The Toyota Regional Medical Center in Toyota City, Aichi Prefecture, operates an outpatient clinic specializing in COVID-19 fever using Nexstetho. Patients are asked to place the Nexstetho on their own chest under the direction of the doctor, and the doctor listens to the patient through headphones from a short distance away to make a diagnosis. The operation of the outpatient clinic specializing in COVID-19 fever, named the "Toyota Model," has given medical personnel a sense of security against infection, and has also revitalized teamwork in the hospital by tackling new challenges in difficult times.
We will also introduce how they are taking on new challenges by accumulating "kaizen" measures in response to the new coronavirus epidemic in the region.
How did you get started with infection control?
Since around March 2020, nosocomial infections have been reported in hospitals in Tokyo.
At our hospital, the "ICT Committee for New Coronavirus Countermeasures" was established in March.
The committee meets online twice a week to make decisions on internal and external matters. Discussions were divided into hospital-wide policies, wards, outpatient departments, home care, nursing department, rehabilitation department, radiology department, health checkups, and hospital administration.
Practical infection control
Medical personnel unexpectedly bring in, behavioral restrictions on staff, division into teams by occupation, dealing with staff anxiety (workshops and handouts)
In mid-April 2020, we will launch an outpatient clinic specializing in fever, where patients with fever or other medical conditions will be examined completely separately outside the hospital.
Outpatient Fever Ver.1
We discussed ways to examine patients with fever and other symptoms without bringing them into the hospital.
We borrowed a van from Toyota Motor Corporation and divided the interior of the van into two sections with plastic to use as an examination room.
Using the Nexstetho (wireless stethoscope) made by ShareMedical, Inc. we were able to complete the entire process from medical consultation to consultation in the car.
We had a policy of setting up outside the hospital and not letting patients with medical conditions into the hospital... (1) Prolonged COVID-19 epidemic was expected Cannot protect against heat, cold, wind, rain, insects, etc. (2) Privacy issues I don't want other people to know that I'm seeing a doctor. In addition to the above, there were some other issues that came up.
Outpatient Fever Ver.2
With the cooperation of Toyota Motor Corporation, we have completely bifurcated the flow lines in the hospital. Patients with symptoms from the entrance can go to the outpatient clinic through a different flow line.
The examination room for suspected COVID-19 patients was also designed so that patients and medical personnel can be completely separated to complete the interview and examination.
The acrylic partition greatly reduced the possibility of infection among medical personnel and the consumption of PPE(personal protective equipment).
The low likelihood of infection also helped to ensure the psychological safety of the medical staff.
Outpatient Fever Ver.3
In Toyota City, community-acquired infections have spread, and the prevalence and probability of prior testing have increased.
As it became necessary to perform more PCR tests, we improved the test so that it can be performed in the fever outpatient clinic without contact through the acrylic plate.
Effectiveness of Nexstetho
As mentioned earlier, it was not just about preventing infection, but also about ensuring the psychological safety of medical personnel!
It was also a great achievement to improve the teamwork of the entire hospital by having various professions inside and outside the hospital work together to tackle new challenges.
Application to online medical care
Nexstetho synapses make it possible to put the auscultation sound on the browser and listen at a greater distance!
Since remote diagnosis is possible, home medical care in mountainous areas and medical care in outer space will be possible with DtoPwithN!
Application to medical MaaS, etc.
A nurse can apply a Nexstetho to a patient in a home visit and listen to the patient remotely while viewing online.
Demonstrations are also underway for implementation in medical MaaS!
Conclusion
Nexstetho has played a variety of roles during the COVID-19 epidemic, and is expected to be used for home care in mountainous areas and for medical treatment at greater distances.
Toyota Regional Medical Center, Department of General Medicine Toyota City-Fujita Health University Community-based Medicine
Keita Kondo, M.D.