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The big problem of the covid-19 outbreak in this round is that the number of infected people has skyrocketed. Even if various hospitals have expanded their potential and many field hospitals have already been established, it is still not enough to support all the patients.
However, if we investigate in detail, it is found that more than 80% of the infected patients are in the “green group”, which is asymptomatic or with mild symptoms, while approximately 15% of patients are in the “yellow group” with moderate symptoms and approximately 5% of patients are in the “red group” with severe symptoms.
In the past, when the number of covid-19 infected people in Thailand was still low. Therefore, the patient care policy emphasizes that all hospital admissions are required. However, when the number of infected people exceeds the hospital’s capacity to accept the patients. It is necessary to change the policy to suit the situation.
Therefore, in the past 1-2 weeks, the population will hear the words “Home Isolation” and “Community Isolation” more often. The principle is that the patients in the green group should be to stay at home or in the community and be monitored by the hospital through the Telemedicine system.
As for beds in hospitals and field hospitals will focus on receiving yellow and red patients instead; if successful like this, it will allow enough beds for those patients who need them. As a result, there are no more severe patients waiting for help at home.
However, staying at home for recovery is relatively new in Thailand. There are just started kicking off in earnest a few weeks ago. So many hospitals or clinics may still find it difficult. It took a little more time for everything to fall into place.
However, there is a good example from “Phra Nakhon Si Ayutthaya Hospital”, where the number of covid-19 infected people has increased and need to do home isolation like in other areas. However, using telemedicine, IT systems, makes bed management and patient monitoring more efficient.
Saowalak Chowpontong, MD, Assistant Director of Customer Relations Phra Nakhon Si Ayutthaya Hospital, said that in the previous period that still used RT-PCR testing, the average number of covid-19 infected people was 4 cases per day. However, when the Ministry of Public Health (MOPH) unlocked using the Antigen Test Kit (ATK), the number of infected people increased to about 30 cases per day.
For bed management, the hospital accepted all patients as inpatients in the past. However, the increasing number of infected patients makes the bed full; even if the field hospitals added beds, they are still “Full in one day”.
For this reason, the bed must be re-managed by categorizing the patients in the green group to be treated at home. Currently, there are patients who are treated at home, and the hospital monitors their symptoms for more than 100 cases. Therefore, hospital beds can be kept for patients who really need them.
For covid-19 patiets who are treated at home, a lung x-ray will be required to screen for any signs of serious illness that may be revealed in the future. After that, medicines will be prescribed and sent to their home for symptomatic treatment, such as Andrographis paniculata extract, antipyretic, nasal decongestants, anticough, a survival bag, and food delivery three meals a day.
For food, the hospital will hire food contractors from the local shops. They will be responsible for delivering food to the patient’s home twice daily, in the morning and afternoon. At noon, it will include lunch and dinner together.
The hospital will use the follow-up process for patient care at home, a telemedicine program called “Covid Tracker”, developed by Mr. Phongchai Petsanghan, managing director and co-founder of the Precision Diet Co., Ltd., which is supported by a grant from the National Innovation Agency.
The patient will receive a thermometer and fingertip oxymeter for monitoring their symptoms in the process of home isolation. Then the patient will log in via Line official and send the information to the hospital.
“Patients will send body temperature and blood oxygen values twice a day at 9.00 and 15.00., the user interface of the program was designed to be easy to use. There is a box to tick the checkbox; for example, tick where you are now. The patients should turn on their GPS, and then we can track that there are actually at home. In addition, there can tick the box according to symptoms, such as has a fever, chest tightness, high body temperature, low heart rate, low blood oxygen, etc. ” said Mr. Phongchai Petsanghan
“When a patient ticks their own symptoms, the information will be sent to the hospital. Then the system will process and categorize the data; for example, if anyone ticks that the temperature exceeds the standard or has low blood oxygen. So the system will alert, allowing hospitals to monitor patients in large numbers because the system automatically processes and categorize fast,” said Dr. Saowaluk.
When the system alerts, the hospital staff will call back to ask about patient symptoms and may require a double check of their body temperature and the oxygen level. Then do sit-up exercises to see if the blood oxygen level has dropped. If it decreases, there is a body malfunction, which may be pneumonia. The hospital will send an emergency ambulance to pick up the patient and have a Fast Track to avoid mingling with other patients. If the patient needs to admit, a bed will be ready and prepared.
“We have been using this program since the first wave of the COVID-19 outbreak. However, when Home Isolation is involved, we have improved the features to be suitable and easy to use by first testing at the model hospital. Then Mr. Phongchai translated the lesson and took it to use in another hospitals for free. Mainly it was the Tele-monitoring system that helps manage the bed better.”
“If we can separate the green group patients, then the beds are enough for yellow and red groups. It makes patient care and bed management much better when managed in this way. In addition, none of the patients had moderate or severe symptoms sleeping at home as it appears on social media,” said Dr. Saowaluk.
At the same time, the primary care network will help make the community understandable. In the beginning, covid-19 patients who had home isolation were disgusted by the community. They were afraid that the infection would spread and infect them. Therefore, the Health Promoting Hospital went to talk to and pull the Local Administrative Organization to help take care of the community and make them understand.
In addition, in the next phase, the hospital plans to do Community Isolation for patients who do not live in a proper place. They will be taken to stay together in Community Isolation with the Sub-District Administrative Organization as the host, with the district taking care and linked to the hospital to do telemonitoring similar to Home Isolation.
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Read more at : https://www.thecoverage.info/news/content/1988
