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Vol. 36. Issue 1.
Pages 54-55 (January - February 2021)
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Vol. 36. Issue 1.
Pages 54-55 (January - February 2021)
Letter to the Editor
DOI: 10.1016/j.jhqr.2020.11.001
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COVID 19 and the new challenges in health management: The pilot experience of the Internal Medicine Department of a Regional hospital
COVID 19 y los nuevos retos en gestión sanitaria: la experiencia piloto del Servicio de Medicina Interna de un hospital de primer nivel
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B. Ares Castro-Condea, V.M. López Mouriñob, I. Sanz Falquec, J. López Castrod,
Corresponding author
jlcastro126@hotmail.com

Corresponding author.
a FEA de Geriatría Adscrita a S. de Medicina Interna, Hospital Público de Monforte, Lugo, Spain
b Unidad de Hospitalización a Domicilio, Hospital Público de Monforte, Lugo, Spain
c Gerente de Hospital Público de Monforte, Spain
d S. de Medicina Interna, Hospital Público de Monforte, Lugo, Spain
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Dear Editor,

A pandemic, any pandemic, always surpasses a healthcare system, any healthcare system. And ours was no exception. Following the well-known culture of safety1 it is up to the wave crest to make a detailed analysis of the weaknesses and strengths that have been revealed during these arduous previous months and that have led to a paradigm shift in the way of understanding healthcare on a global level and particularly in our country. To do this, we would like to show the experience of a 141-bed regional hospital, located in an area with a low incidence of COVID-19 (south of the province of Lugo) and serving a population of 42,000 inhabitants. At the end of February and 15 days before the declaration of the state of alarm by the authorities, the first monographic meeting took place in our Internal Medicine Department to explain to the doctors how little was known about the disease at that time, everything illustrated with the first data from the Epidemic Alert Service and with scientific documentation from China2 and France,3 countries that had the most experience in the management of this disease. A week later, a multidisciplinary crisis cabinet was appointed that met daily to assess the current situation, made up of doctors from the Internal Medicine, Emergency, Anesthesia, Preventive Medicine Departments and members of the hospital management.

Differentiated circuits were created throughout the hospital, from the emergency room to the resuscitation area, not to mention the hospitalization area where we created a COVID and a Pre-COVID plant, with an availability in each of them of 14 double rooms. Multiple explanatory sessions were held at the center, mostly carried out by the Occupational Risk Prevention Service and Preventive Medicine, where they explained the epidemiology and transmission of the virus, as well as the necessary protection measures in each action and procedure protocol carried out in the hospital. They provided continuous training on the placement and removal of personal protective equipment in all areas of the hospital, as well as in the social and health centers to which we provide healthcare. A Contingency Plan was created in the Medical Area, consisting of 4 progressive phases according to the magnitude and impact of the disease in our territory and also proposed shift work for doctors if necessary. Finally, it was not necessary to go beyond phase 1 thanks to the population dispersion of our health area and probably also to the multidisciplinary care provided (in homes, social health centers and hospital) which will have to be evaluated in future studies. Due to the average age of our population (more than 30% older than 65 years) and the high number of Social Health Centers in our small area (11), the Hospital Management together with our geriatrician, attached to the Internal Medicine Department, performed a work plan that consisted of close monitoring of the same through a daily telephone interview with the medical and nursing staff of said centers and scheduled and on-demand visits through the Home Hospitalization Unit. In addition, the social health centers were reinforced with nursing personnel and one of them also with medical personnel, with the intention of handling all positive COVID-19 cases without having to move them whenever their clinical situation allowed it. In mid-March, the first COVID-19 positive patient was admitted to our hospital and since April 15 we have not had positive cases that required admission, which has a much lower impact than in other Regional hospitals in our environment (being the entire Galician Community area of low incidence of the disease). This model of crisis management during the pandemic highlights the great importance of “anticipating events”, working “in a network” between primary and hospital health care and the value of well-used telemedicine that allowed avoiding multiple hospital admissions from the centers social and healthcare, in addition to, through the TELEA monitoring program (Home Assistance Platform), carry out daily follow-up of patients from their homes, which is why we want to communicate this through this letter since we are convinced that teamwork and power anticipate the arrival of the virus, they have been very important to be one of the healthiest areas with the lowest lethality in Spain.

COVID-19 is here to stay. Although the fundamental pillars to prevent its expansion are hand washing and social distance, as long as there is no vaccine, community immunity or effective therapy,4 perhaps in 1 or 2 months we will suffer another new outbreak of the disease, for which we will all be very more prepared without a doubt.

References
[1]
M.M. Cohen, M.A. Eustis, R.E. Gribbins.
Changing the culture of patient safety: leadership's role in health care quality improvement.
Jt Comm J Qual Saf, 29 (2003), pp. 329-335
[2]
N. Zhu, D. Zhang, W. Wang, X. Li, B. Yang, J. Song, et al.
A novel coronavirus from patients with pneumonia in China, 2019.
N Engl J Med, 382 (2020), pp. 727-733
[3]
G. Spiteri, J. Fielding, M. Diercke, C. Campese, V. Enouf, A. Gaymard, et al.
First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020.
Euro Surveill, 25 (2020), pp. 2000178
[4]
M.L. López Reboiro, C. Sardiña González, J. López Castro.
COVID 19 y “Argumentum ad ignorantiam” o “no todo vale”.
Rev Clin Esp, (2020),
Copyright © 2020. FECA
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