5. Principles of hospitalization treatment
Patients received in-hospital treatment according to the following
principles: emergency and severe patients need to be treated first, and
non-emergency and mild patients can be treated later, taking into
account complications and underlying diseases; elective surgeries need
to be postponed; and the treating doctor needs to be contacted if a
patient’s condition changes during routine follow-up. The speed and
quantity of admission were controlled to ensure the safety of patients
and medical personnel during the epidemic. For patients with benign head
and neck tumors or slow-progressing malignant tumors, such as low-risk
differentiated thyroid cancer, because the tumor will not progress
rapidly in the short term and cause serious complications, the
in-hospital treatment of such patients has been postponed until the
epidemic stabilizes.
6. Preparation for admission and screening
After the outpatient doctor completed the third-level triage and issued
the admission orders, an appointment was scheduled. In addition, a
network communication platform was established with the patients or
their families, and the network communication lists for patients
admitted to the Department of Head and Neck were distributed to the
patients and their families. Network screening of the preadmission
epidemic situation was performed. Additionally, a complete blood count
was conducted, and chest CT examinations were performed if necessary. At
the time of admission, each patient’s body temperature was checked at
the entrance of the surgical building. If the body temperature was
normal, patients were admitted to the head and neck surgical unit. Body
temperature was screened again at the entrance of the unit by the
nurses, who used secondary protective measures. Body temperature was
measured with an electronic thermometer, the close contact history with
NCP patients was obtained, the patient and any accompanying persons
signed the ”Integrity Commitment regarding Patient and Family
Epidemiological History with Novel Coronavirus Pneumonia”, and the
patient and any accompanying persons completes the sign-in sheets. If
there were no abnormalities, patients went to the nurse station to
complete the admission procedure. In addition to regular basic and
specialist assessments, the patients were mainly assessed for
respiratory function and past respiratory disease history.
Preoperative examination
The doctor in charge prescribed blood tests and chest CT, as they are
mandatory examinations for the NCP epidemic. The staff made a joint
appointment and provided the date to the patient. The patient entered
the unit and the surgical building with an examination reservation sheet
and a wristband. Nurses assessed patient self-care and managerial
abilities. If there were no abnormalities, under normal circumstances,
patients could only be accompanied by the accompanying person when
agreement for the endoscopic examination had to be signed by a family
member, and the accompanying person wore an accompanying badge and
wristband. The purpose of these measure was to control population flow
in the medical technology department area and reduce the number of
cross-infections.
Surgical patients
Operations were performed only when normal results according to
evaluations by the Head and Neck Surgery Center, Internal Medicine
Center and Anesthesiology Center could be achieved. The patient was
admitted to the operating room under the following conditions: with a
chest CT scan within the prior 7 days, having signed the ”Integrity
Commitment regarding the Epidemiological History with Novel Coronavirus
Pneumonia”, wearing a mask, and having a surgical information sheet
indicating vital signs. Postoperative vital signs were closely
monitored, and the risks of exposure to NCP were strictly assessed.
Patients were encouraged to get out of bed as soon as possible after
surgery, with precise nutrition management.
Postoperative multidimensional integrative medical care at
home
During the NCP epidemic, tumor patients at home still have different
degrees of risks of immune dysfunction and susceptibility to infection
during the postoperative rehabilitation period. We not only pay
attention to the prevention and control of virus infection of inpatients
and the NCP epidemic in the hospital but also provide at-home
psychological support and care related to NCP to patients with tumors.
Through a nursing WeChat platform and a third-party online platform, we
implemented integrative medical care at home and sent notifications
regarding information about protection against NCP for patients with
tumors.
Reexamination and follow-up of patients with head and neck
tumors
For the follow-up of patients during the NCP epidemic, online follow-up
or follow-up by telephone is preferred to reduce population flow and
cross-infection. For patients with differentiated thyroid cancer and
other diseases with relatively slow progression and patients recovered
at the 1-year follow-up, the follow-up time was extended to 1-3 months.
For patients who must complete follow-up, neighborhood community
hospitals are recommended for the necessary examinations, and guidance
is provided after the examination results are provided online. During
follow-up, medical staff is in charge of both anticancer and
antiepidemic responsibilities. In addition to inquiring about
cancer-related information, the medical staff must also provide health
guidance related to epidemic prevention.
From February 1 to March 10,2020, during the epidemic of new coronavirus
infection, our head and neck surgery center completed 97 operations,
including 86 for thyroid cancer ,5 for oral cancer (4 for free flap
reconstruction and 4 for tracheotomy),2 for parotid gland ,1 for
squamous cell carcinoma of the scalp ,2 for cervical lymph node biopsy
and 1 for laryngeal cancer. Seven patients had postoperative fever, the
highest body temperature was 39°, and all patients returned to normal
body temperature on the third day after operation; A case of thyroid
cancer patients with fever on the first day after operation with cough
symptoms, the lung CT did not rule out a new type of coronavirus
infection, so a new type of coronavirus test, two consecutive tests were
negative, the patient’s body temperature returned to normal on the third
day after operation.All patients were followed up 2 weeks after
operation, without fever symptoms, and all doctors and nurses had no
fever symptoms.