatment “sink”, community hospitals to support the bottom

The people’s aspiration and demand for a healthy life has raised new requirements and challenges for primary health care institutions. Primary health care institutions as the bottom of the network of medical and health services, strengthen the service capacity of primary health care institutions, and gradually improve the amount of treatment in primary institutions, is one of the important issues to be studied and resolved in the deepening of medical reform.

According to the reporter’s understanding, at present, even in a first-tier city like Shanghai, grassroots community hospitals are generally equipped with DR equipment, like CT equipment, a more high-end medical equipment penetration rate is still relatively low. For this problem, Zhang Qiang said, not only community hospitals, medical equipment to the entire process of sinking primary care institutions is divided into three stages, “the first stage is the sinking of equipment, the second stage is the sinking of services, and the third stage is the sinking of data.”

Since the outbreak of the epidemic began in 2020, the sinking of medical devices to the primary level has accelerated. With the popularity of the equipment, given the objective conditions such as the lack of talents in the primary medical structure, how to make the equipment better serve the entire primary medical institution’s treatment system has become a key challenge.

In response to the reporter’s question, the solution proposed by Liangying Medical is based on the equipment, relying on the cloud platform, through the digital intelligence program to help local governments to build regional precision medicine diagnosis center with county hospitals as the core, set up imaging, electrocardiography, pathology, ultrasound and other sub-centers, upward linkage to provincial hospitals, downward radiation township hospitals, to provide remote diagnosis, remote consultation, remote education, remote service four platforms, in order to improve the equipment configuration of county hospitals. In order to improve the equipment configuration level and diagnosis level of county hospitals, and help realize “small diseases do not leave the township and big diseases do not leave the county”.

Doctors are observing CT images of patients

On January 14, the State Council’s joint prevention and control mechanism press conference, Shanghai Municipal Health Commission Director Wen Daxiang said, at present, Shanghai community health service centers have set up more than 6300 oxygen suction positions, 11,292 infusion positions, 903 nebulizer treatment positions, equipped with more than 1,200 cardiac monitoring equipment, finger oxygen meter 49,000. In addition, digital radiographs (DR) have been configured in full coverage, and CT equipment has been configured for the community health service centers that are in a position to do so, with more than 40 units currently configured.

Along with the inclination of more medical resources, community hospitals will also play a more critical role in the three-tier medical service network in urban and rural areas. What other key resources will community hospitals need to invest in order to cope with the future pressure of diagnosis and treatment?

As the person in charge of community hospitals, Shen Zhiping pointed out in response to a reporter’s question, first of all, can strengthen their own testing capabilities, such as some tests such as CT examinations still need to be sent to higher-level medical institutions, which may cause efficiency limitations; secondly, the construction of wards, the current pressure on the admission of patients in higher-level hospitals, community hospitals to divert these patients will need to expand the wards, as well as supporting cardiac monitoring, respiratory machines. At the same time, supporting cardiac monitoring, ventilators and other equipment and training more qualified medical staff.

“Whether it’s CT equipment sinking or taking on more patients with new crowns, this means that community hospitals will have the ability to ‘bottom out’ on new crowns and even other diseases, so that residents in the district can solve their health problems at home.” Shen Zhiping said.