Doctor Stevanović wrote to the KS Government: How to organize healthcare in the fight against coronavirus

SARAJEVO, (Patria) - Prim.dr. Dragan Stevanović, who made himself available to the General Hospital "Prim.dr. Abdulah Nakaš" during the fight against coronavirus, sent an open letter to the Prime Minister of the KS Government, the KS Minister of Health, and the President of the KS Crisis Staff, outlining what needs to be done to more effectively fight and overcome the crisis caused by the coronavirus.

"Since I have no other official way to propose measures to you, based on my own knowledge and experience to date, and based on conversations with many colleagues, allow me to propose the adoption of several urgent measures for better organization of the health service in Sarajevo Canton.

The unimplemented decision, which has been applied for a long time in Sarajevo Canton regarding urgent patient admission on Mondays and Fridays at the General Hospital, and on other days at UKCS, MUST be immediately repealed.
Namely, in a health crisis situation, when only urgent (emergency) conditions are admitted, treated, and managed, both hospital institutions MUST manage such conditions every day at their level, in accordance with their capabilities. This solution reduces unnecessary crowds at hospital emergency centers, reduces patient transfers from hospital to hospital, and thus potentially reduces the spread of viral infection among healthcare users.

Triage of patients referred to hospitals is carried out in Primary Healthcare (Health Centers and Emergency Medical Services). Triage is performed by the most experienced doctor on duty at the institution, not by junior doctors.

Staff at triage centers in Primary Healthcare must have full protective equipment. The triager who refers patients for hospital treatment must have a written decision from the minister specifying which type of patient is admitted by which hospital institution.

Triagers must conduct an epidemiological survey and examination of the patient according to the survey questionnaire, fill it out, and classify patients upon issuing a referral as:

A) HIGHLY SUSPICIOUS OR HIGH-RISK FOR CORONA 19 INFECTION
B) POSSIBLE CORONA 19 INFECTION
C) LOW PROBABILITY OF CORONA 19 INFECTION
And they must indicate this classification on the referral.

According to the current orders of the Crisis Staff, hospitals would accept patients according to the following criteria:

UKCS

a) All patients who are clearly tertiary level – acute coronary syndrome, cardiac surgery, vascular surgery, neurosurgery, hematology, oncology, hemodialysis patients, thoracic surgery patients, polytrauma, and other tertiary and secondary B-level patients, regardless of Corona infection classification.

b) All other patients highly suspicious of Corona 19 infection, except for gynecological patients and children.

d) Children and gynecological patients with a low probability of Corona 19 infection.

General Hospital

a) Children and gynecological patients with a high or possible Corona 19 infection

b) All other patients at the secondary level of hospital care who have a low probability of Corona 19 infection.

Testing for Corona 19 in Sarajevo Canton should be carried out at three levels.

a) In a private laboratory (or several) by decision of the minister, upon the order of the epidemiological service to prevent the spread of the epidemic chain, as well as at the suggestion of the chief triagers of primary healthcare, in consultation with an epidemiologist when they are unsure of the risk group to which a patient belongs before referral to the hospital.

b) At the General Hospital, according to WHO criteria for patients referred for examination or admission to the hospital (an additional private laboratory can also be engaged for the needs of OBS)

c) At UKCS, according to WHO criteria, for patients referred there for treatment, for patients from other cantons who are unable to test, and for patients requiring retesting.

Task the KS Health Insurance Fund (if not already done) to ensure that electronic prescriptions for medications for chronic patients at contracted pharmacies are valid until the crisis is overcome, so that patients do not unnecessarily burden the healthcare system to pick up medications. Make a decision (if not already made) that the supply of the public healthcare sector and authorized testing laboratories with all necessary medical supplies is carried out through the crisis staff (an authorized wholesaler can be used with the approval of the crisis staff and distribution from the crisis staff by type and quantity). This also implies shortened procurement procedures.

Designate at least one private hospital in the Canton (I know of at least two locations that can serve as a reserve hospital for the Canton, and there are likely more), mobilize and physically protect it to prevent the introduction of Corona 19 infection, and keep it as a "clean" hospital in case of an incident of infection in clean areas of existing public hospitals, so that uninfected patients can receive safe emergency medical care.
Equip these hospitals now with equipment and necessary medical supplies, and assign medical teams from reserves not engaged in the public sector. These medical teams must be in self-isolation to protect them from potential infection.

Task the Medical Chamber of Sarajevo Canton to form telephone teams of retired doctors, doctors from the private sector, and unemployed doctors of all specialties for consultations with patients upon request for advice. Provide them with free phones through the operator. This will reduce the unnecessary telephone pressure on public sector institutions for consultations not directly related to Corona 19 infection.

Deeply aware of the fact that no healthcare system was prepared for this health crisis, including ours, that not all situations and possibilities can be foreseen in daily events, and that health authorities in our Canton are making superhuman efforts to keep the situation under control, I kindly ask you all to take these proposals or remarks in a completely well-intentioned and collegial manner, with the desire to utilize all resources with minimal loss of human lives.

I am at your disposal at any time," the letter from Prim.dr. Dragan Stevanović states.