Orders regulating the work of the surgical department. Surgical activities of a nurse. Nurse Sequence
did not come into force Edition from 15.11.2012
| Name document | ORDER of the Ministry of Health of the Russian Federation of 15.11.2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO THE ADULT POPULATION UNDER THE" SURGERY "PROFILE |
| Document type | order, order, rules, standard |
| Host body | ministry of Health of the Russian Federation |
| Document Number | 922H |
| Date of adoption | 01.01.1970 |
| Revision date | 15.11.2012 |
| Registration number in the Ministry of Justice | 28161 |
| Date of registration with the Ministry of Justice | 17.04.2013 |
| Status | did not come into force |
| Publication |
|
| Navigator | Notes |
ORDER of the Ministry of Health of the Russian Federation of 15.11.2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO THE ADULT POPULATION UNDER THE" SURGERY "PROFILE
Appendix 7. RULES OF ORGANIZATION OF ACTIVITIES OF THE SURGICAL DEPARTMENT
1. These Rules establish the procedure for organizing the activities of the surgical department, which is a structural unit of a medical organization.
2. The surgical department of a medical organization (hereinafter - the Department) is created as structural subdivision medical organization.
3. The department is headed by a head who is appointed and dismissed by the head of the medical organization, which includes the department.
4. A specialist is appointed to the position of the head of the Department and a surgeon who meets the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of health care, approved by order of the Ministry of Health and social development Russian Federation dated July 7, 2009 N 415n, specialty "surgery".
5. The structure and staffing of the Department are approved by the head of the medical organization, in which the department is created, and are determined based on the volume of medical and diagnostic work and bed capacity, taking into account the recommended staffing standardsprovided by Appendix No. 8 to the Procedure for the provision of medical care to the population in the "surgery" profile, approved by this order.
6. The equipment of the Department is carried out in accordance with the equipment standard stipulated by Appendix No. 9 to the Procedure for providing medical care to the population in the "surgery" profile, approved by this order.
observation room;
doctors' office;
wards for patients, including single rooms (isolation wards);
operating or operating unit;
dressing room;
dressing room (for purulent wounds);
procedural;
dressing room (plaster);
manager's office.
Zakonbase: B electronic document paragraph numbering corresponds to the official source.
nursing;
senior office nurse;
a room for storing medical equipment;
The premises of the hostess sister;
pantry and handout;
dining room;
Room for collecting dirty linen;
shower and toilet for medical workers;
showers and toilets for the sick;
a room for sanitization;
sanitary room.
8. The main functions of the Branch are:
provision of specialized, including high-tech, medical care by performing operations using surgical (including microsurgical) methods based on standards of medical care;
preparation and carrying out of diagnostic procedures in stationary conditions;
Mastering and implementation in clinical practice modern methods diagnostics, treatment, rehabilitation and prevention of diseases and conditions requiring surgical treatment;
development and implementation of new medical technologies related to the treatment of patients with diseases in the "surgery" profile;
development and implementation of measures aimed at improving the quality of medical and diagnostic work in the department of surgery;
Rehabilitation of patients with diseases in the "surgery" profile in stationary conditions;
examination of temporary disability;
Provision of advisory assistance to medical specialists from other departments of a medical organization on the prevention, diagnosis and treatment of diseases and pathological conditions that require surgical treatment;
maintenance of accounting and reporting documentation, provision in the prescribed manner of reports on the activities of the Branch, the maintenance of which is provided for by the legislation of the Russian Federation
9. To ensure its activities, the Department uses the capabilities of the medical, diagnostic and auxiliary units of the medical organization, which includes the Department.
10. The department can be used as a clinical base for medical educational organizations secondary, higher and additional vocational education, as well as scientific organizations.
Appendix N 8
to the Procedure for the provision of medical
assistance to the adult population by profile
"surgery" approved by order
Ministry of Health
Russian Federation
dated November 15, 2012 N 922н
The following medical documentation is kept in the surgical department of the polyclinic:
Outpatient card (form No. 025 / U and form No. 025 / U-04);
Research referral forms;
Patient register;
Hospital referral log;
Operation log;
Dispensary Patient Journal;
Trauma and tetanus vaccination log;
Register of blood directions for HBs-antigen and Wasserman reaction;
AIDS referral register;
Register of infectious post-injection complications;
Dressing room quartzing journal;
Operating room quartzing log;
Quality control log for pre-sterilization processing of instrumentation;
Autoclave operation control log;
Dry heat cabinet operation control log.
There are a lot of documents, but they are all necessary. In case of careless filling out or not keeping records of this or that type of activity, complications may develop in patients, violations of the order of work in the clinic and hospital. We have already discussed the importance of filling out the patient's outpatient card. Once again, it must be emphasized that this map is maintained throughout the life of each patient of the clinic. It includes all types of examination and treatment of the patient, all identified lifetime diagnoses. This is the main legal document outpatient. All types of examinations are carried out on its analysis. Hence the importance correct design diagnosis of the patient, determination of the timing of temporary disability. It should be emphasized that the doctor of the polyclinic can issue a sick leave personally for up to 30 days, then the patient, if necessary, is sent to the control expert commission.
Research referral forms must be typed. If the medical institution, due to economic reasons, cannot do this, then they must be handwritten in advance. This will save time on patient care.
A patient register is necessary to compile a register of the provision of medical care, which is compiled monthly and sent to insurance companies... Salary medical worker polyclinics directly depends on the volume and quality of treatment of patients. There were cases when wages were reduced to employees of certain polyclinic offices due to the small number of patients being treated.
The hospital referral log is divided into two headings: emergency referrals and planned patients. Once again, it should be emphasized that emergency patients in a polyclinic may not be fully examined. At the same time, all planned patients are subject to laboratory, radiological and ultrasound examinations to reduce the length of hospital stay before surgery.
The transaction log should be clearly completed. Each operation protocol describes the nature of the intervention, the complications present.
The register of dispensary patients should show the dynamics of the treatment of registered patients. It should reflect the timing of follow-up examinations, the treatment measures taken and their effectiveness.
The register of trauma and tetanus vaccinations is filled out individually for each patient. It is very important to reflect in it the volume of tetanus vaccinations, the need for revaccination.
The registers of registration of blood directions for HBs-antigen, AIDS and syphilis are kept to identify the incidence of the population, to prevent infection of others and medical personnel. It is advisable that all patients treated by the surgeon undergo these additional studies.
A register of post-injection complications is necessary to identify iatrogenic diseases and to carry out anti-epidemic measures in those medical institutions where a non-sterile injection was made. Each disease is reported to the epidemiological service.
Logs of quartzing the dressing room, operating room, control of the autoclave, dry-heat cabinet, the quality of pre-sterilization processing of instruments are necessary to comply with the basic rules of asepsis and antiseptics, to prevent the development of hospital infections.
medical history and management,
assignment sheets,
log,
operational log;
registration logs for narcotic and potent drugs (Regulated by the order of the Ministry of Health of the Russian Federation dated November 12, 1997 No. 330 "On measures to improve the accounting, prescription and use of narcotic drugs");
abnormal service documentation (alphabetical log, analysis log, prescription selection log, etc.)
Organization of the dressing room
In any surgical department, it is necessary to deploy two dressings: "clean" and "purulent", placing them as isolated as possible from each other, from wards and from service units. In the departments specialized in the treatment of patients with proctological diseases, anaerobic infections and other diseases associated with massive infection of the environment with highly pathogenic microorganisms, it is advisable to deploy a third dressing room for these groups of patients. Dressings in each of these dressings should be done first in "cleaner" patients, then in "more purulent" patients. In the last turn, patients with putrefactive processes, intestinal fistulas, anaerobic infection are bandaged. This principle of operation ensures the longest possible preservation of asepsis in the dressing conditions and prevents cross-infection between patients.
Instruments and sterile dressing material in the dressing room are stored on a "sterile table" located in the place farthest from the entrance door and dressing tables. The "sterile table" is to be closed at least once every 6 hours. The dressing nurse treats her hands and puts on a sterile gown as in preparation for an operation, covers the table with two layers of sterile sheets, puts sterile instruments and dressings on it, and covers it with two layers of sterile sheets. The edges of the sheet are fixed with special linen clamps, for which you can lift the top sheet without touching it and the contents of the table. An oilcloth label is attached to one of these clamps, which indicates the date and time of the last overlapping of the table and the signature of the honey. the sister who produced it. Instruments and dressings are supplied from the “sterile table” by the dressing nurse with a sterile instrument (usually a forceps is used), which is stored separately in 6% hydrogen peroxide or on the “sterile table” itself, in the corner, on a specially laid diaper or oilcloth.
Currently, dressing rooms are additionally equipped with UV germicidal chambers for storing sterile medical instruments. (The Ultra-light camera is designed to store instruments for 7 days).
The dressing room staff wear removable gowns, hats, 4-layer gauze masks, and disinfected (non-sterile) rubber gloves. In recent years, due to the increase in the incidence of viral hepatitis and HIV, the use of protective glasses or face shields is recommended. Before performing dressings, staff wash their hands under a tap with soap and then put on gloves. In this case, the hands do not become sterile, therefore, manipulations in the wound are performed only with instruments. Between individual dressings, gloved hands are washed under a tap with soap. If the gloves come in contact with blood or wound fluid, they must be replaced. Gloves are disinfected immediately after use in accordance with OST 42-21-2-85. If it is necessary to perform hand manipulations, they are prepared as before the operation, and sterile gloves are put on.
The dressing room should have two washbasins (sinks): “for hands” and “for gloves”. Three labeled towels should be hung next to each one, which are changed every day: "for doctors", "for a nurse", "for a nurse." This is due to the fact that due to the work responsibilities of the junior honey. personnel are usually more contaminated than the hands of nurses and doctors, and the requirements for cleanliness of the hands of a dressing nurse are the highest. In the "purulent" dressing room, they additionally put on oilcloth aprons, which the nurse wipes with a 3% chloramine solution after each dressing.
The doctor performing the dressing should not approach the “sterile table”. Instruments and dressings are supplied only by the dressing nurse. The doctor takes it from the nurse's forceps without touching the latter. The used dressing is collected in trays disinfected for 1 hour in a 3% chloramine solution and placed in a closed container (bucket with a lid), where it is filled with a chloramine solution to a concentration of 6%, taking into account the volume of the dressing for 1 hour.
In the dressing room:
preliminary cleaning is carried out before the start of the working day: horizontal surfaces are wiped with a disinfectant solution to collect dust that has settled overnight;
cleaning after each dressing: the surface of the dressing table and the floor around it are treated with a disinfectant solution;
daily final wet cleaning using a disinfectant solution, which is used to treat equipment, floors and walls to the height of human growth;
general cleaning is carried out once a week, during which the entire inventory and the room, including the ceiling, are washed using detergents and a 3% chloramine solution.
All dressings should be equipped with powerful (150-300 W) ultraviolet lamps, which should be treated for at least 2 hours a day. It is advisable to leave the UV lamps on during all non-working hours.
ORGANIZATION OF STATIONARY MEDICAL ASSISTANCE TO THE POPULATION
PERSPECTIVE OF STATE MINIMUM SOCIAL STANDARDS IN HEALTHCARE AND BUDGETARY FINANCING STANDARDS FOR HEALTHCARE PER RESIDENT
MAIN TYPES OF INPATIENT CARE SERVICES PROVIDED BY GOVERNMENT HEALTHCARE FOR FREE
TERRITORIAL PROGRAM OF STATE GUARANTEES FOR THE PROVISION OF HEALTHCARE SERVICES FOR CITIZENS
STRUCTURE AND FUNCTIONS OF THE CITY HOSPITAL
HOSPITAL PLANNING AND FINANCING
TYPES AND SCOPE OF PAID MEDICAL SERVICES
MAIN ORDERS REGULATING THE OPERATIONS OF THE HOSPITAL
STRUCTURE, FUNCTIONS, DOCUMENTATION OF RECEPTION REST. PROCEDURE FOR REFERRING PATIENTS TO HOSPITALIZATION. RECEPTION AND DISCHARGE OF PATIENTS
MAIN DEPARTMENTS OF THE SURGICAL PROFILE, THEIR ROLE IN THE TREATMENT AND DIAGNOSTIC PROCESS OF THE HOSPITAL
DESCRIPTION OF THE SURGICAL DEPARTMENT. NUMBER OF BEDS IN THE DEPARTMENT, CHAMBERS, EQUIPMENT OF THE DEPARTMENT. ISOLATION OF "CLEAN" AND "PURULENT" OFFICES
ORGANIZATION AND WORKING CONDITIONS OF DOCTORS AND MEDICAL PERSONNEL
NUMBER OF ACTUALLY WORKING DOCTORS, THEIR QUALIFICATION. NUMBER OF BETS PROVIDED BY THE STAFF-ORGANIZATIONAL STRUCTURE OF THE DEPARTMENT
FUNCTIONS OF THE DEPARTMENT HEAD AND DOCTOR-ORDINATOR
MEDICAL ETHICS AND MEDICAL DEONTOLOGY IN THE ACTIVITIES OF THE ORDINATOR DOCTOR ..
MANAGEMENT FUNCTION OF THE DEPARTMENT HEAD
ORGANIZATION OF CONSULTATIONS, CONSILIUMS, CLINICAL, CLINICAL, PATHOLOGO-ANATOMIC CONFERENCES, TRAINING WITH DOCTORS, SECONDARY HEALTH CARS ON ADVANCED QUALIFICATIONS
FUNCTIONS OF HEADS AND NURSES OF THE DEPARTMENT
ACTIVITIES OF THE CHAMBER NURSE ON PERFORMANCE OF DOCTOR'S APPOINTMENTS AND CONTROL OF COMPLIANCE WITH SANITARY-HYGIENIC, ANTI-EPIDEMIC AND MEDICAL-SECURITY REGIME IN THE HOSPITAL
1.21. RESPONSIBILITIES OF THE ATTENDANT DOCTOR, HEAD OF DEPARTMENT, DEPUTY HEAD DOCTOR IN ORGANIZATION OF WORK ON EXPERTISE OF TEMPORARY DISABILITY
1.22. DOCUMENTS REGULATING THE PROCEDURE FOR ISSUING THE DISABILITY SHEETS AND CERTIFICATES OF TEMPORARY DISABILITY
1.23. SANITARY CONDITION OF THE DEPARTMENT, MEASURES FOR PREVENTION AND CONTROL OF INTRAHOSPITAL INFECTION
1.24. PROCEDURE FOR PROVIDING MEDICAL CARE TO TRAUMATOLOGICAL PATIENTS
ORGANIZATION OF PATIENT CARE, DAY MODE
1.25. ORGANIZATION OF PATIENT CARE. DAILY REGIME.
1.26. OBSERVANCE OF MEDICAL AND PROTECTIVE REGIME
1.27. ORGANIZATION OF MEDICAL NUTRITION OF PATIENTS
1.28. HEALTH AND HYGIENE TRAINING OF THE POPULATION AND THE FORMATION OF A HEALTHY LIFESTYLE
1.29. CONTINUITY IN THE OPERATIONS OF THE HOSPITAL WITH THE POLYCLINIC AND OTHER HEALTHCARE ORGANIZATIONS
1.30. ACCOUNTING AND REPORTING DOCUMENTATION OF THE STATIONARY
1.31. BASIC ACCOUNTING AND REPORTING DOCUMENTS USED FOR STUDYING DIFFERENT KINDS OF DISEASE
1.32. DAY STATIONARY
1.33. ASSESSMENT OF THE QUALITY OF MEDICAL CARE PROVIDED TO THE POPULATION BY STRUCTURAL UNITS AND THE HOSPITAL AS A WHOLE
1.34. QUALITY STANDARDS (TIME PROTOCOLS) FOR DIAGNOSTIC AND TREATMENT OF PATIENTS
1.36. ORGANIZATION OF WORK AND FUNCTIONS OF THE MEDICAL CONSULTING COMMISSION (VKK) ON MATTERS OF MEDICAL REHABILITATION AND EXPERTISE OF EMPLOYMENT
1.37. STRUCTURE, FUNCTIONS, ORGANIZATION OF WORK OF MEDEC. PROCEDURE FOR REFERRING PATIENTS TO MREK
2. INDICATORS OF PERFORMANCE AND DEFECTS CHARACTERIZING THE PERFORMANCE OF THE SURGERY DEPARTMENT OF THE INPATIENT IN 2009 AND 2010
2.1. EVALUATION OF HOSPITAL PERFORMANCE
2.2. MODEL OF THE FINAL RESULTS OF THE SURGERY DEPARTMENT FOR 2009-2010
2.3. COMPARATIVE ANALYSIS OF THE SURGICAL DEPARTMENT FOR 2009-2010
2.4. FINDINGS
2.5. GENERALIZED CHARACTERISTIC OF THE DEPARTMENT OPERATION
2.6. OFFERS
LIST OF USED LITERATURE
GENERAL INFORMATION ABOUT THE HOSPITAL AND PUBLIC HEALTH INDICATORS.
ORGANIZATION OF STATIONARY MEDICAL ASSISTANCE TO THE POPULATION
Inpatient assistance - the most important type of therapeutic and prophylactic care for the population, which is provided for the most severe forms of diseases that require constant medical supervision. Inpatient care is provided in inpatient departments of hospitals, specialized hospitals, special dispensaries.
The main principles of medical care for the population are:
Availability of medical care and pharmaceutical support
Preventive health care.
Priority medical and drug support for children and mothers
Controllability professional activity medical professionals
State responsibility authorities, management and employers for the health of citizens.
Equal opportunity enterprise development, health care institutions and organizations, regardless of departmental affiliation and forms of ownership. The economic interest of individuals and legal entities in the preservation and strengthening of the health of citizens.
Public and citizen participation in health protection.
A hospital is a medical and prophylactic institution that provides the population with inpatient medical care, and in the case of a combination with a polyclinic, and outpatient care. The most appropriate structural form is a hospital combined with a polyclinic. In regional (regional, republican) and central district hospitals, the polyclinic is an obligatory structural unit; this unit may not be available in city hospitals. In accordance with the nomenclature of health care institutions, a number of hospitals are intended to provide medical care mainly to the rural population - regional (territorial, republican), central district and district, as well as precinct. Rendering inpatient care the children's population is carried out in children's city, regional (regional, republican), district hospitals, as well as in children's departments of central district hospitals; obstetrics - in maternity hospitals (maternity hospital) and departments. By profile, multidisciplinary and specialized hospitals are distinguished. Hospitals are part of dispensaries (see. Dispensary), as well as medical and sanitary units (Medical and sanitary unit). Hospitals, the bed capacity of which is at least 50% used by medical universities for teaching or medical research institutes for scientific purposes, are called clinical.
The main task of hospitals is to provide medical care in cases where treatment or complex diagnostic tests is impossible in an outpatient setting; if recovery or improvement of the patient's condition can be achieved faster in a hospital than with outpatient treatment; if the patient's stay at home poses a threat to others (with a number of infectious and venereal diseases, some types of mental disorders, etc.)
In order to better provide the population of rural areas with specialized inpatient and outpatient-polyclinic care, inter-district specialized departments are organized in large CRHs, which also provide organizational, methodological and advisory assistance to medical workers of medical and preventive institutions in the attached areas, improve their skills, develop specific measures to improve the relevant types of specialized medical care.
The district hospital is designed to provide medical care to the rural population in the main fields (therapy, surgery, pediatrics, obstetrics, infectious diseases) and is usually organized on the central farmsteads of collective and state farms. The capacity and structure of local hospitals are different and depend on the size of the population, the radius of service, the presence of industrial enterprises and agro-industrial complexes, the characteristics of settlement, transport links, etc.
Providing inpatient care for the rural population requires clear interaction and continuity in the work of district, central district and regional hospitals. One of the most important principles for the implementation of this provision is phasing: patients who need complex examination methods, surgical and conservative treatment are sent to regional hospitals, as well as to inter-district specialized departments of the Central District Hospital.
Specialized hospitals include infectious diseases and children's infectious diseases, psychiatric, neuropsychiatric and narcological, ophthalmological, traumatological, tuberculosis, etc., as well as hospitals of specialized dispensaries (dermatovenerologic, anti-tuberculosis, neuropsychiatric, cardiological, narcological, endocrinological). Such hospitals are being created for the population of the entire region (region, republic), city.
The Rehabilitation Hospital is intended for patients with the consequences of injuries, neurosurgical interventions, orthopedic and neurological diseases requiring a complex of rehabilitation measures. As part of rehabilitation hospitals, mainly highly specialized departments of neurological and orthopedic-traumatological profile are organized. The neurological departments hospitalize patients with the consequences of cerebral circulation disorders, head injuries and surgical interventions on the brain, diseases and injuries of the spinal cord, with diseases of the peripheral nervous system. Patients with the consequences of injuries and diseases of the musculoskeletal system, as well as with diseases and consequences of spinal injuries without dysfunctions of the spinal cord, are sent to the orthopedic and trauma departments. In addition, cardiological, gastroenterological, pulmonary and other departments for medical rehabilitation are being established in a number of rehabilitation hospitals, as well as multidisciplinary hospitals.
An ambulance hospital is a complex medical and prophylactic institution designed to provide round-the-clock emergency medical care to the population in the hospital and at the prehospital stage in case of acute diseases, injuries, accidents and poisoning. The main tasks of emergency medical care in the service area are to provide emergency medical care to patients with life-threatening conditions requiring resuscitation and intensive therapy; implementation of organizational, methodological and advisory assistance to medical institutions on the organization of emergency medical care; constant readiness to work in emergency conditions (mass inflows of victims); ensuring continuity and interconnection with all medical and preventive institutions of the city in the provision of emergency medical care to patients at the pre-hospital and hospital stages; analysis of the quality of emergency medical care and assessment of the effectiveness of the hospital and its structural units; analysis of the population's need for emergency medical care. Such hospitals are organized in large cities with a population of at least 300 thousand inhabitants, their capacity is at least 500 beds. The main structural divisions of the emergency hospital are a hospital with specialized clinical and diagnostic departments and offices; ambulance station; organizational and methodological department with an office of medical statistics. On the basis of emergency medical care, city (regional, regional, republican) centers of emergency specialized medical care can function. With her, a consultative and diagnostic remote center for electrocardiography is organized for the timely diagnosis of acute heart diseases.
A hospital of any type is managed by the chief physician, who is appointed and dismissed by a higher health authority or may be elected by a collective meeting. The chief physician has deputies for the medical part, for outpatient work (if there is a polyclinic in the hospital), for the examination of the working capacity, and for the economy. The chief physician manages the hospital on the basis of one-man management, together with his deputies, he is responsible for the organization, level and quality of the treatment and diagnostic process in the institution in accordance with modern requirements science and practice, is responsible for the state of the material and technical base and compliance with sanitary and anti-epidemic requirements, provides advanced training for all hospital personnel, using for this purpose advanced training institutes for doctors, advanced training faculties and the in-hospital system of classes, medical and nursing conferences.
The main structural unit of the hospital is a department headed by the head, who is appointed and dismissed by order of the head physician. The head of the department directly supervises the work of the residents and, through the head nurse of the department, the work of the nursing staff. The department consists of 30-70 or more beds, they use all the medical and diagnostic services of the hospital in their activities.
PERSPECTIVE OF STATE MINIMUM SOCIAL STANDARDS IN THE FIELD OF HEALTHCARE AND BUDGETARY FINANCING STANDARDS FOR HEALTHCARE PER RESIDENT
One of the distinctive features of the Belarusian health care model is the formed system of social standards, which is one of the most important changes that have taken place in the past 5 years.
The system of state social standards determines the minimum level of guarantees for residents of Belarus in all socially significant areas, including healthcare. In other words, this is the level against which it is unacceptable to reduce the volume and quality of services to the population. Legal basis for the implementation of social standards, the Law of the Republic of Belarus "On State Minimum Social Standards" became.
The minimum social standards in the field of health care are determined by the Law of the Republic of Belarus. These include:
The standard of provision of primary care doctors
Bed capacity in hospitals with round-the-clock stay
Pharmacy provision rate
The standard of provision with ambulance teams.
On the initiative of the Ministry of Health of the Republic of Belarus by the Resolution of the Council of Ministers of the Republic of Belarus dated June 20, 2007 No. No. 811 "On amendments and additions to the resolution of the Council of Ministers of the Republic of Belarus dated May 30, 2003. No. 724 "the list of social standards in the field of healthcare has been expanded:
The standard of sanitary and technical provision of health care organizations;
Availability rate vehicle (for outpatient clinics, nursing hospitals, district hospitals);
Additional standard for agro-towns (presence of a pharmacy organization).
State minimum social standards in the field of Health:
The norm of budgetary provision of health care expenditures per inhabitant;
The standard for the provision of doctors (1 district therapist for 1700 residents, a pediatrician for 800 residents, 1 general practitioner for 1200 residents);
Hospital bed provision rate (9 beds per 1000 inhabitants);
Pharmacy provision rate (1 pharmacy per 8000 inhabitants);
The standard for the provision of ambulance teams (1 team per 12,000 residents);
Vehicle availability standard (for outpatient clinics and nursing hospitals - 1 vehicle unit, for district hospitals - 2 vehicles);
The standard of sanitary and technical provision of rural health organizations (running water supply, domestic sewerage, water heating system, supply and exhaust ventilation).
The value of the norm of budgetary financing of expenses for the provision of medical care to one resident of the region (hereinafter - the norm of budgetary financing) is determined taking into account the justified need of the population of the region in medical care and reflects the amount of funds for reimbursement of material and equivalent costs for the provision of medical care per one resident area.
Minimum Social Standards in Healthcare 2010:
|
NORMATIVE |
PERFORMANCE |
|
Healthcare costs per 1 inhabitant 549 129 rubles |
Healthcare costs per 1 inhabitant 552 336 rubles |
|
1 local therapist per 1700 residents Pediatrician for 800 residents 1 general practitioner per 1200 inhabitants |
1 local therapist per 1650 inhabitants 1 pediatrician per 715 inhabitants 1 general practitioner per 1,173 inhabitants |
|
9 beds per 1000 inhabitants |
10.2 beds per 1000 inhabitants |
|
1 pharmacy per 8000 inhabitants |
1 pharmacy for 5688 inhabitants |
|
1 SIP brigade per 12,000 inhabitants |
1 SMP brigade per 11252 inhabitants |
Budget funding standards are calculated for each type of medical care specified in the Territorial Program. The sum of the standards for budget financing for all types of medical care specified in the Territorial Program is the average regional standard for budgetary financing of health care costs per one inhabitant of the region.
MAIN TYPES OF INPATENT CARE SERVICES PROVIDED BY STATE HEALTHCARE ORGANIZATIONS FREE OF CHARGE
Types of medical care provided to the population at the expense of budget funds
Citizens of the Republic of Belarus are guaranteed at the expense of state budget funds:
1.primary health care:
2.diagnostics and prescription of treatment carried out by district doctors (therapists, pediatricians, obstetricians-gynecologists and others) and general practitioners on an outpatient basis, as well as at home in cases of impossibility of the patient's appearance at an appointment or posing a threat to the health and life of the patient himself or others ;
3.services of specialist doctors, provided in accordance with the established procedure in the direction of district doctors or general practitioners in healthcare organizations, including regional and republican levels;
4.diagnostic services - clinical, instrumental and laboratory methods research, methods of radiation diagnostics in the direction of district doctors, general practitioners and medical specialists;
5. prevention, diagnosis and treatment of dental diseases, with the exception of types of dental services related to paid services in accordance with the law;
6. Preventive measures against cancer, congenital malformations, HIV / AIDS infection, diseases of the mammary glands and thyroid gland, tuberculosis, diseases of the cardiovascular system, as well as the formation of a healthy lifestyle;
7. anti-epidemic measures: vaccination, carried out in accordance with the National Calendar of Preventive Vaccinations and according to epidemic indications, as well as the identification, registration and treatment of post-vaccination reactions and complications; identification of patients with infectious diseases and notification of bodies and institutions of state sanitary supervision; preventive measures in the focus of infection;
clinical and laboratory examination of persons who were in contact with a patient with an infectious disease or who arrived from countries unfavorable for epidemically dangerous diseases; preventive measures to ensure the sanitary and epidemiological well-being of the population, including state sanitary supervision over the implementation of sanitary legislation by individuals and legal entities;
8. laboratory support of ongoing surveillance and anti-epidemic activities;
9. primary medical examination by a narcologist, narcological control, narcological registration and observation;
10. primary psychiatric examination, dispensary observation, diagnosis and treatment of psychotic forms of mental disorders, military psychiatric examination, medical and labor examination;
11. referral to hospitalization in the presence of medical indications in accordance with the standards, criteria and procedure for hospitalization determined by the Ministry of Health of the Republic of Belarus;
12. Emergency medical care provided for the following indications:
1.internal and external bleeding, life-threatening;
2.Emergency conditions in cardiology - myocardial infarction, unstable angina pectoris, cardiac asthma, pulmonary edema, cardiogenic shock, cardiac arrhythmia (atrial fibrillation and flutter, first-onset or tachystolic forms; paroxysmal tachycardia; ventricular fibrillation, heart block or syncope conditions), acute vascular insufficiency, pulmonary embolism, infective endocarditis, rheumatic diseases (intensive care), hypertensive crises, suspected dissecting aortic aneurysm;
3. pulmonary diseases - attacks of bronchial asthma, spontaneous pneumothorax, other diseases and conditions accompanied by symptoms of acute respiratory failure;
5.acute diseases of the genitourinary system - acute pyelonephritis, acute glomerulonephritis, acute paranephritis, paraphimosis, priapism, volvulus and hydatid, acute diseases of the testicle and its appendages of infectious etiology, acute renal failure, chronic renal failure in the stage of decompensation, acute renal colic retention of urine;
6. Emergency conditions due to endocrine pathology - hypoglycemic and hyperglycemic coma, addison crisis, thyrotoxic crisis, hypothyroid coma;
7. damage to the nervous system - acute hemo- and liquorodynamic cerebral disorders, hemorrhagic stroke, ischemic stroke, subarachnoid hemorrhage, myasthenia gravis, convulsive conditions;
8. blood diseases (leukemia, aplastic anemia, myelodysplastic syndromes, hemophilia and other hereditary hemostasiopathies, idiopathic thrombocytopenic purpura, hemolytic anemias);
9. mental disorders of a citizen, which
determine:
immediate danger to him and (or) others;
his helplessness, that is, the inability to meet basic life needs;
significant harm to his health due to the deterioration of his mental state, if he is left without psychiatric help;
10.injuries - acute craniocerebral and cerebrospinal, spine, dislocations and subluxations, fractures of bones, joints, muscle trauma, traumatic shock, burn disease, compression syndrome, electrical trauma, mechanical asphyxia, heatstroke, sunstroke, hypothermia in violation vital functions, drowning, injuries and ruptures of the parenchymal and hollow organs of the abdominal and chest cavity, retroperitoneal space, pelvis, neurovascular bundles; wounds, emergency prevention of wound infection;
11. dental diseases - acute conditions (abscess, phlegmon, acute toothache);
12. acute diseases and eye injuries, including the ingress of foreign bodies;
13. acute diseases of the ear, throat, nose, life-threatening, including the ingress of foreign bodies;
14. acute poisoning;
15.Puulent-inflammatory diseases of all localizations,
requiring urgent intervention;
16. acute conditions associated with pregnancy, childbirth;
17. Emergency conditions in gynecology - ectopic pregnancy, pelvioperitonitis, peritonitis, uterine bleeding, acute conditions associated with ischemia and necrosis of fibromatous nodes, ovarian apoplexy, rupture and torsion of ovarian cysts;
18.other emergency conditions - thrombosis and embolism of the main and peripheral arteries, disorders of water-electrolyte metabolism and acid-base state that threaten the patient's life, anaphylactic shock, frostbite, acute allergic reactions, asphyxia, precoma and coma of various etiologies, acute and chronic adrenal insufficiency, acute liver failure, hyperthermic reactions
of various etiologies with the threat of disruption of vital functions, acute infectious diseases associated with a threat to the patient's life and (or) a threat to the health and life of others;
13.inpatient care:
1. to women in labor, postpartum women, women with pregnancy pathology;
2. children under 18 years of age with diseases;
3.patients with acute and exacerbations of chronic diseases, if there are indications for hospitalization (round the clock, day stay), according to the directions in accordance with the criteria and procedure for hospitalization;
4. tuberculosis, cancer patients, patients with benign tumors, patients suffering from mental illness, alcoholism, substance abuse and drug addiction, in cases that pose a threat to the patient's life and (or) a threat to the health and life of others, patients with infectious and venereal diseases;
5. patients who are subject to planned surgical interventions, if there are indications for hospitalization;
14. other types of medical care provided by the Child's homes, the medical and rehabilitation expert commission service, the blood transfusion station, the pathological anatomical bureaus and other regional health organizations;
15. other activities in the field of health care: maintenance of a medical supply base, centralized accounting at health care authorities and organizations;
16.Privileged provision of medicines and medical products, including dressings, technical means social rehabilitation (hearing aids, eye prostheses, manufacturing and repair of dentures).
17. Benefits for drug provision and prosthetics selected categories citizens are determined by the current legislation of the Republic of Belarus.
18. In the provision of emergency and inpatient medical care, including in day hospitals, home hospitals, children's sanatoriums and other health care organizations supported by the budget, free drug assistance is provided in accordance with the current legislation of the Republic of Belarus.
The norms and standards of drug provision in public health organizations are determined by the list of essential medicines, as well as protocols for examination and treatment of patients, approved by the Ministry of Health of the Republic of Belarus.
19. Other types of medical care not included in the Territorial Program are provided to the population of the region on a paid basis in accordance with the Resolution of the Cabinet of Ministers of the Republic of Belarus of August 27, 1996 No. 566 "On Paid Types of Medical Assistance and Services Provided in State Healthcare Institutions" (Collection of decrees of the President and resolutions of the Cabinet of Ministers of the Republic of Belarus, 1996, No. 25, article 653).
Conditions for the provision of medical care to the population at the expense of the budget:
The following conditions for the provision of medical care at the expense of the budget have been determined for the population:
1.in outpatient clinics:
Securing citizens to an institution at the place of residence or at the place of temporary residence;
Establishment of the scope of diagnostic, therapeutic and rehabilitation measures for a particular patient by the attending physician;
Referral of patients to hospitalization in accordance with clinical indications requiring adherence to the hospital regimen, active therapeutic measures and round-the-clock medical supervision;
Absence of food in day hospitals and provision of patients with medicines within the list of essential medicines approved by the Ministry of Health of the Republic of Belarus;
2.in stationary institutions:
Hospitalization in accordance with clinical indications in the healthcare organization at the place of attachment;
Planned hospitalization according to the queue;
Possible accommodation of patients in wards for 4 or more beds;
Providing patients with medicines within the list of essential medicines approved by the Ministry of Health of the Republic of Belarus;
Provision of patients, women in labor and postpartum women with medical nutrition in accordance with the allocations provided for the specified purposes in the budget;
Providing the opportunity for one of the parents or another family member, at the discretion of the parents, to be with the sick child;
Providing food and bed for a person caring for a hospitalized infant, as well as for a child under 3 years of age if there is a medical indication for care.
Every resident of the region has the right to receive medical assistance in any health care organization and from any private health care worker at his discretion on a paid basis at the expense of personal funds or funds of individuals and legal entities.
Volumes free medical care:
The volume of free medical care provided to the population of the region by state healthcare organizations is determined based on the resolution of the Council of Ministers of the Republic of Belarus dated July 18, 2002 No. 963 "On state minimum social standards in the field of healthcare", taking into account the actual volume of medical care per one inhabitant ...
The size of the budgetary funding standard is determined taking into account the justified norms and standards of the regional population's need for medical care and reflects the amount of funds for reimbursing material and equivalent costs for the provision of medical care per one inhabitant of the region.
The territorial program establishes the following standards for the volume of free medical care:
1. outpatient and polyclinic care.
Indicators of the volume of outpatient care are expressed in the number planned per one inhabitant:
Outpatient clinic visits; home visits by doctors; days of treatment; treated patients (hospitalization rate); average duration (number of days) of patient treatment in day hospitals.
The standard of visits to outpatient clinics is 11.6 visits per year.
The standard of home visits to patients by doctors is 0.72.
Day hospitals:
the standard of treatment days is 0.52;
standard of treated patients (hospitalization rate) - 0.075;
the average duration of a patient's treatment is 7 days;
2. inpatient medical care.
Indicators of the volume of inpatient care for patients for treatment in hospitals with round-the-clock stay is expressed in the number of planned per inhabitant: bed-days; treated patients (hospitalization rate); the average duration (number of days) of the patient's treatment.
Bed-days standard - 3.125.
The rate of treated patients (hospitalization rate) is 25% of the region's population.
The average duration of a patient's treatment is 12.5 days.
3. first aid.
The indicator of the volume of ambulance services is expressed in the number of calls to ambulance teams per inhabitant.
The standard for calling ambulance teams is 0.33.
Officials and heads of local executive and administrative bodies, as well as state healthcare organizations for non-compliance with the standards of budgetary provision of healthcare costs per capita and the volume of medical care provided to the population of the region at the expense of the budget, as well as for the deterioration of the established level of state minimum social standards in the field of health care and misuse of allocated budget funds for their provision are responsible in accordance with applicable law.
TERRITORIAL PROGRAM OF STATE GUARANTEES FOR THE PROVISION OF HEALTHCARE SERVICES FOR CITIZENS
The territorial program was developed in accordance with the resolution of the Council of Ministers of the Republic of Belarus dated August 10, 2000 No. 1225 "On improving the health financing mechanism" (National Register of Legal Acts of the Republic of Belarus, 2000, No. 80, 5/3802), Resolution of the Council of Ministers of the Republic Belarus of October 21, 2002 No. 1452 "On the progress of the implementation of the Resolution of the Council of Ministers of the Republic of Belarus of August 10, 2000 No. 1225" (National Register of Legal Acts of the Republic of Belarus, 2002, No. 120, 5/11330) and the Resolution of the Council of Ministers Of the Republic of Belarus of July 18, 2002 No. 963 "On the State Minimum Social Standards in the Field of Health Care" (National Register of Legal Acts of the Republic of Belarus, 2002, No. 84, 5/10825).
The territorial program determines the types, volumes and conditions for the provision of medical and drug assistance to the population of the region in accordance with the appropriations provided for in the budget for these purposes.
The territorial program is based on the principles of the Law of the Republic of Belarus of November 11, 1999 "On State Minimum Social Standards" (National Register of Legal Acts of the Republic of Belarus, 1999, No. 89, 2/97) and ensures the implementation of the constitutional rights of citizens in the field of social guarantees ...
The basis of the Territorial Program is the volume of medical and pharmaceutical assistance guaranteed by the state, which provides for the provision of quantitatively regulated medical assistance for the prevention, diagnosis and treatment of diseases, as well as medical and social assistance provided by regional health organizations.
On the basis of the state minimum social standards in the field of health care in the cities and districts of the region, city and district territorial programs of medical care for the population are developed and approved in the prescribed manner, the volume of medical care provided, which cannot be less than the volume established by the regional program.
The volumes and conditions for the provision of medical care provided for by the Territorial Program are minimal and can be expanded by local executive and administrative bodies, subject to the availability of financial resources of local budgets.
Objectives of the development of the Territorial Program:
1.Creation of a unified mechanism for the implementation of the constitutional rights of the population of the region to receive free treatment in public health organizations at the expense of the budget;
2. Ensuring a balance of the state's obligations to provide citizens with a guaranteed volume and quality of free medical care and the budget funds allocated for this;
3. increasing the efficiency of the use of available health care resources.
Territorial programs are developed annually by health authorities within the time frame established for the development of a draft budget and are approved by local executive and administrative bodies within 2 weeks after the approval of local budgets. Control over the quality, volume and compliance with the conditions for the provision of medical care within the framework of the Territorial Program is carried out by the Health Protection Department of the Minsk Regional Executive Committee.
STRUCTURE AND FUNCTIONS OF THE CITY HOSPITAL
A city hospital is a complex medical and prophylactic institution that provides inpatient care to the population of the entire city or part of it.
Regardless of the profile of the bed fund, the structure of a modern city hospital, as a rule, includes the following subdivisions: an admission department, in which there should be an isolation ward, diagnostic beds and an intensive care unit are possible; department of intensive care and resuscitation: department for patients' stay; diagnostic units, including the X-ray department (office), departments of functional diagnostics, endoscopy, ultrasound diagnostics; pathological department; laboratories (clinical, biochemical, bacteriological, immunological, serological, radioimmunoassay, etc.); medical units - an operating unit, departments of physiotherapy and physiotherapy exercises, radiation therapy, hyperbaric oxygenation, hemodialysis and hemosorption; pharmacy, centralized sterilization; blood transfusion department and other departments. The presence of one or another of these units depends on the functions and capacity of a particular hospital, the degree of centralization of diagnostic and treatment services in the city (district).
The profiling of beds in hospitals is established by the higher health authority to ensure that the needs of the population for inpatient care are met. Depending on the tasks solved by a particular hospital, the size of the population served and its need for different types medical aid structural divisions of the hospital can have different capacities. So, in emergency hospitals, a large intensive care unit and intensive care unit, a sufficient number of planned and emergency operating rooms, and a unit for express diagnostics are needed. In hospitals for rehabilitation treatment that widely use non-drug treatment methods, in addition to departments of physiotherapy and physiotherapy exercises, rooms for mechanotherapy, social and professional rehabilitation (Rehabilitation), a water and mud baths, a swimming pool should be provided.
The main functions of the city hospital are to provide highly qualified specialized medical and preventive care to the population; preferential provision of medical assistance to workers in construction, industry and transport, adolescents employed in industry and the system of secondary vocational education; introduction into practice of modern methods of prevention, diagnosis and treatment of patients based on the achievements of science and technology, as well as advanced experience in the work of medical institutions; development and improvement of organizational forms and methods of medical care and patient care; hygienic education of the population and promotion of a healthy lifestyle; wide involvement of the public in the development and implementation of measures aimed at improving medical and preventive care for the population. The city children's non-infectious hospital performs similar functions in relation to the child population (up to the age of 14 years inclusive).
Emergency medical aid hospital - a hospital designed exclusively for the provision of emergency inpatient and out-of-hospital care; has an ambulance and emergency station.
CITY CLINICAL HOSPITAL OF EMERGENCY CARE OF THE CITY OF Grodno is a multidisciplinary specialized institution of the city for the provision of round-the-clock emergency medical care to the population in case of acute diseases, injuries, accidents, poisoning, as well as mass injuries, catastrophes, natural disasters.
The hospital is deployed with 578 beds, an ambulance station consisting of 3 substations and 3 emergency rooms.
The hospital has 14 main departments, namely: surgical, neurosurgical, 1st 2nd and 3rd traumatology, pediatric traumatology, urological, gynecological, pregnancy pathology department, obstetric physiological and observational departments, burns, newborn observational, physiotherapy; as well as departments: blood transfusion, detoxification, hyperbaric oxygenation, laboratory diagnostics, trauma center, magnetic resonance imaging, computed tomography, X-ray, functional diagnostics department. The hospital also has 3 beds for the provision of surgical care by vascular surgeons.
The structure of the GKB SMP includes the following divisions:
Administrative and management department: accounting, planning and economic department, personnel sector, sector of automated control systems, engineering and technical department
General hospital department: organizational and methodical office, accounting and medical statistics office, admission department
The hospital has 14 main departments, namely: surgical, neurosurgical, 1st 2nd and 3rd traumatology, pediatric traumatology, urology, gynecology, pregnancy pathology department, obstetric physiological and observational departments, burns, newborn observational; the hospital also has 3 beds for the provision of surgical care by vascular surgeons.
Auxiliary medical and diagnostic units: departments of blood transfusion, detoxification, hyperbaric oxygenation, clinical diagnostic laboratory, express laboratory, laboratory of clinical biochemistry, trauma center, magnetic resonance imaging, computed tomography, X-ray, functional diagnostics department, physiotherapy department, psychotherapist's office, centralized sterilization room, pharmacy.
Maintenance department: catering unit, medical archive, warehouse.
The main functions performed by UZ "GKB SMP of Grodno":
1. Provision of first, emergency medical care to patients with acute and sudden illnesses, injuries, poisoning and other accidents.
2. Providing qualified medical advice to residents of Grodno and the Grodno region within their competence.
3. Diagnostics, treatment of patients with traumatological, orthopedic (adults and children) profiles.
4. Surgical care, emergency and planned.
5. Rehabilitation of patients: physiotherapy, physiotherapy exercises.
6. Computer and magnetic resonance imaging.
7. Diagnostics, treatment of gynecological patients.
8. Obstetrics in departments: physiological, observational, pregnancy pathology.
9. Activities to improve the qualifications of employees.
10. Combustiology.
The hospital has modern diagnostic equipment: devices for ultrasound, MRI, CT, endoscopes, laparoscopes, arthroscopes, microscopes for neuro- and vascular surgery. The hospital also has 1-, 2-, 3- and 4-bed wards. Chambers of UVOV and persons equated to them - 9 chambers \u003d 12 beds in a hospital. All wards are equipped with plumbing and also have a connection with the post of the department.
As a rule, patients are admitted to the hospital by referrals from outpatient clinics, polyclinics, dispensaries and other medical facilities at the level of primary health care, and they are urgently delivered and sent by an ambulance. The concentration of many types of urgent surgery in one medical facility allows for its profiling and equipping the department with modern diagnostic and therapeutic equipment. After performing complex surgical interventions, further treatment of patients is carried out in intensive care units. In extremely difficult situations, specialists from the medical aviation departments can come to the aid of doctors. For the implementation of this assistance, the leading specialists of the republic are involved and a special ground sanitary transport is used.
Therapeutic and diagnostic capabilities of the department: CT, MRI, ultrasound, FGDS, colonoscopy, clinical diagnostic laboratory and department, X-ray department, laparoscopy.
THE CITY CLINICAL HOSPITAL OF EMERGENCY CARE OF THE CITY OF GRODNO is deployed for 578 beds.Currently, the ambulance service of the city of Grodno serves up to 130 thousand calls per year. More than 19 thousand people receive treatment in the emergency hospital per year, who undergo over 9 thousand operations. The trauma center provides about 100 thousand visits per year. Around the clock assistance to residents of Grodno and adjacent areas is provided by 29 teams, of which: 3 teams of intensive care, 3 - cardiological and 4 - pediatric care. At any time of the day or night, they are ready to provide timely qualified medical assistance
The direct treatment of patients is carried out by resident doctors, the main elements of whose work are keeping a history of the disease, diagnostics and treatment, examination of working capacity, rehabilitation and rehabilitation treatment, consultations, consultations. On the basis of the hospital, the departments of the Grodno State Medical University are deployed: faculty surgery with a course of urology, traumatology and orthopedics, neurosurgery, obstetrics and gynecology, resuscitation and anesthesiology, clinical biochemistry. There are up to 20 - 25 patients per resident. Among the medical records kept by hospital residents, the main ones are "Card of an inpatient (medical history)", "Patient registration sheet", "card of a patient who left the hospital", "Certificate of incapacity for work", various registers, etc.
The specificity of the organization of the surgical service of the emergency hospital is the need to provide assistance to a number of patients for emergency or vital indications. In the emergency room there are teams of surgeons on duty, anesthesiologists and operating unit personnel. For a more complete examination of patients, clinical and X-ray laboratory assistants, endoscopists and doctors of ultrasound diagnostics are involved on duty. If necessary, doctors of almost all specialties can participate in consultations.
Staff standards for medical personnel of inpatient institutions and their departments.
The number of beds per 1 medical position at the clinical hospital level:
grown-up children
Obstetric 15 ---
Department for newborns
Observational --- 15
Physiological --- 20
Gynecological 20 ---
Vascular Surgery 12 ---
Traumatological 20 20
Urological 20 20
Surgical (purulent surgery) 20 20
Microsurgical 14 ---
Neurosurgical 15 15
Burn 12 12
Orthopedic 20 20
Toxicological 5 ---
HOSPITAL PLANNING AND FINANCING
Healthcare belongs to the sphere of intangible services. Implementation of modern management and planning principles is especially difficult in healthcare. This is due to the complexity of the infrastructure, the variety of types of institutions, profiles of hospital beds and specialization, the subordination of health care institutions to bodies of different levels of government (republican, city, district, departmental).
Financial and material support of the industry is carried out according to the leftover principle. Health care is not always in the field of vision of the governing bodies of the republic. But even the resources allocated to health care are not used rationally enough due to the lack of a well-functioning management mechanism. Planning turned out to be especially neglected - the main link, the core of industry management. Extensive indicators act as planning boundaries: the number of beds, visits, etc. There are practically no qualitative indicators reflecting the efficiency of resource use. Planning is carried out only within the framework of the national economic and territorial plans. There is no long-term sectoral plan, sectoral plans for design and survey work, capital construction. The mechanisms of economic management of the industry need to be improved: prices, resource allocation, paid services, financing norms, wages, material incentives, etc.
One of the main disadvantages of planning is that for a long time planning was based not on the real needs of the population for specific types of medical care, the need for medical institutions to use certain resources, equipment, but on indirect indicators such as the number of beds, positions of visits, the capacity of the existing networks, etc.
The goal of health planning is to develop a strategy for managing the industry based on in-depth and comprehensive analysis and measures to ensure the optimal use of all resources to achieve better satisfaction of the needs of the population for health care.
In modern conditions, in the transition to financing of the health care system per inhabitant, the planning orientation should be directed not at the available resources necessary for maintaining a health care institution, but at financing the provision of certain volumes of medical care.
Planning tasks at the present stage:
to ensure a decrease in the unit cost of medical care;
optimize the structure and placement of the network of healthcare institutions;
provide health care institutions with a real economic tool that allows them to make competent management decisions;
contribute to the development of a rational economic mechanism in the industry;
to promote the spread of progressive forms of medical care;
ensure scientific and technological progress.
The general planning scheme can be presented as follows:
determination of the main goals and functions of health care facilities (inpatient, outpatient and polyclinic, consultative or medical, specialization, etc.);
determination of the types and volumes of medical care, the provision of which leads to the achievement of the goal;
formation of a network of health care facilities;
determining the need for resources;
calculation of estimated incoming funds;
adjustment of planned indicators;
determination of indicators that most accurately characterize the degree of achievement of goals.
The regulatory framework should be based on data:
the age structure of the population (a factor that determines the incidence rate of the population);
the level of morbidity, depending on environmental, socio-economic and other conditions;
the level of appealability associated with morbidity, territorial remoteness, established traditions of treatment, etc .;
real and anticipated flows of patients to health care facilities and other institutions;
resettlement of residents and its impact on the implementation of the need for medical care;
financial costs of treatment in other health care facilities (comparative characteristics).
When forming a promising network of healthcare institutions, the following principles should be observed:
optimality (the network of health care institutions should ensure full and equal accessibility of medical care to residents at the minimum time);
unity of regulatory support for the needs of urban and rural residents in health care;
combination of territorial and program-targeted planning in the formation of the network structure;
consistency, i.e. functional and organizational unity of all health care facilities of the territory providing medical care to urban and rural residents;
grading (hierarchical subordination) in the organization of medical care, taking into account the systems of population settlement;
stages (sequence) of medical care, depending on the nature and complexity of the disease;
territorial approximation of specialized medical care by creating inter-district and zonal centers;
compliance of the capacity and structure of health care institutions with the size of the population served.
The capacity and structure of certain types of health care institutions must be linked to the size of the population served based on the system of planning and organizational restrictions by introducing the concept of a functional medical unit (FLE). In order to exclude small inpatient departments in the hospital or inadequate in terms of load, receptions in polyclinics, the minimum capacity of various types of institutions is established, which determines their expedient structure. First of all, this concerns the main structural and functional elements - the minimum capacity of the hospital department and the scope of activities of a medical position.
Planning for hospital care and bed use
A hospital bed is one of the main indicators of health care resources. At present, the bulk of budget funds is spent on the development and maintenance of a network of stationary institutions.
When drawing up a plan for the structure of a network of inpatient institutions, it is necessary to proceed from the standards of the need for bed capacity and the number of the served population in various settlement systems.
To determine the service area of \u200b\u200bany specialized department of the hospital by the number of population in thousands, taking into account their rational load, the formula is used
N is the minimum population size at which a department of a given minimum capacity can be opened (a full-fledged functional medical unit);
M is the minimum allowable size of a functional medical unit (number of beds in the department);
F - differentiated prospective standard of need (number of beds per 1000 population).
The number of beds per planned population can be calculated using the formula
K \u003d FxH / 1000, where
K is the number of hospital beds;
H - population of the city (district).
The main economic indicators that characterize the use of bed resources include:
T p is the average bed downtime;
P is the average length of stay of the patient on the bed;
B - the number of patients treated.
It is recommended to use the following indicators as a standard of useful employment (use) of a bed per year for the purposes of territorial planning: 340-345 days of employment of a bed per year in urban hospitals and 310-320 - in rural ones. Hence, the scheduled downtime is 20-25 and 50-55 days, respectively. This time is necessary for the discharge of the patient from the hospital, admission of a new one and compliance with the sanitary and epidemiological regime in the hospital departments.
Under the planned function (turnover) of a hospital bed, it is customary to consider the number of patients that can be served by the bed during the year given the estimated amount of use (occupancy) of the bed per year and the average length of stay of the patient in the bed. The planning function is calculated using the following formula
F - turnover (function) of the hospital bed;
D is the average duration of bed use per year;
P is the average length of stay of the patient in bed (in days).
Average bed downtime for organizational reasons can be determined by the formula
T n \u003d (365-D) / F, where
T p - the average downtime of one bed;
D is the average number of days of bed use per year;
F is the turnover of the hospital bed.
For the optimal rate of bed downtime (with each change of patient), for other reasons, it is rational to take 1 day (for the therapeutic and surgical profile of beds), for gynecological 0.5, infectious for adults, anti-tuberculosis for adults and maternity 2 days, infectious for children 3 days ...
The maximum duration of possible occupancy of the bed can be calculated using the formula
D \u003d 365- (T p / F)
The optimal indicator of the average number of days of bed occupancy per year for a given hospital, taking into account the loss of bed-days due to repairs and for organizational reasons, can be calculated using the formula
D \u003d 365-T p - (T p / F), where
bed downtime associated with bed repairs in the year T р \u003d possible number of bed-days losses in the planned year due to repairs / average annual number of beds.
Determining the need for beds:
Taking into account the level of hospitalization of the population, the indicator of the population's need for beds can be calculated using the formula
K \u003d [H x Y x P / D] x 100, where
N - population size;
Y - level (volume of hospitalization) (%);
P is the average number of patients staying in bed;
D is the average length of bed use per year.
The need for beds, taking into account the number of patients treated and the planned bed turnover, is found by the formula
K \u003d M / F, where
K is the number of beds;
M is the number of patients treated;
F is the turnover of the hospital bed.
The need for beds, taking into account the number of bed-days spent and the number of days of use of the bed per year, is determined by the formula
K \u003d (M x P) / D \u003d K d / P, where
K is the number of beds;
M is the number of hospitalized (treated) patients (actual);
Р - the planned number of days of stay of the patient on the bed;
K d - the number of bed-days spent;
D is the average duration of use (occupancy) of the bed per year.
In this way, the number of beds is determined based on the number of patients treated. This calculation is reasonable when the financing of patients is based on the number of patients treated.
Planning of staff positions for hospital workers
The planning of posts in the hospital is carried out mainly on the basis of staffing standards. Besides, you can use the methods of rationing. The time spent on one patient every day is determined based on the timing.
The workload of a medical position in a hospital - the number of patients whom a medical position can serve during the day is determined by the formula
N b \u003d (B x K) / T, where
N b - the number of patients per day per one medical position;
IN - work time a doctor;
K is the coefficient of using the doctor's working time for direct patient care per day;
T is the average time spent per patient per day.
The coefficient of using the doctor's working time for direct patient care per day is calculated based on the daily costs of 0.5 hours for other purposes (conferences, health education, emergency classes, etc.)
The doctor's position is calculated by the formula
N k \u003d (N b x 365) / D, where
N k - the standard of the doctor's position (the number of beds per position);
D is the average bed occupancy per year.
The number of patients treated is determined by the formula
N \u003d (N b x F x B h) / (B h + q), where
N is the standard of the doctor's position, expressed in the number of patients treated;
N b - the number of patients served per day for one position;
F - hospital bed turnover;
B h - the annual budget of the working time of the position (in hours);
q - vacation (in hours).
Determination of the number of positions required to ensure round-the-clock work (duty) of medical personnel during the entire calendar year is made according to the formula:
D n \u003d (M / N) x (k / G), where
D n - the required number of posts for round-the-clock work;
M is the capacity of the department (number of beds);
N is the value of the indicator according to the standard standards (load in beds per position);
k is the number of hours in a calendar year (8760 hours at 365 days a year);
Г - the annual budget of the working time of the position (in hours).
FINANCING THE HOSPITAL.
Financing of hospital institutions is carried out depending on their subordination from the budget of the district, region, republic. The heads of healthcare institutions have the right to independently approve the cost estimate within the allocated appropriations for the current maintenance and make changes to it, with the exception of costs for wages, food and medicines.
Most of the money spent on hospitals is spent on wages, meals for patients, medicines, dressings, reagents and X-ray films. The wage fund is calculated based on the staffing table approved by the chief doctor of the hospital, in accordance with the established tariff rates and the terms of remuneration of health workers. The chief doctors of medical institutions have the right to increase the size wages up to 30%, depending on the intensity and quality of health workers' work within the allocated wage fund, as well as introduce brigade forms of organization and remuneration. Also, the financial standards for the purchase of equipment, transport, hard and soft inventory are significantly increasing.
The main planning document that determines the total volume, target direction and quarterly distribution of funds allocated for the maintenance of the hospital is its cost estimate approved in the prescribed manner.
The cost estimate of the hospital is drawn up for a calendar year in accordance with the standard form established by the Ministry of Finance of the republic and reflects all hospital costs, including costs for the hospital and other structural units.
The estimate may include only expenses that are necessary due to the nature of the activities of the organization.
The appropriations provided for in the estimate must be justified by calculations for individual types of expenses for each budget item.
Calculations for the estimate are made by the hospital based on performance indicators (the number of beds, the number of staff positions, the number of outpatient visits, etc.) and in accordance with the current legislation in terms of spending funds for the payment of wages, as well as in compliance with the established norms of expenses for certain types of expenses (food, purchase of medicines and dressings funds and purchase of soft inventory), current prices and tariffs.
In the calculations for the estimate, general information is provided on the cubic capacity of buildings by external dimensions, the internal area of \u200b\u200bbuildings, the heating system, the availability of water supply and sewerage, which are used in planning the volume of costs for household expenses and major repairs.
The hospital's cost estimate is approved by the head of the institution (or deputy head).
For hospitals that are on the republican or local budgets, the estimate is approved within the time frame established for the presentation of the quarterly distribution of income and expenses of the corresponding budget.
The estimate is approved in two copies, one of which remains in the hospital, and the second is sent to a higher organization.
When considering and approving a hospital budget, the lawfulness and correctness of the costs included in the estimate must be carefully checked.
Key metrics for determining hospital spending
The hospital provides medical care to the population in two forms:
inpatient - hospitalization of patients; outpatient-polyclinic - providing medical care to a patient in a polyclinic (outpatient clinic) or at home.
One of the main indicators of a hospital that determines the cost of a hospital estimate is the bed capacity, and of an outpatient department - the number of doctor's posts and visits.
The unit of account for determining the cost of maintaining hospitals is the bed and staffing, polyclinic departments - the doctor's position.
When drawing up a hospital estimate, it is important to correctly determine the number of beds at the beginning of the planning period, based on their actual availability at the last reporting date and taking into account the possibility of deploying beds in the remaining period of time until the end of the year, within the number of beds provided for in the plan.
The increase in the number of beds in the planned year (the increase in beds) is determined by the higher health authority when forming the estimate, based on the need and the possibility of their placement and in accordance with the indicators of the state plan for economic and social development.
When planning the hospital bed capacity, it is necessary to take into account the efficiency of using the existing bed stock.
To determine the cost of maintaining the hospital, the average annual number of beds is calculated, which is set depending on the timing of the deployment of new beds, by adding to the rolling number of beds at the beginning of the planned year their average annual growth.
To calculate the cost of food for patients and the purchase of medicines, it is necessary to establish the number of days of functioning of one bed per year and, on the basis of this, the total number of bed-days in the hospital by multiplying the average annual number of beds by the number of days of functioning of one bed per year.
The number of days of functioning of one bed per year for each profile of beds is different and should be determined taking into account the statistical reporting data of the action plan for the effective use of the bed fund.
When determining the number of days of functioning of one bed in a year, it is necessary to take into account the possibility of increasing the number of days of using beds due to their better distribution among specialized departments, as well as reducing the time for overhaul of the organization, disinfection and other reasons.
Beds temporarily closed due to disinfection, overhaul or quarantine are considered to be actually deployed.
Additional beds are not included in the number of active beds, but the number of days during which these beds were occupied by patients is included in the indicator "Number of bed days".
The number of bed-days spent by mothers with sick children in intensive care units is not included in the total number of bed-days in the hospital, but is shown separately.
Main items, sub-items and expense items:
Current:
Purchase of goods and payment for services:
Salaries of workers and employees,
Payroll,
Purchase of supplies and consumables
Business trips and business trips
Payment for transport services,
Communication service fee,
Payment of utility services,
Other operating expenses,
Subsidies and current transfers .
Capital:
Purchase of equipment and durable goods,
Overhaul,
Acquisition of land and intangible assets.
TYPES AND SCOPE OF PAID MEDICAL SERVICES.
The list of paid medical, maintenance services carried out in the UZ "GKBSMP, Grodno
for citizens of the Republic of Belarus:
Services list:
1 Medical support for recreational, sports competitions, mass cultural and social events
2 Clinical diagnostic laboratory
3 X-ray examinations
4 Functional diagnostics
5 Endoscopic examinations
6 Ultrasound diagnostics
7 X-ray computed tomography
8 Performing massage procedures with mechanical action by hand
9 Magnetic resonance imaging
10 Obstetric and gynecological services
11 Physiotherapy procedures
12 Consultations of specialist doctors, including employees of departments with categories, academic degrees, scientific titles
13 Treatment of alcohol withdrawal syndrome (medication)
14 Certification of drivers for admission to work (cashless payment)
15 Session of hyperbaric oxygenation (HBO) (per patient)
16 Transportation of a patient not requiring medical assistance
For foreign citizens:
1 Clinical and diagnostic laboratory for foreign citizens
2 X-ray examinations for foreign citizens
3 Functional diagnostics for foreign citizens
4 Endoscopic examinations for foreign citizens
5 Ultrasound diagnostics for foreign citizens
6 X-ray computed tomography for foreign citizens
7 Performing massage procedures by mechanical action with hands for foreign citizens
8 Magnetic resonance imaging for foreign citizens
9 Urology for foreign citizens
10 Surgical procedures for foreign citizens
11 Consultations of specialist doctors, including employees of departments with categories, academic degrees, scientific titles
12 Provision of emergency medical care to foreign citizens
13 Inpatient stay for foreign citizens
14 Session of hyperbaric oxygenation (HBO) (per patient) for foreign citizens
15 General Manipulation for Foreign Citizens
Price lists for carrying out diagnostic instrumental measures can be found in the GKB SMP in Grodno.
Paid medical services are additional to the volume of free medical care guaranteed by the state and are provided by state health organizations, as well as unitary enterprises created by the relevant state bodies in accordance with agreements on paid medical services concluded with individuals or legal entities (hereinafter referred to as the customer) in writing (hereinafter - agreement), with the exception of paid medical services provided anonymously.
Public health organizations can provide paid medical services also in specially created offices, departments functioning at the expense of extra-budgetary funds.
Paid medical services are carried out by state health organizations that have a special permit (license) for the relevant type of activity.
The procedure for concluding contracts in public health organizations.
A person wishing to receive a paid medical service gets acquainted with the procedure for the provision of paid medical services, a list of paid medical services, their cost, conditions for the provision, receipt and payment of these services, qualifications of specialists, benefits for certain categories of citizens, the mode of operation of the state health organization, which are communicated in the form of poster, booklet and other information.
An individual wishing to receive a paid medical service applies to the state health organization with a written application.
In the contract concluded by the state healthcare organization and the customer - natural person, except for the case specified in part one of this clause, or by the customer - legal entity, the volume of paid medical services, the conditions and terms of their receipt, the procedure for settlements, the rights, obligations and responsibilities of the parties are determined.
Public health organizations are obliged to:
Ensure that the paid medical services provided to the customer comply with the requirements established by law; keep statistical records of rendered paid medical services and submit information on time to the Ministry of Statistics and Analysis; issue to the customer a document confirming the acceptance of cash in accordance with the legislation of the Republic of Belarus; ensure timely consideration of claims from the customer; to monitor the quality of the provision of paid medical services within the official duties of responsible persons of state health organizations.
The customer of paid medical services is obliged:
Pay the cost of paid medical services in a timely manner;
Provide the necessary data on the state of health;
Follow the rules internal regulations in the state healthcare organization;
Timely inform the state healthcare organization about the circumstances that may affect the execution of the contract;
Perform other obligations stipulated by the contract.
The customer has the right:
Require the presentation of a special permit (license);
Submit claims for compensation for real damage caused by non-fulfillment or improper fulfillment of the terms of the agreement, compensation for damage in case of harm to life or health, compensation for causing moral damage in accordance with the legislation of the Republic of Belarus;
In case of non-compliance by the state healthcare organization with the obligation on the timing of the performance of paid medical services of its choice (unless otherwise stipulated in the contract), agree to a new term for the provision of paid medical services or demand the performance of paid medical services by another specialist;
Terminate the contract and demand compensation for actual damage;
Demand the payment of a forfeit in the manner and amount determined by the legislation on the protection of consumer rights or by an agreement.
1.9. The main orders regulating the activities of the hospital:
1) Order of the Ministry of Health of the USSR No. 770 of 05/30/1986 "on the procedure for medical examination of the population."
3) Order of the Ministry of Health of the Republic of Belarus No. 13 of 25.01.1990 “on the creation of a system for the rehabilitation of sick and disabled people in the Republic of Belarus”.
4) Order of the Ministry of Health of the Republic of Belarus No. 447 of 12/14/1990 "On clinical examination of patients with risk factors."
5) Order of the Ministry of Health of the Republic of Belarus No. 487 dated 12/14/1990 “On changing the mandatory nature of clinical examination into recommendation”.
6) Order of the Ministry of Health of the Republic of Belarus No. 143 dated February 28, 1991 “On the state of anti-tuberculosis care for the population and measures to improve it.
7) Order of the Ministry of Health of the Republic of Belarus No. 104 of 03.06.1992 “On the prophylactic medical examination of the population exposed to radiation as a result of the Chernobyl disaster”.
8) Order of the Ministry of Health of the Republic of Belarus No. 129 of 07.07.1992 "On increasing the role of hygienic education and upbringing, the formation of a healthy lifestyle."
9) Resolution of the Council of Ministers of the Republic of Belarus No. 801 of December 31, 1992 "On medical rehabilitation expert commissions".
10). Order of the Ministry of Health of the Republic of Belarus No. 47 of 03.24.1993 "On measures to improve cardiac care for the population of the Republic of Belarus."
12). Order of the Ministry of Health of the Republic of Belarus No. 80 dated 05/12/1993 "On the provision of traumatological and orthopedic assistance to the population of the Republic of Belarus."
13). Order of the Ministry of Health of the Republic of Belarus -No 132 of 14.07.1993 "On improving the medical and sanitary provision of adolescents, students and recruits in the Republic of Belarus."
14) .Law of the Republic of Belarus "On the sanitary and epidemiological well-being of the population" dated 23.11.1993.
15). Order of the Ministry of Health of the Republic of Belarus No. 13 dated 25.12.1993 “On the establishment of medical rehabilitation departments”.
16) .Order of the Ministry of Health of the Republic of Belarus No. 10 of 10.01.1994 "On compulsory medical examinations of workers employed in harmful conditions labor ".
17). Law of the Republic of Belarus No. 3317-X11 of 17.10.1994 "On the prevention of disability and rehabilitation of disabled people."
19). Order of the Ministry of Health of the Republic of Belarus No. 159 dated 20.11.1995 "On the development of programs for synthesized prevention and improvement of the method of clinical examination of the population."
20). Order of the Ministry of Health of the Republic of Belarus No. 192 of 29.07.1997 "On voluntary medical insurance in the Republic of Belarus".
21). Resolution of the Ministry of Health and the Ministry of Labor and Social Protection of the Republic of Belarus "On approval of the Instruction on the procedure for issuing certificates of incapacity for work and certificates of temporary incapacity for work and Instructions for filling out certificates of incapacity for work and certificates of temporary incapacity for work" No. 52/97 dated 09.07.2002.
22). "Instructions for determining the disability group": Approved by the Resolution of the Ministry of Health of the Republic of Belarus No. 61 of 12.08.2002.
23). Instruction for determining the cause of disability ": Approved by the Resolution of the Ministry of Health of the Republic of Belarus No. 61 of 12.08.2002.
... STRUCTURE, FUNCTIONS, DOCUMENTATION OF RECEPTION REST. PROCEDURE FOR REFERRING PATIENTS TO HOSPITALIZATION. RECEPTION AND DISCHARGE OF PATIENTS.
In accordance with the order of the Ministry of Health of the Republic of Bashkortostan No. 22 dated April 24, 2006 "On improving the organization of medical care for the population by the admission departments (rooms) of healthcare institutions of the republic", it is recommended to deploy diagnostic beds at the admission departments (at the rate of 3 per 100 inpatient departments).
The patient is admitted to the hospital through the admission department, where they carry out:
Accounting for the movement of patients in the hospital.
Transfer of patients from one department (or hospital) to another.
Reception of patients.
Establishing a diagnosis of patients upon admission.
Filling out medical records.
Distribution of patients by departments.
Sanitary treatment of patients.
Registration and accounting of accepted and discharged patients.
Acceptance of things and delivery of them.
Receiving transmissions for the sick.
Meeting patients with relatives.
Providing emergency care.
Issuance of certificates of the patient's condition.
There are the following types of hospital admissions: planned (in the direction of the clinic); emergency (delivery by ambulance) and admission by gravity. In the hospital, a schedule of planned places is drawn up by days of the week.
Located on the ground floor of an 11-storey building. The structure of the emergency room includes the following rooms, taking into account the admission and discharge of patients: 1-lobby-waiting room (for patients and their relatives), cloakroom, reception, hospital information desk, 2-examination room, 3-boxes for examining incoming patients, 4- sanitary room, 5-isolation ward, 6-chamber for storing clothes, 7-treatment room, 8-dressing room, 9-small operating room, 10-X-ray room, 11-laboratory, 12- nurse's room, 13- discharge, 14-room doctor on duty, 15-toilet with washbasin.
The main tasks of the admission department:
Registration of patients admitted to the admission department, registration of those hospitalized, as well as those who received outpatient care and patients who were denied hospitalization;
Distribution of incoming patients into planned and emergency, as well as by the nature, severity and profile of the disease;
Medical examination and diagnostics of all patients who applied to the admission department, regardless of the channel of admission;
Examination of patients using laboratory and instrumental methods, organization of emergency consultations for patients by qualified specialists of hospital departments, in clinical hospitals - by employees of departments and scientific workers;
Examination and provision of medical care to patients who have applied to the emergency department, but do not need inpatient treatment;
Providing emergency medical care, carrying out resuscitation measures in necessary situations, transporting patients to the hospital department;
Registration and maintenance of established medical records;
Registration of documentation in case of refusal of hospitalization, including a certificate of the established form about the patient's stay in the admission department of the hospital;
Observation of patients in the admission department until the diagnosis is clarified (if an infectious disease is suspected, in an isolation ward);
Execution of the document "Protocol of medical examination of persons to establish the fact of alcoholic, narcotic, toxic intoxication" (order of the Ministry of Health of the Republic of Belarus dated February 18, 2002, No. 1773 "On approval of the regulation on the procedure for examining persons to establish the fact of alcoholic, drug, and toxic intoxication") ;
Transfer and registration of telephone messages to the police on all cases of citizens' treatment with violent bodily injuries, road traffic accidents. Transfer and registration of information about corpses and persons delivered in an unconscious state unaccompanied by relatives or without identity documents at the Accident Registration Bureau (ARNS);
Receiving information by the staff of the admission department about the movement of patients in the hospital;
Control over the validity of referring patients to inpatient treatment and the correctness of registration of referral documents;
Relationship and continuity with medical institutions: transfer of assets to the polyclinic, coordination of transfer of patients to other hospitals, transfer of information about the movement of patients in the hospital to the hospitalization department of the city ambulance station;
Conducting sanitization of patients sent to hospital departments;
Maintaining constant readiness of the department to work in emergency situations and when identifying patients with AOI.
The work of the admission department of any hospital is regulated and based on a number of regulatory documents.
Admissions office documentation:
1. Accounting f. 001 / y - "Journal of admission and hospitalization refusals."
2. Accounting f. 003 / y - "Medical card of an inpatient".
3. Accounting f. 066 / y - “Statistical card of a person who left the hospital”.
4. Accounting f. 060 / y- "Journal of Infectious Diseases" identified in the admission department.
5. Accounting f. 050 / y - "Register of records of X-ray and cardiological studies" (the journal records the data of X-ray studies, ECG, taken in the admission department).
6. Accounting f. 069 / y- "Journal of records of outpatient operations."
7. Accounting f. 029 / y- "Journal of procedures accounting".
8. Accounting f. 074 / y "Journal of registration of outpatients", regardless of the reason for contacting the emergency department.
9. Protocol of medical examination to establish the fact of alcoholic, drug and toxic intoxication (order of the Ministry of Health of the Republic of Belarus dated February 18, 2002, No. 1773. "On approval of the regulation on the procedure for examining persons to establish the fact of alcohol, drug, and toxic intoxication").
10. Journal of registration of analyzes and their results, taking biological material for chemical and toxicological studies (order 1773 of 18.02.2002 “On approval of the Regulation on the procedure for examining persons to establish the fact of alcoholic, narcotic, toxic intoxication”).
11. The register of the emergency prophylaxis of tetanus (order of the Ministry of Health of the Republic of Belarus No. 275 dated 01.09.1999 “On further improvement of the calendar of preventive vaccinations”).
12. Book of accounting of poisonous and narcotic drugs in the offices of medical and preventive institutions (order No. 215 dated 05.06.1999 of the Ministry of Health of the Republic of Belarus "On the procedure for keeping records and dispensing of poisonous, narcotic drugs and special prescription forms").
13. Book for handing over used ampoules from under narcotic drugs (order No. 215 of 05.06.1999 of the Ministry of Health of the Republic of Belarus "On the procedure for storing, accounting and dispensing poisonous, narcotic drugs and special prescription forms").
14. Accounting f. 015 / y- "Journal of registration of receipt and delivery of corpses."
15. Accounting f. 017 / y- "Biological death statement".
16. Accounting f. 002 / y- "Register of reception of pregnant women, women in labor and parturient women" (admission departments of maternity hospitals).
17. Accounting f. 096 / y - "History of childbirth" (admission departments of maternity hospitals).
18. Accounting f. 058 / y- "Emergency notification of infectious disease, food, acute occupational poisoning, unusual reaction to vaccination."
19. Accounting f. 089 / y - "Notification of a patient with a diagnosis of active tuberculosis, venereal disease, trichophytosis, microsporia, favus, scabies, trachoma, mental illness" for the first time in his life.
20. Journal of issued numbered certificates of referral of patients to the admission department of the hospital.
21. Journal of transfer of assets to polyclinics.
22. Register of receipts for the acceptance of values \u200b\u200bfrom the patient.
Organization of the admissions office.
The main principle of the admission department is full responsibility for the life and health of patients, regardless of the channel of admission to the admission department. From the moment of admission, the patient and his relatives have the right to a respectful and humane attitude of medical workers, while all measures should be taken to urgently clarify (establish) the diagnosis and resolve the issue of treatment tactics.
Control over the work of the admission department is carried out by the deputy chief physician for the medical part.
The work of the admission department is directed by the head of the department. In the evening and at night, weekends and holidays direct supervision is carried out by the responsible doctor on duty in the admission department.
For a clear organization of work on receiving patients, conducting an examination in an optimal short time, efficiency in the admission of a large group of patients in case of an emergency (mass trauma, mass food poisoning, chemical damage, detection of a sick or suspicious person with especially dangerous infectious diseases, quarantine infection), the admission department should have:
Folder with instructions for personnel on duty on work in emergency situations;
A folder with a set of documents in case a patient (suspicious) is identified for especially dangerous diseases, quarantine infections;
A folder with instructions for evacuation in case of fire, mines and other emergencies;
A folder with the current instructional and methodological materials of higher organizations and orders of the chief physician on the work of the admission department;
Information material about specialized city centers and round-the-clock duty specialists in the city;
Information material with the phones of emergency services and responsible persons on duty of the health committee of the Grodno City Executive Committee, the Ministry of Health of the Republic of Belarus, the Ministry of Emergencies of the Republic of Belarus, the Minsk City Department of the Ministry of Emergencies;
A folder with instructions on the algorithm of actions of nurses when providing medical care before calling a doctor, instructions for providing emergency care in extreme cases (hypertensive crisis, myocardial infarction, cardiogenic shock, paroxysmal tachycardia, anaphylactic shock, an attack of bronchial asthma, pulmonary edema, eclampsia, uterine bleeding (for maternity hospitals additionally);
A folder with a set of instructions for observing the sanitary and anti-epidemic regime in the admission department;
Standards for examining patients in the admission department in accordance with the profile of the hospital beds;
Table of poisons and antidotes;
Schedule of duty of responsible administrators and doctors on duty according to the profile of departments;
Regulations on the responsible doctor on duty.
The procedure of the admissions office.
Reception of patients is carried out by the flow method, which excludes the possibility of a counter flow of incoming and inpatient patients.
Patients admitted to the admission department are subject to the referral of a polyclinic doctor, another medical institution, an emergency medical doctor (paramedic), as well as those who have applied independently.
When patients are admitted to medical institutions, accompanying persons must have the following documents:
A doctor's referral with an indication of the diagnosis, the onset of the disease, the examination and treatment carried out before hospitalization, information about the indication for which disease is registered in the dispensary, the medical care provided at the prehospital stage. When a child is sent for hospitalization by a doctor of a children's clinic, health institutions, it is additionally necessary to have a certificate of the absence of contacts with infectious patients at the place of residence, the children's team that he visits or is.
An accompanying sheet (study f. 114 / y), filled out by an ambulance doctor for each hospitalized patient, including when transporting patients and women in labor. The accompanying sheet must be filled out clearly and completely, the signature of the doctor (paramedic) is legible, and the number of the brigade and the substation is indicated on the sheet. The procedure for certifying the admission of a patient in a hospital provides for the signature of the doctor on duty, (paramedic, nurse) of the admission department in the emergency call card (account number 110) indicating the date and time of the patient's admission and certification of this record with the stamp of the hospital admission department.
An extract from the history of the disease (study f. 027 / y) in case of transfer of the patient from the hospital department of one medical institution to another, indicating the diagnosis, the nature of the treatment, the data of laboratory and other diagnostic studies, the list of treatment used, the assessment of the condition and the medical care provided before transfer to other health care facilities.
Referral of the established form indicating the time and date of the patient's admission to the admission department, preliminary diagnosis, examination data and the provision of medical care, specialist consultations, if any, justification for transfer from the admission department of one medical institution to the admission department of another medical institution, indicating the time, method transportation and support, surname with whom the translation was agreed.
When a patient is admitted, the nurse on duty or the medical registrar on duty enters all the data about the patient in the journal f.001 / u "Journal of admission and hospitalization refusals."
All hospitalized patients and all those who were denied hospitalization from among those sent by ambulance and medical institutions are entered in the log.
In multidisciplinary hospitals with a large number of visits, the journal f. 001 / y can be kept separately: one - for planned, the second - for patients hospitalized for emergency indications and who are denied hospitalization.
In the rest of the admission departments, the registration of those hospitalized and those who are denied hospitalization, from among those referred, is kept in one journal f.001 / y.
A reliable time stamp of the patient's admission to the emergency department, his departure home or transfer to the hospital department, the time of the first doctor's examination is necessary to analyze the length of stay in the emergency department of both emergency and planned patients.
If the patient is taken to the emergency department unconscious, the passport part is filled out according to the words of the relatives or persons accompanying the patient. The staff on duty of the admission department in these cases is obliged to carefully compare the data about the patient with those documents that are with the patient.
In the absence of documents and the impossibility of obtaining oral information about the identity of the patient who is in an unconscious state, such a patient is entered in the journal f 001 / y as "unknown" and his admission is immediately reported to the BRNS. After receiving information about his identity in the passport section of the journal f. 001 / y changes are being made.
1. Initial examination of the patient in the admission department:
a) arriving in a planned manner:
Examination of the patient;
Checking the availability of all documents necessary for hospitalization;
A brief entry in the medical history of the examination results, the formulation of the preliminary diagnosis;
b) upon admission of patients for urgent and urgent indications:
Victims and patients delivered by ambulance teams are subject to mandatory and immediate admission to the admission department of the hospital, regardless of the availability of free places in the specialized department of the hospital. In case of delivery of a patient in serious condition, an ambulance worker hands over the patient to the emergency doctor on duty "from hand to hand";
In cases where any additional consultations and research are required to resolve the issue of the need for hospitalization of the patient, they are organized and carried out by the medical staff of the admission department (the doctor (paramedic) of the emergency medical service should not stay in the admission departments of hospitals);
If the delivered patient only needs outpatient care or short-term medical supervision, the emergency doctor on duty, without delaying the ambulance, receives the patient and ensures that all necessary measures are taken;
In the case when the patient is delivered in a serious condition, requiring resuscitation measures (unconscious, collapse, myocardial infarction, etc.), he must be hospitalized immediately in the intensive care unit, bypassing the emergency department and all diagnostic and therapeutic measures are carried out in this department;
A detailed medical history is filled in by a doctor of the specialty, according to the profile of which the patient was sent to the hospital. The resuscitation physician records the results of his examination separately. The best option is a joint appointment between a specialist doctor and a resuscitator, which indicates an awareness of the common responsibility for the patient.
When a patient is admitted for emergency and urgent indications; the doctor of the admission department is obliged to:
Conduct an immediate thorough examination of the patient;
Assign and conduct the necessary laboratory and special instrumental studies ( general analysis blood, urine, biochemical blood test, ECG coagulogram, X-ray, ultrasound, endoscopy, etc.);
Organize a call for specialists from hospital departments, if there are none on the staff of the admission department, to patients with an unidentified diagnosis and unclear forms of the disease;
After examining the patient and evaluating the examination, the conclusions of specialists, make a decision on hospitalization of the patient in a specialized hospital department;
Clearly draw up a "medical card of an inpatient" (f. 003 / y), indicating the date, hours, minutes of the patient's examination in the admission department, make records about the patient's condition and the data of the examination, manipulation, medication;
Depending on the patient's condition, he must organize the transportation of the patient to the hospital department, indicating the method of transportation, escort;
All patients who are in serious condition before being admitted to a specialized department, or before being transferred to other hospitals, are examined by specialists of the department of anesthesiology, resuscitation and intensive care;
In all cases of a patient's delay in the admission department for more than one hour, the doctor on duty must make a special note in the medical history and indicate the reasons that caused the delay.
Upon admission of patients with:
Bodily injuries associated with gunshot, stab wounds, chopped wounds, fractures, frostbite, bruises, concussions and so on;
Personal injury and poisoning associated with attempted suicide;
Bodily injuries and poisoning caused by burns with acids and various toxic substances;
Injuries and injuries sustained in explosions and other emergencies;
Injuries and injuries associated with careless handling of firearms and ammunition;
Injuries resulting from road traffic accidents;
Personal injuries and injuries associated with the unsatisfactory condition of building structures, buildings, structures and violations of safety at work;
Other bodily injuries in case of suspicion of a violent nature of their origin - the medical staff on duty must immediately inform the operational duty officer of the Internal Affairs Directorate of the Minsk City Executive Committee by phone 02, then make an entry in the log, indicating the name of the person who received the information, time and date.
Absolute indications for hospitalization should be considered acute illnesses, injuries, emergency conditions, the treatment of which is possible only in a hospital setting.
Relative indications for hospitalization are diseases that require inpatient treatment at the first stage, followed by follow-up care in outpatient clinics, diseases requiring in-depth inpatient examination for the purpose of differential diagnosis (exacerbation of gastric ulcer, chronic pancreatitis, celiac trunk stenosis, etc.) .), as well as diseases, especially surgical ones, in which dynamic monitoring of the condition of patients is necessary.
Death of a patient in the emergency department:
The deaths of a patient delivered for inpatient treatment and death in the emergency department should be regarded as inpatient death. For each such patient, an entry should be made in the "Journal of admission and refusals in hospitalization" f 001 / y and filled in "Medical card of an inpatient", (f 003 / y), where all resuscitation measures, laboratory and other diagnostic measures should be noted research.
The timing and outcomes of treatment in accordance with the disease that caused the death, the registration of this death is carried out in the intensive care unit.
If an infectious disease is suspected, the doctor on duty at the admission department must:
Isolate the patient in an isolation ward (stay no more than 6 hours);
Organize hourly observation of the patient, provide medical assistance;
Conduct the required amount of diagnostic research, consultation of specialists;
Transfer the patient to an infectious diseases hospital by arranging transportation through the ambulance service;
All identified infectious diseases are recorded in the "Journal of Infectious Diseases" f. 060 / y, information and emergency notification is transmitted to the CG and E (no later than 24 hours from the moment the disease is detected).
The doctor on duty at the admission department who has identified an infectious disease is obliged to organize all anti-epidemic measures.
When a patient (suspicious) is identified for especially dangerous infections, the doctor on duty takes measures in accordance with the instructions for OOI.
In case of admission of a patient in a state of alcoholic intoxication if it is not possible to immediately resolve the issue of hospitalization, the doctor on duty at the admission department is obliged to arrange for him to be closely monitored, the required scope of examination. Responsibility for the patient's life is fully borne by the staff of the admission department, and therefore all decisions made and especially the decision to refuse hospitalization should be clearly reasoned with reflection in the journal f. 001 / for all examination data, laboratory and other research methods, examination by specialists and in particular by a neurologist, to exclude traumatic brain injury.
When cardiovascular pathology and other diseases are detected in patients with alcohol intoxication, it is necessary to provide them with medical assistance in a timely manner.
The issue of referring such patients to inpatient departments in another hospital or refusal of hospitalization is resolved jointly with the person in charge of the hospital in accordance with the requirements of healthcare legislation.
Refusal of the patient from hospitalization :
In the event of a categorical refusal to inpatient treatment of the patient himself, admitted to the emergency department in an urgent manner with absolute or relative indications for hospitalization, the doctor of the emergency department must:
Carry out a thorough examination of the patient and the necessary laboratory and other studies;
Explain to the patient and accompanying relatives the need for hospitalization and the possible consequences of refusing to be hospitalized;
Call the head of the department to the emergency department for examination of the patient (in the evening, at night, on weekends and holidays - the responsible doctor on duty - a specialist);
Write down in detail in the journal f. 001 / y data of a joint examination with the head of the department (the responsible doctor on duty - a specialist), indicating the time of examination and leaving the patient.
Refusal of medical intervention, as well as hospitalization with an indication of the possible consequences, issue in the journal f. 001 / by the patient himself or his relatives with a certificate of the record signed by the patient, as well as by the doctor and the head of the department (responsible doctor on duty - specialist);
Issue to the patient a certificate of stay in the admission department indicating the results of examination, consultations, special laboratory and other research methods, diagnosis, treatment and labor recommendations;
Transfer the "asset" to the territorial polyclinic;
Registration of the date, time, surname of the person who took over the "asset" should be made in the "asset transfer log".
The specified order of actions can only be in the absence of chronic mental illnesses, acute mental disorders, especially due to emergency pathology (anemia of the cerebral cortex with gastrointestinal bleeding, intoxication with pancreatic necrosis, etc.).
In these situations, the issue of hospitalization and subsequent treatment, including surgery, is decided by a council of doctors (at least 3 specialists), a psychiatrist is urgently called for consultation.
In cases where the patient needs to be transferred to other hospital institutions, in the absence of the necessary bed profile in the hospital, the doctor of the admission department must:
Examine the patient and, if necessary, additional diagnostic tests;
Make an entry in the journal f. 001 / y, indicating the date, time of inspection, inspection data and research conducted. Establish a preliminary diagnosis, substantiate the decision on the need to transfer the patient to another hospital. The transfer of the patient can be carried out only in extreme cases and only in the interests of the patient after consulting the responsible person on duty at the hospital (in the daytime - the head of the admission department);
Draw up a referral in the prescribed form indicating the diagnosis, data of laboratory and instrumental studies, provided medical measures;
Arrange the transportation of the patient by hospital ambulance, accompanied by medical staff, with the preliminary coordination of this issue with the management of the hospital or department where the patient is transferred.
It is forbidden to transfer patients to other medical institutions in serious condition.
All cases of the use of ambulance vehicles are recorded by employees of the admission department in the "Journal of the use of ambulance vehicles of the hospital".
If a patient is diagnosed with a disease that does not require emergency hospitalization, the doctor of the admission department must:
To register the patient in the journal f. 001 / y;
Carry out a thorough examination and the necessary amount of diagnostic studies, call a specialist doctor for consultation, establish a diagnosis, provide medical assistance;
To issue a certificate of the established form about the patient's stay in the admission department, indicating the diagnosis, the data of the examination, the medical assistance provided, and give recommendations for further observation in the clinic;
Explain to the patient and his relatives that there is no need for emergency hospitalization. In a conflict situation, when, at the insistence of the patient to hospitalize him, immediately report to the responsible doctor on duty. The decision is made jointly, in each case individually and in the interests of the patient.
If the diagnosis of an acute surgical disease of the abdominal organs is not confirmed, the doctor on duty at the admission department is obliged to examine the patient together with the head of the surgical department or the responsible surgeon on duty.
The doctor on duty at the admission department is obliged to immediately notify the relatives of patients in the following cases:
When a child under 18 years old is admitted to the hospital unaccompanied by his parents, regardless of the severity of the disease;
Upon admission of patients in an unconscious state (if documents are available), as well as in those cases when the patient, taken to the hospital, is in a condition recognized as life-threatening;
When transferring a patient to another hospital directly from the admission department;
When delivering by "ambulance" a patient about accidents;
About all patients admitted unaccompanied by relatives in an ambulance in case of sudden illness outside the home;
In case of death in the admission department;
In the event of the death of foreign citizens who do not have relatives in Minsk, immediately notify the embassy of the country of which the deceased was a citizen.
Registration of patients who applied to the admission department on their own is carried out in the outpatient registration register f. 074 / y.
If the patient enters the admission department of the hospital, the doctor of the admission department must:
To register the patient in the "Outpatient register" f. 074 / y;
Make an examination of the patient, conduct a diagnostic examination, provide medical assistance, organize a consultation with specialists;
If there are indications for hospitalization, send the patient to a specialized department, register in the journal f. 001 / y and "Medical card of an inpatient" f. 003 / y, in compliance with the rules for hospitalization of patients;
If the patient does not need emergency hospitalization, after a medical examination, diagnostic study, he is provided with the necessary medical assistance. In the "Journal of registration of outpatients" f. 074 / y, the results of the medical examination, the diagnostic studies carried out, the conclusions of the specialists involved in the consultation, the diagnosis, the medical care provided, the recommendations for observation in the polyclinic, indicating the time of examination and leaving the patient, are recorded. The patient is issued a certificate of the established form about his stay in the admission department with an indication of the diagnosis, the diagnostic study performed, the amount of medical care provided, and recommendations. In cases requiring dynamic supervision of a doctor, the asset is transferred to the clinic.
The doctor on duty is obliged to inform the territorial polyclinics for an "active visit" in the following cases:
About all acute diseases in children under 3 years of age, whose parents refused to be hospitalized.
Diagnostic beds (wards - isolation wards)
Patients should stay in isolation wards for no more than 6 hours.
Patients with an unclear diagnosis, somatic patients with suspected infectious diseases, patients who are intoxicated are hospitalized in the wards - isolation wards, if it is not immediately possible to resolve the issue of hospitalization.
This group of patients should be monitored hourly by a responsible physician of the appropriate profile. For all patients hospitalized in these wards, a medical history is filled out, according to the ordinal registration number in the journal f. 001 / y, but is not counted in f. 014 (report of a medical institution).
If the patient is not hospitalized, the medical history is submitted to the archive and stored on a general basis.
Patients are provided with medical care, the necessary diagnostic tests are carried out. After the morning report, the head of the admission department examines all patients who are in isolation wards or diagnostic wards in the daytime, a specialist doctor on weekends, in the evening and at night, and together with the head of the department of the relevant profile decides whether to send them to hospital departments or to be discharged ... Patients are counted behind the relevant specialized department.
In diagnostically difficult cases, the head of the admission department organizes a consultation of specialists. Patients in serious condition should not remain in diagnostic wards - isolation wards and are hospitalized in specialized departments or intensive care units.
In the event of the subsequent hospitalization of this patient, the medical history is started with the same numbering, and the medical history, brought up while in the diagnostic beds, is pasted into the history as an insert.
CONTENTS 1. Basic regulatory orders for the organization of the work of the surgical department. 2. Organization of the post of the surgical department 3. Organization of the dressing room 4. Organization of the treatment room 5. Standard for cleaning in the surgical department 5.1. Four zones of cleanliness of the surgical department: 5.2 Schedule of work of bactericidal irradiators in zones 5. 3 Sanitary and epidemiological measures in a particularly clean zone (sterile). 5.4 Sanitary and epidemiological measures in a particularly clean area (non-sterile). 5.5 Sanitary and epidemiological measures in a conditionally clean area. 5.6 Sanitary and epidemiological measures in the dirty area. 6. Organization of work in service rooms 7. Modes of operation of bactericidal irradiators used in GAUZ RT "BSMP". Zero level documents. Regulations for the work of the surgical department.
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Types of management
"Information management" - The concept of information management. Information management covers all aspects. Various information resources and information Systems... The importance and role of information management in modern society... Information management concept. The main directions of information management.
"Communication Management" - Data from internal research in Russian companies... Let's compare the possibilities. Project. We need a lobbyist. Manager's communicative competence. Communication literacy. Risks. Typical training. Agency. We conduct it on our own or invite experts. How to involve management in communication. Internal research data.
"Strategic management" - Coordinate system (axes, units) Risks and compensation. Some key strategic concepts (1). Some key strategic concepts (2). I. Brodsky. Time is compressed: Firm? project, Position? business trip. Strategic management Greek strategos, from stratos - army and ago - leading. Introduction.
"Financial management of the enterprise" - Characterizes the change in indicators for reporting period... Main functions financial manager (continued). Topic 4. Sources of funding business activities... Regulatory legal regulation... Involved funds. Price policy. Subordinated - in demand after bonds with a maturity advantage.
"Quality Management System" - Regulations of this document were developed taking into account the regulatory documents in force in international and European practice of certification and accreditation. Russian certification systems. International practice of certification. Process approach. The main stages of building a quality management system.
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