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“Late one night， a pregnant woman who had been in cardiac arrest for more than 20 minutes came in，” recalls Guo Shubin. “We immediately began to perform the cesarean section operation while trying our best to save her. Even though her heart still wasn’t beating， and the newborn had no heartbeat either， we couldn’t give up. After another 20 minutes， the baby suddenly burst out crying， and the mother’s heart magically started beating again.”
Such breathtaking stories happen almost every day in the emergency department of Beijing Chaoyang Hospital. Guo Shubin， director of the emergency department， considers his division a world apart from other departments. “Dying people coming back to life and families devastated by the loss of one or more members are everyday scenes，”says Guo. “For many， this is the last hope to hang on to life.”
Leave No Patient Behind
Guo has been working as an emergency physician for quite some time. Before he transferred to Beijing Chaoyang Hospital in 2015， he had been working in the emergency department of Peking Union Medical College Hospital for 13 years， where he excelled in comprehensive departmental management and innovation. When he first arrived at Beijing Chaoyang Hospital， the department’s biggest problem in his mind was that emergency resources were being severely taken up by other departments.
“Emergency and non-emergency cases were often mixed together，”he explains. “As many as 30 percent or more of patients coming to the emergency department only needed simple treatment or were suffering from geriatric or chronic diseases. Those who really needed emergency treatment were often waiting in line.”
This phenomenon is not unique to Beijing Chaoyang Hospital. Compared to emergency systems in developed countries such as the United States and some European countries， the most prominent feature of emergency departments and even the entire medical system in China is the large population base. Statistics from China’s National Health Commission show that from January to November 2018， a total of 7.54 billion people received treatment in the country’s medical and health institutions， of which 2.76 billion were treated in public hospitals， accounting for 36 percent of the total patients treated. The volume of emergency patients exceeded 120 million as early as 2013.
In many countries， more than 90 percent of patients make their first visits to primary hospitals. However， the situation is different in China because Chinese people have an obvious preference for higher-level hospitals with bettertrained medical staff and more advanced equipment. Especially in big cities like Beijing， Class A hospitals like Beijing Chaoyang Hospital， the highest-ranked hospitals in China， are overcrowded throughout the year. Emergency department corridors filled with beds are a common scene.
Guo’s primary reform goal was to ensure emergency resources were truly allocated to patients with emergent and severe conditions or those stricken with difficult diseases. “We should never lose a patient who can be saved，” stresses Guo. To improve the efficiency of emergency treatment and resource allocation， Guo has been attaching importance to “regional”cooperation of medical resources， which means integrating resources throughout all levels of hospitals within the same area and improving the efficiency of medical referrals between hospitals at various levels based on different medical situations of patients. From May 2016， Guo began to work on the establishment of a joint out-of-hospital medical treatment system to transfer patients who were out of immediate danger but suffering from combined organic diseases or multi-system disorders. “Patients in the new system can receive medical treatment of the same quality at hospitals of the same levels， and the resources of the emergency department are no longer sapped，” explains Guo. Since the number of beds in the emergency department is limited， the vast majority must be saved for patients who need immediate and intensive care.
Another critical step for Guo’s reform was closed-off management for emergency rooms and observation rooms. In a small office， a doctor surrounded by a dozen patients and their families is quite a common scene in Chinese hospitals.“For doctors， this kind of situation is quite noisy and makes it hard to focus，” says Guo. “We closed off the emergency rooms and observation rooms to reduce distractions and interference during our work.”
Guo launched a grading diagnosis and treatment system in his department in February 2017. Patients were classified by international standards for different treatment. First- and second-grade patients in a life-threatening situation would receive active treatment in five minutes， and third- and fourth-grade patients would receive treatment within 15 minutes and two hours， respectively.
The improved process for emergency treatment not only released previously occupied medical resources， but also guaranteed the quality of rescue， improved clinical operations and environment and greatly enhanced medical， social and economic benefits.
Internet Plus Medicine
Guo often compares emergency physicians to “special forces” in the military. They must have quick reaction capabilities， wide-ranging medical skills and the ability to identify dangerous and even fatal symptoms immediately. They must be able to work under great pressure， handle complex matters and communicate effectively with patients and their families. Contrasting their foreign counterparts， Chinese doctors often participate in the entire process of rescuing patients， so their comprehensive skills are often better. Guo majored in gastroenterology from undergraduate to postdoctoral studies as a medical student. However， since graduation， he has been working as an emergency physician for nearly two decades. Because of his many years in the emergency department， Guo has developed a profound understanding of the general situation. Just as he launched the drive to reform his department， Beijing started its landmark reform to separate drug sales from medical treatment at public hospitals. A highlight of the municipal reform was using the medical reimbursement and medical service fees as leverage to divert patients to different levels of hospitals to increase the workload of community hospitals and other medical institutions at grassroots levels while freeing up higher-level hospitals to concentrate on treating difficult and complicated cases. By the end of 2017， less than a year after the reform was carried out in the capital， the volume of patients visiting Class A hospitals for emergency treatment fell by 12 percent.
Guo’s reform of Beijing Chaoyang Hospital’s emergency department conformed to the general trend of graded treatment and the establishment of medical unions in China.“The emergency department is the first place in a hospital to treat emergent and severe cases，” says Guo. “The current direction of China’s medical reform is to divert patients with common diseases to community hospitals and those with emergent， severe and serious illnesses to bigger and higher-level hospitals. So， although the total number of emergency cases in Class A hospitals has dropped， the volume of difficult and complicated cases as well as emergent and severe cases has increased.” Today， the emergency department of Beijing Chaoyang Hospital receives 260，000 patients every year， and the proportion of patients with emergent and severe diseases far exceeds that of many other hospitals.
Now in the emergency department of Beijing Chaoyang Hospital， guidance information for various medical services is clearly showed to all visitors entering the area from different entrances. The whole treatment procedure， from registration to check-up， is displayed at electronic screens. Doctors attending ward rounds carry mobile devices to receive triage information and no longer need to sort through thick stacks of paper medical records. All beds in emergency rooms and observation rooms are equipped with vital signs monitors. And a large liquid crystal display is installed in every emergency room to ensure that doctors can keep an eye on patients’ conditions and attend to them in time. At the end of 2018， the Chinese Academy of Medical Sciences issued a ranking of hospitals’ emergency medicine scientific and technological influence. The breadth and depth of hospitals’ scientific and technological activities were evaluated on three aspects： scientific and technological output， academic influence， and scientific and technological conditions. The emergency department of Beijing Chaoyang Hospital ranked second on the list， only behind West China Hospital of Sichuan University.
But Guo’s vision is even broader. Beginning in 2018， he promoted the establishment of a remote clinical diagnosis and treatment center in his hospital， with an aim to integrate thousands of hospitals in China into a system to share remote medical teaching and treatment processes. Against a backdrop of the fast development of both the internet and artificial intelligence in China， Guo hopes that more hospitals at grassroots levels can share experience with large hospitals to push the country’s medical system to become fairer.
Guo believes that in the near future， virtual reality devices or a pair of Google glasses could help young doctors at community hospitals in China watch professors and senior doctors from Beijing’s Class A hospitals attend ward rounds or discuss complicated cases in real time.
Science Popularization
Guo holds quite a few social titles alongside being director of the emergency department of Beijing Chaoyang Hospital. The titles he values most include member of the Science Popularization Committee under the Chinese Medical Association and head of the Medical Science Popularization Society under the Chinese Medical Doctor Association.
Guo recalls the scene when a senior patient with severe cerebral infarction was sent to the emergency department. The patient was still conscious when he arrived， but soon lost consciousness. His family couldn’t accept that his conditions worsened after he arrived at the hospital and accused the hospital of malpractice. A doctor-patient dispute was about to ensue.
“I came to the room， spent several minutes quickly analyzing the patient’s condition and explained the whole situation to his family，”recounts Guo. “Much of the general public doesn’t quite understand that plenty of conditions are not diseases as much as results of the irreversible aging process. When some people reach a certain age， some diseases may become unavoidable.” Guo thinks it important to provide ordinary people with as much medical science knowledge as possible to help avoid preventable diseases and ensure every condition is treated correctly. Such a trend would be greatly significant for the development of medical science popularization， which aligns with the future direction and strategy of China’s medical reform.
Two years ago， the Chinese Union for Medical Science Popularization was established thanks in part to Guo’s efforts. Guo was elected its chairman. Statistics released at the launch ceremony were thought-provoking： Compared to developed Western countries， the general public in China doesn’t have adequate knowledge of medical science. A 2015 survey by China Association for Science and Technology showed that only 6.2 percent of Chinese people were equipped with adequate scientific knowledge. People’s knowledge about health and capabilities to rescue others in emergencies were also insufficient.
“Statistics show that investing one dollar in medical science popularization generates an ‘income’ of seven dollars，” asserts Guo. “Investing more can also drop the incidence rates for some diseases. Patients equipped with enough medical knowledge will find the right help， reducing both their expenses and pain. All of society will benefit from medical science popularization.”
Guo often participates in the health programs hosted by well-known Chinese media， spreading health knowledge to the public and promoting social awareness on health and healthy lifestyles. He also promoted the Chinese Union for Medical Science Popularization to bring various organizations together， to inspire medical professionals to spread science knowledge and to work with mainstream Chinese social media platforms to build a large stage for health science popularization.
Guo believes there are three types of “good doctors.” The first possesses fine medical skills and saves abundant people. The second has strong management capabilities， so they save even more people by leading excellent medical teams. The third was born with a heart for public good. They employ various means to popularize medical knowledge， which could benefit the most people. To Guo， the third type is the charm and the top tier of medicine.
Such breathtaking stories happen almost every day in the emergency department of Beijing Chaoyang Hospital. Guo Shubin， director of the emergency department， considers his division a world apart from other departments. “Dying people coming back to life and families devastated by the loss of one or more members are everyday scenes，”says Guo. “For many， this is the last hope to hang on to life.”
Leave No Patient Behind
Guo has been working as an emergency physician for quite some time. Before he transferred to Beijing Chaoyang Hospital in 2015， he had been working in the emergency department of Peking Union Medical College Hospital for 13 years， where he excelled in comprehensive departmental management and innovation. When he first arrived at Beijing Chaoyang Hospital， the department’s biggest problem in his mind was that emergency resources were being severely taken up by other departments.
“Emergency and non-emergency cases were often mixed together，”he explains. “As many as 30 percent or more of patients coming to the emergency department only needed simple treatment or were suffering from geriatric or chronic diseases. Those who really needed emergency treatment were often waiting in line.”
This phenomenon is not unique to Beijing Chaoyang Hospital. Compared to emergency systems in developed countries such as the United States and some European countries， the most prominent feature of emergency departments and even the entire medical system in China is the large population base. Statistics from China’s National Health Commission show that from January to November 2018， a total of 7.54 billion people received treatment in the country’s medical and health institutions， of which 2.76 billion were treated in public hospitals， accounting for 36 percent of the total patients treated. The volume of emergency patients exceeded 120 million as early as 2013.
In many countries， more than 90 percent of patients make their first visits to primary hospitals. However， the situation is different in China because Chinese people have an obvious preference for higher-level hospitals with bettertrained medical staff and more advanced equipment. Especially in big cities like Beijing， Class A hospitals like Beijing Chaoyang Hospital， the highest-ranked hospitals in China， are overcrowded throughout the year. Emergency department corridors filled with beds are a common scene.
Guo’s primary reform goal was to ensure emergency resources were truly allocated to patients with emergent and severe conditions or those stricken with difficult diseases. “We should never lose a patient who can be saved，” stresses Guo. To improve the efficiency of emergency treatment and resource allocation， Guo has been attaching importance to “regional”cooperation of medical resources， which means integrating resources throughout all levels of hospitals within the same area and improving the efficiency of medical referrals between hospitals at various levels based on different medical situations of patients. From May 2016， Guo began to work on the establishment of a joint out-of-hospital medical treatment system to transfer patients who were out of immediate danger but suffering from combined organic diseases or multi-system disorders. “Patients in the new system can receive medical treatment of the same quality at hospitals of the same levels， and the resources of the emergency department are no longer sapped，” explains Guo. Since the number of beds in the emergency department is limited， the vast majority must be saved for patients who need immediate and intensive care.
Another critical step for Guo’s reform was closed-off management for emergency rooms and observation rooms. In a small office， a doctor surrounded by a dozen patients and their families is quite a common scene in Chinese hospitals.“For doctors， this kind of situation is quite noisy and makes it hard to focus，” says Guo. “We closed off the emergency rooms and observation rooms to reduce distractions and interference during our work.”
Guo launched a grading diagnosis and treatment system in his department in February 2017. Patients were classified by international standards for different treatment. First- and second-grade patients in a life-threatening situation would receive active treatment in five minutes， and third- and fourth-grade patients would receive treatment within 15 minutes and two hours， respectively.
The improved process for emergency treatment not only released previously occupied medical resources， but also guaranteed the quality of rescue， improved clinical operations and environment and greatly enhanced medical， social and economic benefits.
Internet Plus Medicine
Guo often compares emergency physicians to “special forces” in the military. They must have quick reaction capabilities， wide-ranging medical skills and the ability to identify dangerous and even fatal symptoms immediately. They must be able to work under great pressure， handle complex matters and communicate effectively with patients and their families. Contrasting their foreign counterparts， Chinese doctors often participate in the entire process of rescuing patients， so their comprehensive skills are often better. Guo majored in gastroenterology from undergraduate to postdoctoral studies as a medical student. However， since graduation， he has been working as an emergency physician for nearly two decades. Because of his many years in the emergency department， Guo has developed a profound understanding of the general situation. Just as he launched the drive to reform his department， Beijing started its landmark reform to separate drug sales from medical treatment at public hospitals. A highlight of the municipal reform was using the medical reimbursement and medical service fees as leverage to divert patients to different levels of hospitals to increase the workload of community hospitals and other medical institutions at grassroots levels while freeing up higher-level hospitals to concentrate on treating difficult and complicated cases. By the end of 2017， less than a year after the reform was carried out in the capital， the volume of patients visiting Class A hospitals for emergency treatment fell by 12 percent.
Guo’s reform of Beijing Chaoyang Hospital’s emergency department conformed to the general trend of graded treatment and the establishment of medical unions in China.“The emergency department is the first place in a hospital to treat emergent and severe cases，” says Guo. “The current direction of China’s medical reform is to divert patients with common diseases to community hospitals and those with emergent， severe and serious illnesses to bigger and higher-level hospitals. So， although the total number of emergency cases in Class A hospitals has dropped， the volume of difficult and complicated cases as well as emergent and severe cases has increased.” Today， the emergency department of Beijing Chaoyang Hospital receives 260，000 patients every year， and the proportion of patients with emergent and severe diseases far exceeds that of many other hospitals.
Now in the emergency department of Beijing Chaoyang Hospital， guidance information for various medical services is clearly showed to all visitors entering the area from different entrances. The whole treatment procedure， from registration to check-up， is displayed at electronic screens. Doctors attending ward rounds carry mobile devices to receive triage information and no longer need to sort through thick stacks of paper medical records. All beds in emergency rooms and observation rooms are equipped with vital signs monitors. And a large liquid crystal display is installed in every emergency room to ensure that doctors can keep an eye on patients’ conditions and attend to them in time. At the end of 2018， the Chinese Academy of Medical Sciences issued a ranking of hospitals’ emergency medicine scientific and technological influence. The breadth and depth of hospitals’ scientific and technological activities were evaluated on three aspects： scientific and technological output， academic influence， and scientific and technological conditions. The emergency department of Beijing Chaoyang Hospital ranked second on the list， only behind West China Hospital of Sichuan University.
But Guo’s vision is even broader. Beginning in 2018， he promoted the establishment of a remote clinical diagnosis and treatment center in his hospital， with an aim to integrate thousands of hospitals in China into a system to share remote medical teaching and treatment processes. Against a backdrop of the fast development of both the internet and artificial intelligence in China， Guo hopes that more hospitals at grassroots levels can share experience with large hospitals to push the country’s medical system to become fairer.
Guo believes that in the near future， virtual reality devices or a pair of Google glasses could help young doctors at community hospitals in China watch professors and senior doctors from Beijing’s Class A hospitals attend ward rounds or discuss complicated cases in real time.
Science Popularization
Guo holds quite a few social titles alongside being director of the emergency department of Beijing Chaoyang Hospital. The titles he values most include member of the Science Popularization Committee under the Chinese Medical Association and head of the Medical Science Popularization Society under the Chinese Medical Doctor Association.
Guo recalls the scene when a senior patient with severe cerebral infarction was sent to the emergency department. The patient was still conscious when he arrived， but soon lost consciousness. His family couldn’t accept that his conditions worsened after he arrived at the hospital and accused the hospital of malpractice. A doctor-patient dispute was about to ensue.
“I came to the room， spent several minutes quickly analyzing the patient’s condition and explained the whole situation to his family，”recounts Guo. “Much of the general public doesn’t quite understand that plenty of conditions are not diseases as much as results of the irreversible aging process. When some people reach a certain age， some diseases may become unavoidable.” Guo thinks it important to provide ordinary people with as much medical science knowledge as possible to help avoid preventable diseases and ensure every condition is treated correctly. Such a trend would be greatly significant for the development of medical science popularization， which aligns with the future direction and strategy of China’s medical reform.
Two years ago， the Chinese Union for Medical Science Popularization was established thanks in part to Guo’s efforts. Guo was elected its chairman. Statistics released at the launch ceremony were thought-provoking： Compared to developed Western countries， the general public in China doesn’t have adequate knowledge of medical science. A 2015 survey by China Association for Science and Technology showed that only 6.2 percent of Chinese people were equipped with adequate scientific knowledge. People’s knowledge about health and capabilities to rescue others in emergencies were also insufficient.
“Statistics show that investing one dollar in medical science popularization generates an ‘income’ of seven dollars，” asserts Guo. “Investing more can also drop the incidence rates for some diseases. Patients equipped with enough medical knowledge will find the right help， reducing both their expenses and pain. All of society will benefit from medical science popularization.”
Guo often participates in the health programs hosted by well-known Chinese media， spreading health knowledge to the public and promoting social awareness on health and healthy lifestyles. He also promoted the Chinese Union for Medical Science Popularization to bring various organizations together， to inspire medical professionals to spread science knowledge and to work with mainstream Chinese social media platforms to build a large stage for health science popularization.
Guo believes there are three types of “good doctors.” The first possesses fine medical skills and saves abundant people. The second has strong management capabilities， so they save even more people by leading excellent medical teams. The third was born with a heart for public good. They employ various means to popularize medical knowledge， which could benefit the most people. To Guo， the third type is the charm and the top tier of medicine.