COVID-19 衝擊下之門診醫療保衛戰──以台灣某醫學中心為例

Clinic Operation During the COVID-19: A Medical Center in Taiwan

COVID-19 宛如第三次世界大戰，在COVID-19 超強的傳播力，全球醫療正遭受衝擊，不只影響全球人民的健康福祉，更是因此考驗著國家對於衛生政策的改革。為因應COVID-19 的疫情變化，確實阻絕傳染源的傳播途徑，國內各醫療院所配合衛政單位所發佈之政策，於疫情期間確實遵守門禁與入院民眾流量管制。鑒於門診為醫療院所來院病人流動數量之大宗，推估每日高達1 萬人以上於門診區域穿梭。為避免高風險感染看診病人進入院區所衍生之群聚感染，本院根據國外野戰醫院之設置為發想基礎，前瞻性設立「返國門診」，並且導入視訊模式診療，於戶外門診啟動之兩階段分別轉送了44%及54.5% 患有COVID-19 相關症狀之病友至急診求治，避免高感染風險之病人進入院區傳播之疑慮。另一方面更可持續提供民眾就醫需求，不因此疫情而影響就醫權利。在這樣的設置下，病人看診模式改變，調查病人就醫感受，非常滿意程度達72.2%，顯示病友對於此戶外門診之設立給予高度的滿意度之肯定，不僅提高病人與醫護人員對於本院的安全感與信任度，維持持續經營的思考模式，為社區民眾提供完整與安全的醫療服務，也保障了醫護全體工作安全，更因此奠定本院於此次疫情下防疫作為的標竿，期許本院成為國際間醫療院所之楷模。

The effect of the coronavirus disease 2019 (COVID-19) pandemic is similar to that expected of World War III. The rapidly spreading COVID-19 has adversely affected medical systems and both the health and well-being of individuals worldwide, prompting national health policy reforms. In response to the COVID-19 pandemic, medical institutes in Taiwan have complied with health administration policies and implemented access control and restrictions on the hospital capacity to thoroughly block the sources and routes of transmission. Because numerous patients continually visit hospitals and clinics, following the establishment of field hospitals in foreign countries, our hospital set a “back to the home country clinic,” introducing video chat consultation and treatment. The outdoor clinic was implemented across two stages. Patients presenting with respiratory or other symptoms suspicious for COVID-19 (44% and 54.5%, respectively) were transferred to the emergency room to prevent them from entering the hospital and causing cluster spreading. This approach could prevent high-risk patients from entering the hospital while continuing to meet their medical treatment needs during the pandemic. This strategy altered the mode of patient–doctor visits. We increased the sense of security and trust among patients and medical staff, attempted to continually improve our approach, provided the community with comprehensive and safe medical services, and ensured medical staff’s safety. We conducted a survey to determine patients’ satisfaction with this approach. A total of 72.2% of participants expressed being “very satisfied” with the medical service at the outdoor clinic, indicating a highly positive affirmative response of patients to the outdoor clinic and medical services provided by medical staff. Our hospital established a standard for epidemic prevention, which can become a model for medical institutes worldwide.