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.