LETTER TO EDITOR
Year : 2022 | Volume
: 1 | Issue : 2 | Page : 127--129
Setting up a COVID-19 facility in a hospital dedicated to diabetes care- Our experience
Ashutosh Pakale1, Deepali Kunjeer2,
1 Department of Diabetes and Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
2 Department of Hospital Administration, Chellaram Diabetes Institute, Pune, Maharashtra, India
Department of Clinical Medicine, Chellaram Diabetes Institute, Bavdhan, Pune, Maharashtra
|How to cite this article:|
Pakale A, Kunjeer D. Setting up a COVID-19 facility in a hospital dedicated to diabetes care- Our experience.Chron Diabetes Res Pract 2022;1:127-129
|How to cite this URL:|
Pakale A, Kunjeer D. Setting up a COVID-19 facility in a hospital dedicated to diabetes care- Our experience. Chron Diabetes Res Pract [serial online] 2022 [cited 2022 Oct 5 ];1:127-129
Available from: https://cdrpj.org//text.asp?2022/1/2/127/351231
The COVID-19 pandemic has brought the world to a halt and raised challenges for the health-care providers in terms of managing COVID-19 patients as well as regular patients who have been suffering from equally important ailments and needed care and attention. Here, we are sharing our experience of working at a diabetes and multispecialty hospital in Pune, at the peak of the pandemic. Here, we have discussed and pointed out how we have tackled an increased number of patients during the second wave of the pandemic in India in 2021 and how we have established standard operating procedures, especially in a diabetes setup where the patients need to visit at regular intervals and are highly susceptible to the COVID-19 infection.
Although we have faced many challenges, the main challenge was to create a facility within the existing infrastructure to treat COVID-19 and non-COVID patients simultaneously. We work at tertiary care diabetes and multispecialty hospital in Pune, India, having a 12-bedded fully functional intensive care unit (ICU) and a 30-bedded ward. We did not have an isolation facility or a separate building to manage the COVID-19 patients. Hence, it was decided to convert one wing of the hospital into a COVID-19 ward along with the ICU facility. This wing was completely segregated from the other hospital by placing a partition where the idea was to minimize the risk of the spread of COVID-19 in the other area of the hospital.
The next was to manage COVID-19 as well as non-COVID patients simultaneously and to overcome this challenge, for the outpatient department (OPD) patients, a full-proof facility to provide online consultations was started. To emphasize here, we have followed the guidelines given by the Medical Council of India regarding telemedicine/online consultation. The basic aim was to provide comfort to the existing regular patients so that their diabetes is well managed at home and the needy patients were called to the hospital for further management. The patients also utilized this facility of online consultations to the maximum. Furthermore, we had started a specialized fever clinic with separate entrances for triaging the suspected and confirmed cases. Any patient with symptoms suggestive of COVID-19, including but not limited to fever, cough, and shortness of breath of new-onset, was directed to COVID-19 OPD. To minimize the number of staff being exposed to COVID-19, we had altered our approach to patient interaction and examination. Initially, a junior doctor used to examine a patient and then discuss with a senior colleague who would reexamine the patient if required.
For suspected COVID-19 patients who were requiring hospitalization, we admitted them to a separate/isolation ward and got a COVID-19 reverse transcription–polymerase chain reaction test, if negative, we transferred them to a normal ward, and in case of a positive test result, we transferred them to COVID ward. In view of the shortage of beds, especially critical care beds, we made arrangements for a separate COVID ICU which was developed on time and was fully equipped including mechanical ventilators. Those patients who were admitted to COVID ICU, before discharge were shifted to the COVID ward and stabilized were discharged.
For radiological investigations, particularly high- resolution computed tomography (CT) chest, which was one of the important investigations in COVID-19 patients, our hospital does have the facility of CT scan with round-the-clock radiologist backup which made convenient for early diagnosis of the patient and better management.
Another challenge was treating pregnant females, as our hospital did not have gynecologist backup, so in such cases, only stable patients with <6 months of pregnancy were admitted, either complicated patients or with more than 6 months of pregnancy, were transferred to other higher center where round the clock gynecologist backup was available.
Discharged patients from our hospital were regularly followed up telephonically, where the junior doctor used to call them and ask regarding their health/symptoms and vital parameters such as pulse and oxygen saturation. If stable, managed telephonically, in case of any suspicious or alarming symptoms, patients were called back for physical examination in COVID OPD.
For the transportation of COVID patients, we had arranged a separate ambulance facility, where the person/nursing staff and doctor equipped with personal protective equipment (PPE) used to carry the patient. Apart from this as the hospital had a centralized air-conditioning system, which was another challenge in view of the superfast spreading infection rate. Therefore, provisions were made to isolate the air-conditioning system and have a controlled air-conditioning environment for the COVID-19 ward.
The challenges faced on the human resource front were more critical. The fear factor among the staff, the cautiousness required to avoid mixing the COVID-19 and non-COVID ward workers, working in the closed environment with PPE kits and counseling the relatives who could not attend to the patients were the major challenges that we faced. To troubleshoot this problem, we sensitized the staff to the guidelines provided by the governing authorities. A dedicated staff of doctors, nursing staff, and ward attendants were put on duty for stipulated days and replaced by the next batch to control the infection to the health-care workers. Vaccination of the health-care staff was done on a priority as soon as the vaccine became available in India.
In view of the shortage of beds, especially critical care beds in the city, it was a bigger challenge for us in terms of the selection of the patients. As the number of ICU beds was restricted, we always faced a dilemma while calling patients requiring high-flow oxygen. We also kept a real-time update about the bed availability in the other hospitals in the city so that we can help the patients in quick transfers through the cardiac ambulance that was completely equipped for shifting patients.
Our hospital does have a separate dialysis unit and dialyze COVID-19 patients along with non-COVID patients was a serious issue. There was one Reverse Osmosis (RO) plant with limited access to operating the dialysis machines and the option of portable RO did not work out. Hence, a dedicated room with a dedicated machine in the existing dialysis unit was kept for such patients requiring dialysis and guidelines given by the health authority regarding dialysis were followed.
The laundry load of the non-COVID and COVID-19 ward could not have been possibly washed together and it was very difficult to segregate the same in the hospital. To combat this, completely disposable linen was procured for the COVID-19 ward that was disposed of as per the standard waste management protocols. The transport of the blood samples, radiology investigations, and exchange of reports from common sources was another challenge that we faced. A dedicated place for keeping the samples was earmarked outside the COVID-19 ward. The samples were transported by following all COVID-19 appropriate protocols. The digital platform was majorly used for the exchange of reports and hard copies were avoided as far as possible.
Our hospital does have dedicated operation theater and fully functional catheterization laboratory. Regarding the operative procedures, the elective surgical procedures were postponed to a later date whenever possible, whereas the emergency procedures were carried out taking all the necessary precautions.
Considering the treatment protocol for managing both the COVID-19 and non-COVID patients, as per Centre for Disease Control and Prevention (CDC) almost 30%–40% of the COVID-19 patients were asymptomatic and many were with minimal symptoms. Furthermore, the symptoms of COVID-19 mimic other viral/bacterial upper/lower respiratory tract infections, it was a big challenge to scrutinize the patient and treat them. At our center, we followed the guidelines suggested by the WHO and State government for treating COVID-19 patients both on OPD and in-patient department basis. Hyperglycemia (high blood glucose level) is common in the COVID-19 patient due to underlying diabetes along with other factors such as stress or could be due to effects of medication (e.g., steroids) which are used in the treatment of COVID-19 infection, but as our setup being a dedicated diabetes hospital, the hyperglycemia was treated as per hospital protocol.
To conclude, it is imperative for all facilities to develop a dedicated and strong triage when it is expected to treat COVID-19 and non-COVID patients in the same facility for a favorable outcome for patients as well as health-care providers.
|1||Board of Governors in Supersession of the Medical Council of India. Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last updated 2020 Mar 25; Last accessed on 2022 May 01].|
|2||Ministry of Health & Family Welfare Directorate General of Health Services EMR Division. Guidelines to be followed on Detection of Suspect/Confirmed COVID-19 Case in a Non-COVID Health Facility. Available from: https://www.mohfw.gov.in/pdf/Guidelinestobefollowedondetectionof suspect or confirmed COVID19 case.pdf. [Last updated on 2020 Apr 20; Last accessed on 2022 May 01].|
|3||Ministry of Health & Family Welfare. Guidelines for Dialysis of COVID – 19 Patients. Available from: https://www.mohfw.gov.in/pdf/GuidelinesforDialysisofCovid19Patients.pdf. [Last updated on 2020 Apr 07; Last accessed on 2022 May 01].|
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|5||Government of India Ministry of Health and Family Welfare. Clinical management Protocol for COVID-19 (In Adults). Available from: https://www.mohfw.gov.in/pdf/Updated Detailed Clinical Management Protocol for COVID19 adults dated 24052021.pdf. [Last accessed on 2022 May 01; Last updated 2021 May 24].|
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