醫療員工防疫虛擬門診

Virtual Epidemic Clinic for Hospital Personal

為杜絕疫情從社區帶入醫療機構引起群聚，並確保病人及醫療工作人員安全，機構需先期或必要時啟動相關防治措施，包括暴露後之檢驗及醫療處置。然疫情期間住院單位暴露疫病的工作人員，如循醫療常規到門急診就醫，會有許多不便及疑慮；如能在單位就地進行醫療處置，不僅可在黃金時間加速處理時效，更具有限縮風險、疫病分流的實質意義。本文分享某2,600床教學醫院三個階段建立，及優化「關懷員工防疫虛擬門診」的多年經驗，包括處理流程分析，結合循環式品質管理手法的創新做法。包括第一階段於H1N1新流感全球疫情期間設置，不受限於實體診間之虛擬門診；第二階段設立特殊流程進行費用延繳設定，簡便就醫及銷帳；第三階段配合新冠肺炎（COVID-19）全球疫情大規模篩檢需求，增設不同情境的特療註記等。針對74位使用過該虛擬門診的同仁進行認同度調查，「非常同意」皆達80.0％以上。總結，創新策略的有效籌畫，需要有完備的流程分析，透過多工團隊會議前的籌備，讓參與者能腦力激盪，方能建立出貼切、完善且可行的方案。且需持續改善，透過實際使用瞭解其限制，或者面臨新的任務或挑戰。

In order to prevent clusters of contagious diseases originated from the community and protect patient and healthcare personnel, healthcare settings implement infection prevention and control measures proactively or reactively. These include post-exposure diagnostic and therapeutic interventions. If the exposed healthcare personnel of an in-patient hospital service can receive these interventions on the spot, it facilitates the interventions within the golden time, is time saving, and more importantly it prevents spread of the disease. This study described a 2600-bed teaching hospital’s experience in developing a virtual epidemic clinic based on process analysis. This virtual clinic was upgraded according to plan-do-check-act quality improvement process. These included the establishment of a virtual clinic to provide healthcare to employee 24-hour a day and 7-day a week as a part of infection prevention and control measures for novel H1N1 influenza pandemic in the first stage; set up special process for deferred payment, easy access to healthcare, and whose expenses are waived by the hospital; and fined tune process to support extensive screening strategy for COVID-19 in the third stage. We further surveyed 74 staffs regarding their perception of this virtual clinic, and ''strongly agree'' accounted for more than 80.0% of all items. In conclusion, the planning and implementation of a novel strategy requires a complete process analysis, thorough information collection, and facilitates brainstorming during multidisciplinary meetings in order to generate appropriate, comprehensive and feasible solutions. Besides, it is further improved through quality improvement process, awareness of the limitation in real world practice and when facing new taskforce or challenges.