Abstract
PurposeThe described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV‑2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic.Patients and methodsThe study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections.ResultsActive patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV‑2 infection in 164 tested radiation oncology service inpatients was observed.ConclusionIn times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.
Highlights
The continued global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated risk of pulmonary manifestations of coronavirus disease-19 (COVID-19) posed a challenge to all human societies in late 2019 and early 2020 [19]
Changing workflow designs and patient selection led to reduced first-contact appointments and significantly increased downstream appointment compliance
The daily number of first-contact, publicly insured patients scheduled ([confidence interval, CI, 95%; standard deviation, SD, 1.0 vs. 1.3] 7.1 vs. 6.4; p = 0.004) and presenting ([CI 95%; SD 1.4 vs. 1.3] 6.3 vs. 5.4; p = 0.0024) to the outpatient clinic was significantly lower in 2020 compared to 2019
Summary
The continued global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated risk of pulmonary manifestations of coronavirus disease-19 (COVID-19) posed a challenge to all human societies in late 2019 and early 2020 [19]. Due to the late symptom onset alongside high numbers of asymptomatic manifestations, it has been widely reported that controlling viral transmission is crucial to reduce nosocomial disease spread between personnel and patients, especially in healthcare facilities [23]. Active patient flow management was implemented early, at the onset of the pandemic, to adapt to the potential shortage of staff, supply, and government-regulated reduction in hospital treatment capacity [15, 25] instead of cancelling indicated therapies
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