One Year with the COVID-19 Pandemic - Lessons Learnt? Intersectoral Collaboration Measures Established during the Crisis Could Benefit Capacity and Patient Flow Management in Daily Clinical Practice

The COVID-19 pandemic has changed the way hospitals work. Some of the urgently established measures have proven to be so useful that they should be adopted in standard care. Recent research has assessed patient management, human resource planning and communication measures in terms of their impact and practicality for continuation in daily clinical practice. Strategies that were detached from the boundaries of departments and responsibilities in the COVID-19 pandemic and that have proven themselves under extreme conditions show a beneficial influence on patient flow and resource management as well as on the communication culture. The continuation of closer interdisciplinary and cross-sectoral cooperation in a “new clinical routine” could have a positive impact on personnel concepts, communication strategies, acute care capacities and the management of patient pathways.

Managing patient flows in radiation oncology during the COVID-19 pandemic

Purpose The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV‑2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. Patients and methods The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. Results Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV‑2 infection in 164 tested radiation oncology service inpatients was observed. Conclusion In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.