Orders regulating the work of the surgical department. Surgical activity of a nurse. The sequence of actions of a nurse

has not entered into force Edition from 15.11.2012

Document name	ORDER of the Ministry of Health of the Russian Federation of November 15, 2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO ADULTS IN THE PROFILE "SURGERY"
Type of document	order, order, rules, standard
Host body	Ministry of Health of the Russian Federation
Document Number	922N
Acceptance date	01.01.1970
Revision date	15.11.2012
Registration number in the Ministry of Justice	28161
Date of registration in the Ministry of Justice	17.04.2013
Status	has not entered into force
Publication	At the time of inclusion in the database, the document was not published
Navigator	Notes

ORDER of the Ministry of Health of the Russian Federation of November 15, 2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO ADULTS IN THE PROFILE "SURGERY"

Appendix 7

1. These Rules establish the procedure for organizing the activities of the surgical department, which is a structural subdivision of a medical organization.

2. The surgical department of a medical organization (hereinafter referred to as the Department) is created as structural subdivision medical organization.

3. The department is headed by the head, appointed to the position and dismissed from the post by the head of the medical organization, in which the Department was created.

4. A specialist who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and social development Russian Federation dated July 7, 2009 N 415n, majoring in surgery.

5. The structure and staffing of the Department are approved by the head of the medical organization in which the department was created, and are determined based on the volume of ongoing medical and diagnostic work and bed capacity, taking into account the recommended staff standards, provided for in Appendix N 8 to the Procedure for the provision of medical care to the population in the profile "surgery", approved by this order.

6. The equipment of the Department is carried out in accordance with the equipment standard provided for in Appendix No. 9 to the Procedure for the provision of medical care to the population in the field of "surgery", approved by this order.

examination room;

doctor's office;

wards for patients, including single rooms (isolator);

operating room or operating room;

dressing room;

dressing room (for purulent wounds);

procedural;

dressing (gypsum);

manager's office.

Zakonbase: In electronic document the numbering of paragraphs corresponds to the official source.

sisterly;

senior's office nurse;

storage room for medical equipment;

Room of the hostess;

buffet and distributing;

dining room

Room for collecting dirty linen;

shower room and toilet for medical workers;

showers and toilets for patients;

room for sanitation;

sanitary room.

8. The main functions of the Department are:

provision of specialized, including high-tech, medical care by performing operations using surgical (including microsurgical) methods based on medical care standards;

preparation and implementation of diagnostic procedures in stationary conditions;

Development and implementation in clinical practice modern methods diagnosis, 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 profile of "surgery";

development and implementation of measures aimed at improving the quality of diagnostic and treatment work in the Department of Surgery;

Implementation of the rehabilitation of patients with diseases on the profile of "surgery" in stationary conditions;

carrying out examination of temporary incapacity for work;

Providing advice to medical specialists from other departments of a medical organization on the prevention, diagnosis and treatment of diseases and pathological conditions requiring 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. The Department, in order to ensure its activities, uses the capabilities of the medical diagnostic and auxiliary units of the medical organization, within which the Department is organized.

10. The department can be used as a clinical base for medical educational organizations secondary, higher and additional vocational education and scientific organizations.

Appendix No. 8
to the Procedure for the provision of medical
assistance to the adult population on the profile
"surgery", approved by order
Ministry of Health
Russian Federation
dated November 15, 2012 N 922n

The surgical department of the polyclinic maintains the following medical documentation:

Outpatient card (form No. 025/U and form No. 025/U-04);

Research referral forms;

Journal of registration of patients;

Journal of referrals to the hospital;

Operations log;

Journal of dispensary patients;

Journal of registration of injuries and anti-tetanus vaccinations;

Journal of blood directions for Hbs-antigen and Wasserman reaction;

AIDS referral log;

Register of infectious post-injection complications;

Journal of dressing quartzing;

Journal of quartzization of the operating room;

Journal of quality control of pre-sterilization processing of instruments;

Journal of control of the autoclave;

Logbook for monitoring the operation of a dry-heat cabinet.

There are a lot of documents, but they are all necessary. In case of careless filling or not keeping records of one or another type of activity, the development of complications in patients, violations of the order of work in the clinic and hospital are possible. We have already dwelled on the importance of filling out an outpatient card of the patient. Once again, it must be emphasized that this card is kept throughout the life of each patient of the polyclinic. It includes all types of examination and treatment of the patient, all identified intravital diagnoses. This is the main legal document outpatient. According to its analysis, all types of examinations are carried out. Hence the importance correct design diagnosis of the patient, determining 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 and expert commission.

Research referral forms must be printed in a typographical manner. If the medical institution, for economic reasons, cannot do this, then they must be written by hand in advance. This will save time for patient care.

The 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 employees of certain rooms of the polyclinic had their wages reduced due to the small number of patients undergoing treatment.

The journal of referrals to the hospital is divided into two headings: referrals for emergency and planned patients. Once again, it should be emphasized that emergency patients in the clinic may not be examined in full. At the same time, all planned patients are subject to laboratory, radiological and ultrasound research to reduce the length of stay in the hospital before surgery.

The transaction log must be filled out clearly. Each protocol of operations describes the nature of the intervention, the existing complications.

The journal of dispensary patients should show the dynamics of the treatment of registered patients. It should reflect the timing of follow-up examinations, therapeutic measures taken and their effectiveness.

The register of injuries and tetanus toxoid vaccinations is filled out individually for each patient. It is very important to reflect in it the volume of tetanus toxoid vaccinations, the need for revaccination.

Registers of blood referrals for Hbs-antigen, AIDS and syphilis are maintained to identify the incidence of the population, prevent infection of others and medical staff. It is desirable that all patients treated by the surgeon undergo these studies additionally.

The register of post-injection complications is necessary for the detection of iatrogenic diseases and the implementation of anti-epidemic measures in those medical institutions where the non-sterile injection was made. Each disease is reported to the epidemiological service.

Journals of quartzization of the dressing room, operating room, control of the operation of the autoclave, dry-heat cabinet, quality of pre-sterilization processing of instruments are necessary to comply with the basic rules of asepsis and antisepsis, and prevent the development of a hospital infection.

medical history and management

appointment sheets,

log,

transaction log;

registers for recording narcotic and potent drugs (Regulated by order of the Ministry of Health of the Russian Federation dated November 12, 1997 No. 330 “On measures to improve the recording, prescribing and use of narcotic drugs”);

non-normative service documentation (alphabetical journal, analysis journal, prescription selection journal, etc.)

Organization of dressing work

In any surgical department, it is necessary to deploy two dressing rooms: “clean” and “purulent”, placing them as isolated as possible from each other, from the wards and from service units. In departments specialized in the treatment of patients with proctological diseases, anaerobic infections and other diseases associated with massive environmental infection with highly pathogenic microorganisms, it is advisable to deploy a third dressing room for these groups of patients. Dressings in each of these dressing rooms should be made first in the "cleaner" patients, then in the "more purulent". Patients with putrefactive processes, intestinal fistulas, and anaerobic infections are bandaged last. This principle of operation ensures the longest possible preservation of aseptic conditions in the dressing room and prevents cross-infection between patients.

Instruments and sterile dressings in the dressing room are stored on a “sterile table” located furthest from front door and dressing tables place. The "sterile table" is closed at least once every 6 hours. The dressing nurse cleans her hands and puts on a sterile gown as in preparation for the 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 on top. The edges of the sheet are fixed with special linen clips, 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 clips, on which the date and time of the last table overlap and the signature of honey are indicated. the sister who made it. Instruments and dressing material are served 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 bactericidal chambers for storing sterile medical instruments. (Chamber "Ultra-light" is designed to store tools for 7 days).

The staff in the dressing room wears changeable gowns, caps, 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 goggles or face shields is recommended. Before performing dressings, staff wash their hands under a tap with soap and water, then put on gloves. At the same time, the hands do not become sterile, therefore, manipulations in the wound are performed only with tools. Between individual dressings, gloved hands are washed under a tap with soap. If the gloves come into contact with blood or wound discharge, they must be replaced. Immediately after use, gloves are disinfected in accordance with OST 42-21-2-85. If it is necessary to perform manipulations with hands, they are prepared as before the operation, and sterile gloves are put on.

There should be two washbasins (sinks) in the dressing room: “for hands” and “for gloves”. Three labeled towels should hang next to each, which are changed every day: “for doctors”, “for a nurse”, “for a nurse”. This is due to the fact that, due to the production duties, the hands of the junior honey. personnel, as a rule, are 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, oilcloth aprons are additionally put on, which the nurse wipes with a 3% solution of chloramine after each dressing.

The doctor performing the dressing should not approach the "sterile table". Tools and dressings are supplied from it only by the dressing sister. The doctor takes it from his sister's forceps without touching the latter. The used dressing material 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 poured with chloramine solution to a concentration of 6%, taking into account the volume of dressing material for 1 hour.

In the dressing room is carried out:

pre-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 all equipment and the room, including the ceiling, are washed using detergents and a 3% solution of chloramine.

All dressing rooms 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 for all non-working hours.

ORGANIZATION OF HOSPITAL MEDICAL CARE TO THE POPULATION

VIEW ON STATE MINIMUM SOCIAL STANDARDS IN THE FIELD OF HEALTH CARE AND NORMATIVES OF BUDGET FINANCING OF HEALTH CARE EXPENDITURES PER CAPITAL

MAIN TYPES OF INPATIENT MEDICAL CARE SERVICES PROVIDED BY STATE HEALTH ORGANIZATIONS FOR FREE

TERRITORIAL PROGRAM OF STATE GUARANTEES FOR THE PROVISION OF MEDICAL SERVICE TO CITIZENS

STRUCTURE AND FUNCTIONS OF THE CITY HOSPITAL

HOSPITAL PLANNING AND FINANCING

TYPES AND VOLUME OF PAID MEDICAL SERVICES

MAIN ORDERS GOVERNING THE ACTIVITIES OF THE HOSPITAL

STRUCTURE, FUNCTIONS, DOCUMENTATION OF THE RECEPTION ROOM. PROCEDURE FOR REFERRALING PATIENTS TO HOSPITALIZATION. RECEPTION AND DISCHARGE OF PATIENTS

MAIN DEPARTMENTS OF THE SURGICAL PROFILE, THEIR ROLE IN THE MEDICAL AND DIAGNOSTIC PROCESS OF THE HOSPITAL

DESCRIPTION OF THE SURGICAL DEPARTMENT. NUMBER OF BEDS IN THE DEPARTMENT, CHAMBER, EQUIPMENT OF THE DEPARTMENT. Isolation of "pure" and "purulent" compartments

ORGANIZATION AND WORKING CONDITIONS FOR DOCTORS AND MEDIUM STAFF

NUMBER OF ACTUALLY WORKING DOCTORS, THEIR QUALIFICATION. THE NUMBER OF RATES PROVIDED BY THE STATE AND ORGANIZATIONAL STRUCTURE OF THE DIVISION

FUNCTIONS OF THE HEAD OF THE DEPARTMENT AND THE DOCTOR-ORDINATOR OF THE HOSPITAL

MEDICAL ETHICS AND MEDICAL DEONTOLOGY IN THE ACTIVITIES OF A RESIDENT..

MANAGEMENT FUNCTION OF THE MANAGER OF THE DEPARTMENT

ORGANIZATION OF CONSULTATIONS, CONSILIA, CLINICAL, CLINICAL, PATHOLOGICAL AND ANATOMICAL CONFERENCES, TRAINING WITH DOCTORS, MEDIUM HEALTH WORKERS TO PROFESSIONAL DEVELOPMENT

FUNCTIONS OF THE SENIOR AND ROOM NURSES OF THE DEPARTMENT

THE ACTIVITIES OF A WARD NURSE TO FULFILL THE DOCTOR'S APPOINTMENTS AND MONITOR COMPLIANCE WITH THE SANITARY AND HYGIENIC, ANTI-EPIDEMIC AND MEDICAL AND PROTECTIVE REGIME IN THE HOSPITAL

1.21. RESPONSIBILITIES OF THE ATTACHING PHYSICIAN, HEAD OF THE DEPARTMENT, DEPUTY CHIEF DOCTOR IN ORGANIZING THE EXAMINATION OF TEMPORARY DISABILITY

1.22. DOCUMENTS REGULATING THE PROCEDURE FOR ISSUING INABILITY LEAF AND CERTIFICATES OF TEMPORARY INABILITY FOR WORK

1.23. SANITARY CONDITION OF THE DEPARTMENT, MEASURES FOR PREVENTION AND CONTROL OF HOSPITAL INFECTION

1.24. PROCEDURE FOR RENDERING MEDICAL CARE TO TRAUMATOLOGICAL PATIENTS

ORGANIZATION OF PATIENT CARE, REGULATION OF THE DAY

1.25. ORGANIZATION OF PATIENT CARE. DAILY REGIME.

1.26. COMPLIANCE WITH THE MEDICAL AND PROTECTIVE REGIME

1.27. ORGANIZATION OF THERAPEUTIC NUTRITION OF PATIENTS

1.28. MEDICAL AND HYGIENIC EDUCATION OF THE POPULATION AND FORMATION OF A HEALTHY LIFESTYLE

1.29. CONTINUITY IN THE ACTIVITIES OF THE HOSPITAL WITH THE POLYCLINIC AND OTHER HEALTH ORGANIZATIONS

1.30. ACCOUNTING AND REPORTING DOCUMENTATION OF THE HOSPITAL

1.31. MAIN ACCOUNTING AND REPORTING DOCUMENTS USED FOR STUDYING VARIOUS TYPES OF MORSE rate

1.32. DAY HOSPITAL

1.33. ASSESSMENT OF THE QUALITY OF MEDICAL CARE PROVIDED TO THE POPULATION BY STRUCTURAL UNITS AND THE HOSPITAL IN GENERAL

1.34. QUALITY STANDARDS (INTERIM PROTOCOLS) FOR DIAGNOSTICS AND TREATMENT OF PATIENTS

1.36. ORGANIZATION OF WORK AND FUNCTIONS OF THE MEDICAL ADVISORY COMMISSION (MCC) ON MEDICAL REHABILITATION AND EXAMINATION OF WORKABILITY

1.37. STRUCTURE, FUNCTIONS, ORGANIZATION OF WORK OF MREK. PROCEDURE FOR REFERRAL OF PATIENTS TO MREK

2. INDICATORS OF PERFORMANCE AND DEFECTS CHARACTERIZING THE ACTIVITY OF THE SURGICAL DEPARTMENT OF THE HOSPITAL IN 2009 AND 2010

2.1. HOSPITAL PERFORMANCE EVALUATION

2.2. MODEL OF THE FINAL RESULTS OF THE ACTIVITIES OF THE SURGICAL DEPARTMENT FOR 2009-2010

2.3. COMPARATIVE ANALYSIS OF THE SURGICAL DEPARTMENT FOR 2009-2010

2.4. CONCLUSIONS

2.5. GENERALIZED CHARACTERISTIC OF THE DEPARTMENT'S WORK

2.6. SUGGESTIONS

LIST OF USED LITERATURE

GENERAL INFORMATION ABOUT THE HOSPITAL AND INDICATORS OF HEALTH OF THE POPULATION.

ORGANIZATION OF HOSPITAL MEDICAL CARE TO THE POPULATION

Stationary care- the most important type of medical and preventive care for the population, which is provided in the most severe forms of diseases that require constant medical supervision. Inpatient care is provided in inpatient departments of hospitals, specialized hospitals, and special dispensaries.

The main principles of medical care for the population are:

Availability of medical care and pharmaceutical provision

Preventive health care.

Priority medical and drug support for children and mothers

Accountability professional activity medical workers

Responsibility of public authorities, management and employers for the state of health of citizens.

equal opportunity enterprise development, healthcare institutions and organizations, regardless of departmental affiliation and forms of ownership. Economic interest of individuals and legal entities in preserving and strengthening the health of citizens.

Participation of the public and citizens in health protection.

A hospital is a medical and preventive institution that provides the population with inpatient medical care, and in the case of a combination with a polyclinic, outpatient care. The most expedient structural form is a hospital combined with a polyclinic. In regional (regional, republican) and central district hospitals, the polyclinic is a mandatory structural unit; city ​​hospitals may not have this unit. 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 district. Rendering inpatient care the children's population is carried out in children's city, regional (territorial, republican), district hospitals, as well as in the children's departments of the central district hospitals; obstetric care - in maternity hospitals (Maternity Hospital) and departments. According to the profile, multidisciplinary and specialized hospitals are distinguished. Hospitals are part of dispensaries (see Dispensary), as well as medical units (Medical and sanitary unit). Hospitals, the bed capacity of which is not less than 50% used by medical schools 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 studies are impossible in an outpatient setting; if the recovery or improvement of the patient's condition can be achieved faster in a hospital than with outpatient treatment; if the stay of a sick person at home poses a threat to others (with a number of infectious and sexually transmitted diseases, certain types of mental disorders, etc.)

In order to better provide the population of rural areas with specialized inpatient and outpatient care, inter-district specialized departments are organized in large CRHs, which also provide organizational, methodological and advisory assistance to medical workers of medical institutions of attached districts, improve their skills, develop specific measures to improve relevant types of specialized medical care.

The district hospital is designed to provide medical care to the rural population in the main profiles (therapy, surgery, pediatrics, obstetrics, infectious diseases) and is organized, as a rule, on the central estates of collective farms and state farms. The capacity and structure of district hospitals are different and depend on the population, service radius, the presence of industrial enterprises and agro-industrial complexes, settlement patterns, transport links, etc.

The provision of inpatient care to the rural population provides for the need for 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 the 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 (dermal and venereological, anti-tuberculosis, psychoneurological, cardiological, narcological, endocrinological). Similar hospitals are created for the population of the entire region (territory, republic), city.

The Rehabilitation Hospital is intended for patients with the consequences of trauma, neurosurgical interventions, orthopedic and neurological diseases requiring the use of a complex of restorative measures. As part of rehabilitation hospitals, mainly highly specialized departments of neurological and orthopedic-traumatological profiles are organized. Patients with the consequences of cerebrovascular accidents, head injuries and surgical interventions on the brain, diseases and injuries of the spinal cord, and diseases of the peripheral nervous system are hospitalized in the neurological departments. Patients with consequences of injuries and diseases of the musculoskeletal system, as well as with diseases and consequences of spinal injuries without spinal cord dysfunction are referred to the orthopedic and trauma departments. In addition, cardiological, gastroenterological, pulmonological and other departments for medical rehabilitation are being created in a number of hospitals for rehabilitation treatment, as well as multidisciplinary hospitals.

An emergency hospital is a complex medical and preventive institution designed to provide round-the-clock emergency medical care to the population in case of acute diseases, injuries, accidents and poisonings in the hospital and at the pre-hospital stage. The main tasks of the BSMP in the service area are to provide emergency medical care to patients with life-threatening conditions that require resuscitation and intensive care; 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 influx 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 evaluation of the effectiveness of the hospital and its structural divisions; analysis of the needs of the population in 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 subdivisions of the BSMP are a hospital with specialized clinical and treatment-diagnostic departments and offices; ambulance station; organizational and methodological department with an office of medical statistics. On the basis of the BSMP, city (regional, regional, republican) centers of emergency specialized medical care can function. It organizes a consultative and diagnostic remote center for electrocardiography for the timely diagnosis of acute heart diseases.

The management of a hospital of any type is carried out by the chief physician, who is appointed and dismissed by a higher health authority or may be elected by a staff meeting. The chief physician has deputies for the medical department, for outpatient work (if there is a polyclinic as part of the hospital), for the examination of working capacity, for economics. The chief physician manages the hospital on a one-man basis, 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 staff, using for this purpose the institutes for the improvement of doctors, advanced training faculties and the in-hospital system of classes, medical and nursing conferences.

The main structural unit of the hospital is the department, headed by the head, who is appointed and dismissed by order of the chief 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 departments consist of 30-70 or more beds, use all the medical and diagnostic services of the hospital in their activities.

VIEW ON STATE MINIMUM SOCIAL STANDARDS IN THE FIELD OF HEALTH CARE AND NORMATIVES OF BUDGET FINANCING OF HEALTH CARE EXPENDITURES PER CAPITAL

One of the distinguishing features of the Belarusian healthcare model is the formed system of social standards, which is one of the most important changes that have taken place in the last 5 years.

The system of state social standards determines the minimum level of guarantees for Belarusian residents 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 was the Law of the Republic of Belarus "On State Minimum Social Standards".

Minimum social standards in the field of healthcare are determined by the Law of the Republic of Belarus. These include:

Standard for provision with primary care physicians

Standard for the provision of beds in hospitals with round-the-clock stay

Pharmacy supply standard

Standard for the provision of ambulance crews.

At the initiative of the Ministry of Health of the Republic of Belarus by the Decree of the Council of Ministers of the Republic of Belarus dated June 20, 2007 No. No. 811 “On introducing additions and amendments to the Resolution of the Council of Ministers of the Republic of Belarus dated May 30, 2003 No. No. 724 "the list of social standards in the field of healthcare has been expanded:

Standard for sanitary and technical support of healthcare organizations;

Availability standard vehicle(for medical outpatient clinics, nursing care hospitals, for district hospitals);

Additional standard for agro-towns (the presence of a pharmacy organization).

State minimum social standards in the field of Health:

The standard of budgetary security of expenditures on health care per inhabitant;

The standard of provision with doctors (1 district physician per 1700 inhabitants, pediatrician - per 800 inhabitants, 1 general practitioner - per 1200 inhabitants);

Standard for provision with hospital beds (9 beds per 1000 inhabitants);

Pharmacy supply ratio (1 pharmacy per 8,000 inhabitants);

The standard for provision with ambulance teams (1 team per 12,000 residents);

Standard for the provision of vehicles (for medical outpatient clinics and nursing care hospitals - 1 unit of vehicles, for district hospitals - 2 units of vehicles);

Standard for sanitary and technical provision of rural healthcare organizations (flowing water supply, household sewerage, water heating system, supply and exhaust ventilation).

The value of the norm of budget financing of expenses for the provision of medical care to one resident of the region (hereinafter referred to as the norm of budget financing) is determined taking into account the justified need of the population of the region for medical care and reflects the amount of funds for reimbursement of material and equivalent costs for the provision of medical care per resident areas.

Minimum social standards in Healthcare in 2010:

NORMATIVE	PERFORMANCE
Healthcare Expenses per 1 inhabitant 549 129 rubles	Healthcare Expenses per 1 inhabitant 552 336 rubles
1 local therapist per 1700 inhabitants Pediatrician for 800 inhabitants 1 general practitioner per 1200 inhabitants	1 local therapist per 1650 inhabitants 1 pediatrician per 715 inhabitants 1 general practitioner per 1173 inhabitants
9 beds per 1000 inhabitants	10.2 beds per 1000 inhabitants
1 pharmacy per 8000 inhabitants	1 pharmacy per 5688 inhabitants
1 SIP brigade per 12,000 inhabitants	1 ambulance brigade for 11252 residents

Budget financing standards are calculated for each type of medical care specified in the Territorial Program. The sum of norms of budget financing for all types of medical care specified in the Territorial Program is the average regional norm of budget financing of healthcare costs per inhabitant of the region.

MAIN TYPES OF INPATIENT MEDICAL CARE SERVICES PROVIDED BY STATE HEALTH ORGANIZATIONS FOR FREE

Types of medical care provided to the population at the expense of budgetary funds

Citizens of the Republic of Belarus are guaranteed at the expense of state budgetary funds:

1. primary health care:

2. diagnosis and prescription of treatment carried out by local doctors (general practitioners, pediatricians, obstetricians-gynecologists, and others) and general practitioners on an outpatient basis, as well as at home in cases where it is impossible for a patient to attend an appointment or pose a threat to the health and life of the patient or others ;

3. services of medical specialists 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 areas of local 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 in relation to oncological diseases, 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 Immunization Schedule 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 have been in contact with a patient with an infectious disease or who have arrived from countries that are unfavorable for epidemically dangerous diseases; preventive measures to ensure the sanitary and epidemiological welfare of the population, including state sanitary supervision over the implementation of sanitary legislation by individuals and legal entities;

8. laboratory support for ongoing surveillance and anti-epidemic activities;

9. primary medical examination by a narcologist, drug control, drug registration and monitoring;

10. primary psychiatric examination, dispensary observation, diagnosis and treatment of psychotic forms of mental disorders, military psychiatric examination, medical and labor examination;

11. referral for 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 according to the following indications:

1. internal and external bleeding, life-threatening;

2. emergency conditions in cardiology - myocardial infarction, unstable angina, cardiac asthma, pulmonary edema, cardiogenic shock, cardiac arrhythmia (atrial fibrillation and flutter, first appeared or tachysystolic form; paroxysmal tachycardia; ventricular fibrillation, heart block with a rare heart rhythm or syncope conditions), acute vascular insufficiency, pulmonary embolism, infective endocarditis, rheumatic diseases (intensive care), hypertensive crises, suspected dissecting aortic aneurysm;

3. pulmonological 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, testicular 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, renal colic, acute urinary retention;

6. emergency conditions caused by endocrine pathology - hypoglycemic and hyperglycemic coma, addisonian 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 anemia);

9. mental disorders of a citizen, which

cause:

immediate danger to him and (or) others;

his helplessness, that is, his inability to meet the basic needs of life;

significant harm to his health due to the deterioration of his mental state if he is left without psychiatric care;

10. injuries - acute craniocerebral and spinal cord injuries, spine, dislocations and subluxations, fractures of bones, joints, muscle injuries, traumatic shock, burn disease, compression syndrome, electrical trauma, mechanical asphyxia, heat stroke, sunstroke, hypothermia with impaired vital functions, drowning, injuries and ruptures of parenchymal and hollow organs of the abdominal and thoracic 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. purulent-inflammatory diseases of all localizations,

requiring urgent intervention;

16. acute conditions associated with pregnancy, childbirth;

17. emergency conditions in gynecology - ectopic pregnancy, pelvic peritonitis, 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, disturbances in water and electrolyte metabolism and acid-base status that threaten the patient's life, anaphylactic shock, frostbite, acute allergic reactions, conditions of asphyxia, precoma and coma of various etiologies, acute and chronic adrenal insufficiency, acute liver failure, hyperthermic reactions

of various etiologies with a threat of violation 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. women in childbirth, puerperas, women with pathology of pregnancy;

2. children under 18 with diseases;

3. patients with acute and exacerbations of chronic diseases, if there are indications for hospitalization (round the clock, day stay), on referrals in accordance with the criteria and procedure for hospitalization;

4. tuberculosis patients, oncological patients, patients with benign tumors, patients suffering from mental illness, alcoholism, substance abuse and drug addiction, in cases that pose a threat to the life of the patient and (or) a threat to the health and life of others, patients with infectious and venereal diseases;

5. patients subject to planned surgical interventions, if there are indications for hospitalization;

14. other types of medical care provided by the Children's Homes, the service of the medical and rehabilitation expert commission, the blood transfusion station, pathoanatomical bureaus and other healthcare organizations of the region;

15. other activities in the field of healthcare: maintaining a medical supply base, centralized accounting departments under healthcare authorities and organizations;

16. preferential provision of medicines and medical products, including dressings, technical means social rehabilitation (hearing aids, ocular prostheses, manufacturing and repair of dentures).

17. Benefits for drug provision and prosthetics certain 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, hospitals at home, children's sanatoriums and other healthcare organizations, maintained at the expense of 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 state healthcare organizations are determined by the list of essential medicines, as well as protocols for the 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 Decree of the Cabinet of Ministers of the Republic of Belarus dated August 27, 1996 No. 566 "On paid types of medical care 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, art. 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 are defined for the population:

1. in outpatient clinics:

Assignment of citizens to an institution at the place of residence or at the place of temporary residence;

Establishment of the volume of diagnostic, therapeutic and rehabilitation measures for a particular patient by the attending physician;

Referral of patients for hospitalization in accordance with clinical indications requiring compliance with the hospital regimen, active therapeutic measures and round-the-clock medical supervision;

Lack of nutrition 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 fixation;

Planned hospitalization in accordance with the queue;

Possible placement 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;

Providing patients, women in childbirth and puerperas with medical nutrition in accordance with the appropriations provided for these purposes in the budget;

Providing an opportunity for one of the parents or another family member at the discretion of the parents to be with a sick child;

Provision of food and bed for a person caring for a hospitalized infant, as well as for a child under the age of 3 years, if there are medical indications for care.

Every resident of the region has the right to receive medical care in any healthcare organization and from any medical worker of private healthcare at will on a paid basis at the expense of personal funds or funds of individuals and legal entities.

Volumes free medical care:

The volumes of free medical care provided to the population of the region by state healthcare organizations are determined on the basis of 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 volumes of medical care per inhabitant .

The value of the norm of budget financing is determined taking into account the reasonable norms and standards of the needs 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 inhabitant of the region.

The territorial program establishes the following standards for the volume of free medical care:

1. outpatient care.

Indicators of the volume of outpatient care are expressed in the number of planned per capita:

Visits to outpatient clinics; visits to patients by doctors at home; days of treatment treated patients (hospitalization rate); average duration (number of days) of treatment of a patient in day hospitals.

The standard of visits to outpatient clinics is 11.6 visits per year.

The standard for visiting patients by doctors at home is 0.72.

Day hospitals:

standard treatment days - 0.52;

standard of treated patients (level of hospitalization) - 0.075;

the average duration of treatment of the patient - 7 days;

2. inpatient medical care.

Indicators of the volume of inpatient care for patients for treatment in hospitals with a round-the-clock stay is expressed in the number of planned per capita: bed-days; treated patients (hospitalization rate); average duration (number of days) of treatment of the patient.

The standard for bed-days is 3.125.

The standard for treated patients (hospitalization rate) is 25% of the region's population.

The average duration of treatment for a patient is 12.5 days.

3. ambulance.

The indicator of ambulance volume is expressed in the number of ambulance calls 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 security of health care 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 the allocated budgetary funds for their provision are liable in accordance with the current legislation.

TERRITORIAL PROGRAM OF STATE GUARANTEES FOR THE PROVISION OF MEDICAL SERVICE TO CITIZENS

The territorial program was developed in accordance with the Decree of the Council of Ministers of the Republic of Belarus dated August 10, 2000 No. 1225 "On improving the mechanism for financing healthcare" (National Register of Legal Acts of the Republic of Belarus, 2000, No. 80, 5/3802), the Decree of the Council of Ministers of the Republic Belarus of October 21, 2002 No. 1452 "On 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 Republic of Belarus dated July 18, 2002 No. 963 "On State Minimum Social Standards in the Field of Health" (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 dated 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 state-guaranteed volume of medical and drug care, which provides for the provision of quantitatively regulated medical care for the prevention, diagnosis and treatment of diseases, as well as medical and social assistance provided by healthcare organizations in the region.

On the basis of the state minimum social standards in the field of healthcare 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 amount 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 if there are financial opportunities for local budgets.

The 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 state healthcare organizations at the expense of the budget;

2. ensuring a balance between the obligations of the state to provide citizens with a guaranteed volume and quality of free medical care and the budget funds allocated for this;

3. Improving the efficiency of the use of available health care resources.

Territorial programs are developed annually by health authorities within the time frame set for the development of the 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 preventive institution that provides inpatient care to the population of the whole city or part of it.

Regardless of the profile of the bed fund, a modern city hospital, as a rule, includes the following units: an emergency department, which should have an isolation room, diagnostic beds and an intensive care unit are possible; department of intensive care and resuscitation: department for the stay of patients; diagnostic divisions, including the X-ray department (office), departments of functional diagnostics, endoscopy, ultrasound diagnostics; pathological department; laboratories (clinical, biochemical, bacteriological, immunological, serological, radioimmune diagnostics, etc.); medical units - operating block, departments of physiotherapy and exercise therapy, radiation therapy, hyperbaric oxygenation, hemodialysis and hemosorption; pharmacy, centralized sterilization; blood transfusion department and other units. 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 hospital beds in hospitals is established by a 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 number of people served and its need for various types medical care, the structural units of the hospital may have different capacities. For example, emergency hospitals need a large intensive care and resuscitation unit, a sufficient number of planned and emergency operating rooms, and a unit for express diagnostics. In rehabilitation hospitals that widely use methods of non-drug treatment, in addition to departments of physiotherapy and physiotherapy exercises, rooms for mechanotherapy, social and vocational rehabilitation (Rehabilitation), a water and mud bath, and a swimming pool should be provided.

The main functions of the city hospital are the provision of 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 the best practices of medical institutions; development and improvement of organizational forms and methods of providing medical care and patient care; hygienic education of the population and propaganda healthy lifestyle life; wide involvement of the public in the development and implementation of measures aimed at improving medical and preventive care for the population. Similar functions in relation to the children's population (under the age of 14 inclusive) are performed by the city children's non-infectious hospital.

Emergency hospital - a hospital designed exclusively for the provision of emergency inpatient and out-of-hospital care; It has an ambulance and emergency station.

CITY CLINICAL EMERGENCY HOSPITAL OF THE CITY OF GRODNO is a multidisciplinary specialized institution of the city to provide 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 ambulance stations.

The hospital has 14 main departments, namely: surgical, neurosurgical, 1st, 2nd and 3rd traumatological, pediatric traumatological, urological, gynecological, department of pregnancy pathology, 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, department of functional diagnostics. The hospital also has 3 beds for surgical care by vascular surgeons.

The structure of the GKB SMP includes the following divisions:

Administrative and management department: accounting department, planning and economic department, personnel sector, sector of automated control systems, engineering department

General hospital department: organizational and methodological office, accounting and medical statistics office, admission department

Hospital 14 main departments, namely: surgical, neurosurgical, 1st, 2nd and 3rd traumatological, pediatric traumatological, urological, gynecological, pregnancy pathology department, obstetric physiological and observational departments, burns, newborn observational; the hospital also has 3 beds for 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, radiological department, functional diagnostics department, physiotherapy department, psychotherapist's office, centralized sterilization, pharmacy.

Housekeeping department: catering unit, medical archive, warehouse.

The main functions performed by ME "GKB SMP Grodno":

1. Providing first, emergency medical care to patients with acute and sudden illnesses, injuries, poisonings and other accidents.

2. Provision of qualified medical and advisory assistance to residents of the city of Grodno and the Grodno region within its competence.

3. Diagnosis, treatment of patients with traumatological, orthopedic (adults and children) profiles.

4. Surgical care, emergency and planned.

5. Rehabilitation of patients: physiotherapy, exercise therapy.

6. Computed and magnetic resonance imaging.

7. Diagnosis, treatment of gynecological patients.

8. Obstetrics in the departments: physiological, observational, pathology of pregnancy.

9. Measures to improve the skills of employees.

10. Combustiology.

The hospital has modern diagnostic equipment: ultrasound, MRI, CT, endoscopes, laparoscopes, arthroscopes, microscopes for neuro- and vascular surgery. The hospital also has 1-, 2-, 3- and 4-bed rooms. Chambers of UVOV and persons equated to them - 9 chambers = 12 beds in a hospital. All wards are equipped with plumbing, and also have a connection with the post office.

As a rule, patients are admitted to the hospital in the direction of doctors from outpatient clinics, clinics, dispensaries and other healthcare facilities at the level of primary health care, and on an emergency basis they are 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 air ambulance departments can come to the aid of doctors. To implement this assistance, leading specialists of the republic are involved and special ground ambulance transport is used.

Therapeutic and diagnostic capabilities of the department: CT, MRI, ultrasound, FGDS, colonoscopy, clinical diagnostic laboratory and department, radiology department, laparoscopy.

THE CITY CLINICAL EMERGENCY HOSPITAL OF THE CITY OF GRODNO is deployed with 578 beds. Currently, the ambulance service of the city of Grodno serves up to 130 thousand calls per year. More than 19,000 people receive treatment at the emergency hospital every year, and more than 9,000 surgeries are performed. The trauma center provides about 100,000 visits per year. Round-the-clock assistance to the residents of Grodno and adjacent areas is provided by 29 teams, of which: 3 intensive care teams, 3 cardiological and 4 pediatric care teams. 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 medical residents, whose main elements of work are keeping a medical history, diagnosis and treatment, examination of working capacity, rehabilitation and rehabilitation treatment, consultations, consultations. On the basis of the hospital, the departments of 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 maintained by hospital residents, the main ones are "Inpatient card (medical history)", "Patient registration sheet", "retired from the hospital card", "Disability certificate", various registers, etc.

The specificity of the organization of the BSMP surgical service lies in the need to provide assistance to a number of patients for emergency or vital indications. Teams of on-duty surgeons, anesthesiologists and personnel of the operating unit work at the BSMP. For a more complete examination of patients, clinical and X-ray laboratory assistants, endoscopists and doctors of ultrasound diagnostics are involved in the duty. If necessary, doctors of almost all specialties can participate in consultations.

Staff standards for medical personnel of stationary institutions and their divisions.

Number of beds per 1 medical position at the clinical hospital level:

adult children

Obstetrics 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

Health care belongs to the sphere of intangible services. The implementation of modern principles of management and planning is especially difficult in healthcare. This is due to the complexity of the infrastructure, the variety of types of institutions, the profiles of hospital beds and specialization, the subordination of health care institutions to bodies of various levels of government (republican, city, district, departmental).

The financial and material support of the industry is carried out according to the residual principle. Health care is not always in the field of view of the governing bodies of the republic. But even those resources that are allocated to health care are not used rationally enough due to the lack of a well-functioning management mechanism. Planning, the main link, the core of industry management, turned out to be especially neglected. Extensive indicators serve as planning milestones: the number of beds, visits, etc. There are practically no qualitative indicators that reflect the efficiency of resource use. Planning is carried out only within the framework of the national economic and territorial plans. There are no long-term sectoral plans, sectoral plans for design and survey work, capital construction. The mechanisms of economic management of the industry need to be improved: prices, distribution of resources, paid services, norms of financing, wages, material incentives, etc.

One of the main shortcomings of planning is that for a long time planning was based not on the real need 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 purpose of health planning is to develop an industry management strategy based on a deep and comprehensive analysis and implementation of measures to ensure the optimal use of all resources in order to achieve a better satisfaction of the population's need for medical care.

In modern conditions, in the transition to financing the health care system per inhabitant, the planning orientation should not be directed to the available resources necessary for the maintenance of a health care institution, but to finance the provision of certain volumes of medical care.

Tasks of planning at the present stage:

ensure a reduction in the specific cost of providing medical care;

optimize the structure and placement of the network of health care institutions;

to 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;

promote the spread of progressive forms of medical care;

ensure scientific and technological progress.

The general planning scheme can be represented as follows:

determination of the main goals and functions of health care facilities (inpatient, outpatient, 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 healthcare 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 level of morbidity in the population);

the level of morbidity, depending on environmental, socio-economic and other conditions;

the level of negotiability associated with morbidity, territorial remoteness, established traditions of appeal, etc.;

real and expected flows of patients to healthcare facilities and other institutions;

resettlement of residents and its impact on the realization of the need for medical care;

financial costs of treatment in other health facilities (comparative characteristics).

When forming a promising network of healthcare institutions, the following principles should be observed:

optimality (a network of health care institutions should ensure full and equal access to medical care for residents in the shortest possible time);

the unity of the normative provision of the needs of urban and rural residents in health care;

a combination of territorial and program-target planning in the formation of the network structure;

consistency, i.e. functional and organizational unity of all health facilities of the territory providing medical care to urban and rural residents;

stepping (hierarchical subordination) in the organization of medical care, taking into account the systems of population resettlement;

stages (sequence) of medical care depending on the nature and complexity of the disease;

territorial approximation of specialized medical care through the creation of inter-district and zonal centers;

compliance of the capacity and structure of health care institutions with the number of population served.

The capacity and structure of certain types of health care institutions must be linked to the number of population served based on the system of planning and organizational restrictions by introducing the concept of a functional treatment unit (FLE). In order to exclude small departments in a hospital or inadequate receptions in polyclinics in terms of workload, a minimum capacity of various types of institutions is established, which determines their appropriate structure. First of all, this concerns the main structural and functional elements - the minimum capacity of a hospital department and the volume of activity of a medical position.

Planning of hospital care and use of beds

The hospital bed is one of the main indicators of health care resources. Currently, the main share of budgetary funds goes to the development and maintenance of a network of stationary institutions.

When drawing up a plan for the structure of a network of stationary institutions, it is necessary to proceed from the standards for the need for a bed fund and the number of people served in various settlement systems.

To determine the service area of ​​any specialized hospital department by the number of people 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 treatment unit);

M is the minimum allowable size of a functional treatment unit (number of beds in a department);

F is a differentiated prospective requirement standard (number of beds per 1000 population).

The number of beds per planned population can be calculated using the formula

K = FxH/1000, where

K is the number of hospital beds;

H is the population of the city (district).

The main economic indicators characterizing the use of the bed fund include:

T p - the average idle time of the bed;

P - the average duration of the patient's stay in bed;

B is the number of treated patients.

As a norm of useful employment (use) of a bed per year for the purposes of territorial planning, it is recommended to use the following indicators: 340-345 days of bed occupancy per year in urban hospitals and 310-320 days in rural hospitals. Hence, the planned downtime is 20-25 and 50-55 days, respectively. This time is necessary for the discharge of the patient from the hospital, the arrival of a new one and the observance of 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 a bed can serve during the year for given estimated sizes of use (employment) of the bed per year and the average duration of the patient's stay in bed. The plan function is calculated using the following formula

F - turnover (function) of a hospital bed;

D is the average duration of bed use per year;

P is the average duration of the patient's stay in bed (in days).

The average downtime of a bed for organizational reasons can be determined by the formula

T n \u003d (365-D) / F, where

T p - average downtime of one bed;

D is the average number of days a bed is used per year;

F is the turnover of a hospital bed.

For the optimal indicator of bed downtime (at each change of patient), for other reasons, it is rational to take 1 day (for the therapeutic and surgical profile of beds), for gynecological beds 0.5, infectious for adults, anti-tuberculosis for adults and maternity 2 days, infectious for children 3 days .

The maximum length of time a bed can be occupied can be calculated using the formula

D \u003d 365- (T p / F)

The optimal indicator of the average number of bed occupancy days per year for a given hospital, taking into account the loss of bed days due to repairs and for organizational reasons, can be calculated by the formula

D \u003d 365-T p - (T p / F), where

bed downtime associated with bed repair in the year T p = possible number of bed-days lost in the planned year due to repair / 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 by the formula

K \u003d [H x Y x R / D] x 100, where

H is the population;

Y - level (volume of hospitalization) (%);

P - the average number of stays of the patient in bed;

D is the average duration of bed use per year.

The need for beds, taking into account the number of treated patients and the planned turnover of beds, is found by the formula

K \u003d M / F, where

K - number of beds;

M is the number of treated patients;

F is the turnover of a hospital bed.

The need for beds, taking into account the number of bed-days spent and the number of days the bed is used in a year, is determined by the formula

K \u003d (M x P) / D \u003d K d / P, where

K - number of beds;

M is the number of hospitalized (treated) patients (actual);

P is the planned number of days the patient stays in bed;

K d - the number of spent bed-days;

D is the average duration of use (occupancy) of a bed per year.

In this way, the number of beds is determined based on the number of treated patients. This calculation is appropriate when funding for patients is based on the number of treated patients.

Planning of full-time positions of hospital workers

The planning of positions in the hospital is carried out mainly on the basis of staff standards. In addition, normalization methods can be used. Based on the timing, the time spent on one patient every day is determined.

The load of a medical position in a hospital - the number of patients that 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 for one medical position;

AT - working time doctor;

K - the coefficient of use of the doctor's working time for direct patient care per day;

T is the average time spent per patient per day.

The coefficient of use of the doctor's working time for direct patient care per day is calculated based on the daily cost of 0.5 hours for other purposes (conferences, sanitary education, emergency classes, etc.)

The standard for the position of a doctor is calculated by the formula

N to = (N b x 365) / D, where

N k - standard position of a doctor (number of beds per position);

D is the average bed occupancy per year.

The number of treated patients is determined by the formula

N = (N b x F x B h) / (B h + q), where

N is the standard for the position of a doctor, expressed in the number of treated patients;

N b - the number of patients served per day per one position;

F is the turnover of a hospital bed;

B h - the annual budget of the working time of the position (in hours);

q - vacation (in hours).

The number of positions required to ensure round-the-clock work (duty) of medical personnel throughout the calendar year is determined using 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);

H - the value of the indicator according to staffing standards (load in beds per position);

k is the number of hours in a calendar year (8760 hours with 365 days a year);

Г - the annual budget of the working time of the position (in hours).

HOSPITAL FINANCING.

Financing of hospital institutions is carried out depending on their subordination from the budget of the district, region, republic. The heads of health care institutions have been given the right to independently approve the cost estimate within the allocated allocations for current maintenance and make changes to it, with the exception of the cost of wages, food and medicines.

Most of the funds spent on the maintenance of hospitals are for wages, food for patients, medicines, dressings, reagents and x-ray film. The payroll fund is calculated on the basis of the staffing table approved by the head physician of the hospital, in accordance with the established tariff rates and conditions 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 work of medical workers within the allocated wage fund, as well as to introduce brigade forms of organization and remuneration. Financial standards for the purchase of equipment, transport, hard and soft inventory are also 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 estimate of hospital expenses is compiled for a calendar year according to the standard form established by the Ministry of Finance of the Republic and reflects all hospital expenses, including expenses for a 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 substantiated by calculations for certain types of expenses of each item of the estimate.

Calculations for the estimate are made by the hospital based on production indicators(number of beds, number of staff positions, number of outpatient visits, etc.) and in accordance with the current legislation regarding the expenditure of funds for the payment of wages, as well as in compliance with the established norms of expenses for certain types of costs (food, purchase of medicines and dressings funds and purchase of soft inventory), current prices and tariffs.

In the calculations, the estimates provide general information about the cubic capacity of buildings in terms of external measurement, the internal area of ​​​​buildings, the heating system, the availability of water supply and sewerage, which are used when planning the amount of costs for household expenses and major repairs.

The cost estimate of the hospital 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 limits set 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 reviewing and approving the hospital budget, the legitimacy and correctness of the costs included in the estimate should 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 clinic - providing medical care to a patient in a clinic (outpatient clinic) or at home.

One of the main indicators of the hospital, which determines the cost of the estimate of the hospital, is the bed fund, and the outpatient department - the number of medical positions and visits.

The unit of account for determining the cost of maintaining hospitals is a bed and staffing, outpatient departments - a medical 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 by the plan.

The increase in the number of beds in the planned year (growth of beds) is determined by the higher health authority when forming an estimate, based on the need and possibility of their placement and in accordance with the indicators of the state plan for economic and social development.

When planning the hospital bed fund, it is necessary to take into account the efficiency of using the existing bed fund.

To determine the cost of maintaining a 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 increase.

To calculate the cost of food for patients and the purchase of medicines, it is necessary to establish the number of days of operation of one bed per year and, based on this, the total number of bed days in the hospital by multiplying the average annual number of beds by the number of days of operation 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 efficient use of the bed fund.

When determining the number of days of functioning of one bed per year, it is necessary to take into account the possibility of increasing the number of days of use of 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 among those actually deployed.

Side beds are not included in the number of active beds, however, the number of days during which these beds were occupied by patients is included in the "Number of bed days" indicator.

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 elements of expenses:

Current:

Purchase of goods and payment for services:

Wages of workers and employees,

payroll charges,

Purchasing supplies and consumables

Business trips and business trips

payment for transport services,

communication service fee,

Payment of utility services,

Other current expenses,

Subsidies and current transfers .

Capital:

Purchase of equipment and durables,

overhaul,

Acquisition of land and intangible assets.

TYPES AND VOLUME OF PAID MEDICAL SERVICES.

The list of paid medical services provided in the HSE "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 Endoscopy

6 Ultrasound diagnostics

7 X-ray computed tomography

8 Performing massage procedures by mechanical action with hands

9 Magnetic resonance imaging

10 Obstetric and gynecological services

11 Physiotherapy treatments

12 Consultations of doctors of specialists, including employees of departments with categories, academic degrees, academic titles

13 Treatment of alcohol withdrawal syndrome (medication)

14 Examination of drivers for admission to work (non-cash payment)

15 session of hyperbaric oxygen therapy (HBO) (per patient)

16 Transportation of a patient not requiring medical accompaniment

For foreign citizens:

1 Clinical diagnostic laboratory for foreign citizens

2 X-ray examinations for foreign citizens

3 Functional diagnostics for foreign citizens

4 Endoscopy for foreign citizens

5 Ultrasound diagnostics for foreign citizens

6 X-ray computed tomography for foreign citizens

7 Performing massage procedures by mechanical action by hands for foreign citizens

8 Magnetic resonance imaging for foreign citizens

9 Urology for foreign citizens

10 Surgical manipulations for foreign citizens

11 Consultations of doctors of specialists, including employees of departments with categories, academic degrees, academic titles

12 Provision of emergency medical care to foreign citizens

13 Hospitalization of foreign citizens

14 session of hyperbaric oxygen therapy (HBO) (per patient) for foreign citizens

15 General purpose manipulations for foreign citizens

The price lists for carrying out diagnostic instrumental measures can be found in the State Clinical Hospital of the SMP in Grodno.

Paid medical services are additional to the state-guaranteed volume of free medical care and are provided by state healthcare organizations, as well as unitary enterprises created by the relevant state bodies in accordance with written contracts for reimbursable provision concluded with individuals or legal entities (hereinafter referred to as the customer) medical services(hereinafter - the contract), with the exception of paid medical services provided anonymously.

State healthcare organizations can also provide paid medical services in specially created offices, departments, functioning at the expense of extrabudgetary funds.

Paid medical services are provided by state healthcare 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 providing paid medical services, the list of paid medical services, their cost, the conditions for providing, receiving and paying for these services, qualifications of specialists, benefits for certain categories of citizens, the mode of operation of the state healthcare organization, which are brought in the form of poster, booklet and other information.

An individual wishing to receive a paid medical service shall apply to the state healthcare organization with a written application.

In the contract concluded by the state health organization and the customer - individual, except for the case specified in part one of this paragraph, or by the customer - legal entity, the volume of paid medical services, the conditions and terms for their receipt, the payment procedure, the rights, obligations and responsibilities of the parties are determined.

Public health organizations are required to:

Ensure compliance of the paid medical services provided to the customer with the requirements established by law; keep statistical records of the paid medical services provided and submit information within the established time limits 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 control the quality of the provision of paid medical services within the limits of official duties of responsible persons of state healthcare organizations.

The customer of paid medical services is obliged to:

Timely pay the cost of paid medical services;

Submit the required health information;

Follow the rules internal regulations in a public health organization;

Timely inform the state healthcare organization about the circumstances that may affect the execution of the contract;

Perform other duties stipulated by the contract.

The customer has the right:

Require the presentation of a special permit (license);

Make claims for compensation for real damage caused by non-performance or improper performance the terms of the contract, 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-observance by the state healthcare organization of the obligation on the terms of performance of paid medical services of its choice (unless otherwise stipulated in the contract), give consent to a new term for the provision of paid medical services or require the performance of paid medical services by another specialist;

Terminate the contract and demand compensation for real damages;

Demand the payment of a penalty in the manner and amount determined by consumer protection legislation or an agreement.

1.9. The main orders governing the activities of the hospital:

1) Order of the Ministry of Health of the USSR No. 770 dated May 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 dated January 25, 1990 “On the establishment 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 dated 12/14/1990 "On medical 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 medical examination into a 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 dated 03.06.1992 “On 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) Decree of the Council of Ministers of the Republic of Belarus No. 801 dated December 31, 1992 “On Medical and Rehabilitation Expert Commissions”.

10).Order of the Ministry of Health of the Republic of Belarus No. 47 dated March 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 care to the population of the Republic of Belarus".

13). Order of the Ministry of Health of the Republic of Belarus - No. 132 dated July 14, 1993 "On improving the medical and sanitary provision of adolescents, students and conscripts 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 December 25, 1993 “On the establishment of medical rehabilitation departments”.

16). Order of the Ministry of Health of the Republic of Belarus No. 10 dated January 10, 1994 “On mandatory medical examinations of workers employed in harmful conditions labor."

17). Law of the Republic of Belarus No. 3317-X11 dated 10/17/1994 "On the Prevention of Disability and Rehabilitation of the Disabled".

19).Order of the Ministry of Health of the Republic of Belarus No. 159 dated November 20, 1995 "On the development of programs for synthesized prevention and improvement of the method of medical examination of the population."

20).Order of the Ministry of Health of the Republic of Belarus No. 192 dated July 29, 1997 "On voluntary medical insurance in the Republic of Belarus".

21). Decree of the Ministry of Health and the Ministry of Labor and Social Protection of the Republic of Belarus “On approval of the Instructions on the procedure for issuing sick leave certificates and certificates of temporary disability and the Instructions for filling out sick leave certificates and certificates of temporary disability” No. 52/97 dated 09.07.2002

22). "Instructions for determining the disability group": Approved by the Decree of the Ministry of Health of the Republic of Belarus No. 61 dated 12.08.2002

23). Instructions for determining the cause of disability ": Approved by the Decree of the Ministry of Health of the Republic of Belarus No. 61 of 12.08.2002

. STRUCTURE, FUNCTIONS, DOCUMENTATION OF THE RECEPTION ROOM. PROCEDURE FOR REFERRALING PATIENTS TO HOSPITALIZATION. RECEPTION AND DISCHARGE OF PATIENTS.

In accordance with the order of the Ministry of Health of the Republic of Belarus No. 22 dated April 24, 2006 “On improving the organization of medical care for the population by emergency departments (rooms) of healthcare institutions of the republic”, it is recommended to deploy diagnostic beds at emergency departments (3 per 100 inpatients).

The patient enters the hospital through the admission department, where the following are carried 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 for patients on admission.

Completion of medical documentation.

Distribution of patients by departments.

Sanitary treatment of patients.

Registration and accounting of admitted and discharged patients.

Receiving items and issuing them.

Reception of transfers for patients.

Meeting patients with relatives.

Providing emergency care.

Issuance of information about the patient's condition.

There are the following types of admissions to the hospital: planned (in the direction of the clinic); emergency (delivery by ambulance) and arrival by gravity. The hospital draws up a schedule of planned places by day of the week.

Located on the first 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), wardrobe, registry, hospital information desk, 2-examination room, 3-boxes for examining incoming patients, 4- sanitary room, 5 isolation room, 6 clothes storage chamber, 7 treatment room, 8 dressing room, 9 small operating room, 10 X-ray room, 11 laboratory, 12 medical staff room, 13 discharge room, 14 room doctor on duty, 15-toilet with a washbasin.

The main tasks of the admission department:

Registration of patients entering the admission department, accounting 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 diagnosis 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 researchers;

Conducting examinations and providing medical care to patients who 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;

Preparation and maintenance of established medical records;

Registration of documentation in case of refusal of hospitalization, including certificates of the established form on 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 the isolation ward);

Registration of the document “Protocol of medical examination of persons to establish the fact of alcohol, drug, substance abuse” (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, substance abuse”) ;

Transfer and registration of telephone messages to the police about all cases of citizens with violent bodily injuries, traffic accidents. Transfer and registration of information about corpses and persons delivered in an unconscious state without accompanying relatives or without identity documents at the accident registration office (ARNS);

Obtaining information by employees of the admission department about the movement of patients in the hospital;

Control over the validity of referral of patients for inpatient treatment and the correct execution of referral documents;

Relationship and succession with medical institutions: transfer of assets to the polyclinic, coordination of the 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;

Carrying out sanitization of patients referred to hospital departments;

Maintaining the constant readiness of the department to work in emergency situations and when identifying patients with AIO.

The work of the admission department of any hospital is regulated and based on a number of normative documents.

Reception documentation:

1. Accounting f. 001 / y - "Journal of admission and refusals in hospitalization."

2. Accounting f. 003 / y - "Medical card of an inpatient".

3. Accounting f. 066 / y - "Statistical card of the person who left the hospital."

4. Accounting f. 060 / y - "Journal of Infectious Diseases" identified in the admissions department.

5. Accounting f. 050 / y - "Journal of records of X-ray and cardiological examinations" (the data of X-ray examinations, ECG taken in the admission department are recorded in the log).

6. Accounting f. 069 / y - "Journal of recording outpatient operations."

7. Accounting f. 029 / y - "Journal of accounting procedures."

8. Accounting f. 074 / y "Journal of registration of outpatients", regardless of the reason for contacting the admissions department.

9. Protocol of medical examination to establish the fact of alcohol, drug and substance abuse (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, substance abuse”).

10. Journal of registration of analyzes and their results, taking biological material for chemical and toxicological studies (order 1773 dated February 18, 2002 “On approval of the Regulations on the procedure for examining persons to establish the fact of alcohol, drug, substance abuse”).

11. Journal of emergency tetanus prophylaxis performed (Order of the Ministry of Health of the Republic of Belarus No. 275 dated September 1, 1999 “On further improvement of the preventive vaccination schedule”).

12. Book of registration of poisonous and narcotic drugs in the offices of medical 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 poisonous, narcotic drugs and special prescription forms”).

13. Book of return of used drug ampoules (Order No. 215 dated 06/05/1999 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 the receipt and issuance of corpses."

15. Accounting f. 017 / y - "The act of ascertaining biological death."

16. Accounting f. 002 / y - "Journal of registration of the reception of pregnant women, women in childbirth and puerperas" (reception departments of maternity hospitals).

17. Accounting f. 096 / y - "History of childbirth" (reception departments of maternity hospitals).

18. Accounting f. 058 / y- "Emergency notification of an infectious disease, food, acute occupational poisoning, unusual reaction to vaccination."

19. Account f. 089 / y- "Notice of a patient with a first-ever established diagnosis of active tuberculosis, venereal disease, trichophytosis, microsporia, favus, scabies, trachoma, mental illness."

20. Journal of issued numbered certificates on the treatment of patients in the admissions department of the hospital.

21. Journal of the transfer of assets to polyclinics.

22. Journal of receipts for the acceptance of values ​​from the patient.

Organization of the work of the reception.

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 must 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 unit.

The work of the reception department is managed by the head of the department. Evening and night time, weekends and holidays direct supervision is carried out by the responsible doctor on duty in the admissions department.

For a clear organization of work on receiving patients, conducting examinations 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 patient or a suspect with especially dangerous infectious diseases, quarantine infection), the admission department should have:

A folder with instructions for emergency personnel on duty;

A folder with a set of documents in case a patient (suspicious) is detected for especially dangerous diseases, quarantine infections;

A folder with instructional documents for evacuation in case of fire, mines, and other cases of emergency;

A folder with current instructive and methodological materials of higher organizations and orders of the chief physician on the work of the admissions department;

Information material about specialized city centers and round-the-clock duty specialists in the city;

Information material with telephone numbers of emergency services and responsible duty officers of the Health Committee of the Grodno City Executive Committee, the Ministry of Health of the Republic of Belarus, the Ministry of Emergency Situations of the Republic of Belarus, the Minsk City Department of the Ministry of Emergency Situations;

A folder with instructions on the algorithm of actions of nursing staff in 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, bronchial asthma attack, pulmonary edema, eclampsia, uterine bleeding (additionally for maternity hospitals);

A folder with a set of instructions for observing the sanitary and anti-epidemic regime in the admissions department;

Standards for the examination of patients in the admissions department in accordance with the hospital bed profile;

Table of poisons and antidotes;

Duty schedule of responsible administrators and doctors on duty according to the profile of departments;

Regulations on the responsible doctor on duty.

Receptionist workflow.

Reception of patients is carried out by the in-line method, which excludes the possibility of a counter-flow of incoming and inpatient patients.

Patients arriving at the direction of a polyclinic doctor, another medical institution, an ambulance doctor (paramedic), as well as those who applied on their own, are subject to admission in the admissions department.

Upon admission of patients in the direction of medical institutions, the accompanying persons must have the following documents:

A doctor's referral indicating the diagnosis, the onset of the disease, the examination and treatment carried out before hospitalization, information about the indication of which disease is on the dispensary record, the medical care provided at the pre-hospital stage. When a child is referred for hospitalization by a doctor of a children's clinic, health-improving 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 located.

Accompanying sheet (account f. 114 / y), filled out by an ambulance paramedic 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 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 emergency department in the ambulance call card (account f. 110) indicating the date and time of the patient's admission and certifying this record with a stamp of the hospital admission department.

An extract from the medical history (account f. 027 / y) in case of transfer of a patient from a hospital department of one medical institution to another, indicating the diagnosis, nature of treatment, data from laboratory and other diagnostic studies, a list of treatments used, assessment of the condition and medical care provided before transfer to other hospitals.

Direction of the established form indicating the time and date of admission of the patient to the admission department, preliminary diagnosis, examination data and medical care, consultations of specialists, if any, justification for the transfer from the admission department of one medical institution to the admission department of another medical institution, indicating the time, method transportation and escort, the surname with whom the transfer was agreed.

When a patient is admitted, the nurse on duty or the medical registrar on duty enters all the data about the patient into the journal f.001 / y “Journal of admission and refusals in hospitalization”.

The journal includes all hospitalized patients and all those who are denied hospitalization from among those referred by ambulances and medical institutions.

In multidisciplinary hospitals with a large number of visits, the journal f. 001 / y can be carried out separately: one - for planned, the second - for patients hospitalized for emergency reasons and who are denied hospitalization.

In the other admission departments, registration of those hospitalized and those who are denied hospitalization, from among those referred, is carried out 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 examination by the doctor is necessary to analyze the length of stay in the emergency department of both emergency and planned patients.

If the patient is delivered to the emergency department in an unconscious state, the passport part is filled out according to the words of relatives or persons accompanying the patient. The duty staff 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 complete absence of documents and the impossibility of obtaining oral information about the identity of an unconscious patient, 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 personality in the passport part of the journal f. 001/u changes are 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 record in the medical history of the results of the examination, the formulation of a preliminary diagnosis;

b) upon admission of patients for emergency and urgent indications:

The injured and sick 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 the case of delivery of a patient in a serious condition, the ambulance medical worker transfers the patient to the doctor on duty of the admission department “from hand to hand”;

In cases where any additional consultations and studies 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 emergency department (the ambulance doctor (paramedic) should not linger in the emergency departments of hospitals);

If the delivered patient needs only outpatient care or short-term medical supervision, the doctor on duty at the admission department, 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 (unconsciousness, collapse, myocardial infarction, etc.), he should 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 for which the patient is referred to the hospital. The resuscitator records the results of his examination separately. The best option is a joint record of 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 admissions doctor must:

Perform 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 in the staff of the admission department, to patients with an undetermined diagnosis and unclear forms of the disease;

After examining the patient and assessing the ongoing examination, the conclusions of specialists, make a decision on the hospitalization of the patient in a specialized hospital department;

Clearly draw up a “medical record of an inpatient patient” (f. 003 / y), indicating the date, hours, minutes of the patient’s examination in the admissions department, make notes on the patient’s condition and data on the examination, manipulation, drug treatment;

Depending on the condition of the patient, 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 without fail before being hospitalized in a specialized department, or before being transferred to other hospital institutions, are examined by specialists from the department of anesthesiology, resuscitation and intensive care;

In all cases of a patient's delay in the admission department for a period of more than one hour, the doctor on duty must make a special note in the medical history and indicate the reasons for the delay.

Upon admission, patients with:

Bodily injuries associated with gunshot, stab-cut, chopped wounds, fractures, frostbite, bruises, concussions, and so on;

Bodily injury and poisoning associated with attempted suicide;

Bodily injuries and poisonings resulting from burns with acids and various toxic substances;

Wounds and injuries received in explosions and other emergencies;

Injuries and injuries associated with careless handling of firearms and ammunition;

Injuries resulting from traffic accidents;

Bodily injuries and injuries associated with the unsatisfactory condition of building structures, buildings, structures and violations of safety at work;

Other bodily injuries with suspected 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 journal, indicating the name of the person who received the information, the time and date.

Absolute indications for hospitalization should be considered acute diseases, injuries, emergency conditions, the treatment of which is possible only in a hospital.

Relative indications for hospitalization are diseases that require inpatient treatment at the first stage, followed by follow-up care in outpatient treatment and prevention facilities, diseases requiring in-depth inpatient examination for the purpose of differential diagnosis (exacerbation of gastric ulcer, chronic pancreatitis, stenosis of the celiac trunk, 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 cases of death of a patient delivered for inpatient treatment and deceased in the emergency department should be regarded as death in a hospital. An entry should be made about each such patient in the “Journal of Admission and Refusals in Hospitalization” f 001 / y and the “Medical Card of the Inpatient Patient” (f 003 / y) should be filled in, where all resuscitation measures, laboratory and other diagnostic tests should be noted. research.

Terms and outcomes of treatment in accordance with the disease that caused death, registration of this fatal case is carried out in the intensive care unit.

If an infectious disease is suspected, the duty doctor of the admission department is obliged to:

Isolate the patient in an isolation room (stay no more than 6 hours);

Organize hourly monitoring of the patient, provide medical care;

Carry out the necessary amount of diagnostic research, consultation of specialists;

Transfer the patient to the 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 an emergency notification are transmitted to the CG and E (no later than 24 hours from the moment the disease was detected).

The doctor on duty of the admission department, who detected an infectious disease, is obliged to organize all anti-epidemic measures.

When a patient (suspicious) is detected for especially dangerous infections, the doctor on duty takes measures in accordance with the instructions for the OOI.

If a patient is admitted under the influence of alcohol if it is not possible to immediately resolve the issue of hospitalization, the doctor on duty of the admission department is obliged to organize careful monitoring of him, the necessary amount of examination. Responsibility for the life of the patient is fully borne by the staff of the admission department, in connection with which all decisions made, and especially the decision to refuse hospitalization, must 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 identifying cardiovascular pathology and other diseases in patients intoxicated, it is necessary to provide them with medical care in a timely manner.

The issue of sending such patients to hospital departments in another hospital or refusing hospitalization is decided jointly with the responsible duty officer in the hospital in accordance with the requirements of the healthcare legislation.

Refusal of the patient from hospitalization :

In the event of a categorical refusal of 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 admission department is obliged to:

Conduct a thorough examination of the patient and the necessary laboratory and other studies;

Explain to the patient and his accompanying relatives the need for hospitalization and the possible consequences of refusing hospitalization;

Call the head of the department to the admission department for examination of the patient (in the evening, at night, weekends and holidays - the responsible doctor on duty - specialist);

Record in detail in the journal f. 001 / y data of a joint examination with the head of the department (responsible doctor on duty - specialist), indicating the time of examination and care of the patient.

Refusal of medical intervention, as well as of hospitalization with an indication of the possible consequences, to issue in the journal f. 001 / by the patient himself or his relatives with the signature of the patient, as well as the doctor and the head of the department (responsible doctor on duty - specialist);

Issue to the patient a certificate of stay in the admissions department indicating the results of the examination, consultations, special laboratory and other research methods, diagnosis, medical and labor recommendations;

Transfer the "asset" to the territorial clinic;

Registration of the date, time, surname of the person who accepted the "asset" should be made in the "asset transfer journal".

The specified procedure can be only in the absence of chronic mental illness, acute mental disorders, especially those caused by 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 surgical treatment, is decided by a council of doctors (at least 3 specialists), a psychiatrist is urgently called for a consultation.

In cases where the patient needs to be transferred to other hospital facilities, in the absence of the necessary bed profile in the hospital, the doctor of the admission department is obliged to:

Conduct an examination of the patient and, if necessary, additional diagnostic studies;

Make an entry in the journal. 001 / y, indicating the date, time of inspection, inspection data and ongoing research. Establish a preliminary diagnosis, justify 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 consultation with the responsible duty officer in the hospital (in the daytime - the head of the admissions department);

Issue a referral in the prescribed form indicating the diagnosis, data from laboratory and instrumental studies, and therapeutic measures provided;

Organize the transportation of the patient by ambulance transport of the hospital, 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 using ambulance vehicles are recorded by the employees of the admission department in the "Journal of the use of ambulance vehicles of the hospital".

In the event that a patient has a disease that does not require emergency hospitalization, the doctor of the admission department is obliged to:

To register the patient in the journal f. 001/y;

Perform a thorough examination and the necessary volume of diagnostic studies, call a specialist doctor for a consultation, establish a diagnosis, provide medical assistance;

Issue a certificate of the established form on the patient's stay in the admissions department, indicating the diagnosis, the data of the examination, the medical assistance provided, and give recommendations for further monitoring in the clinic;

Explain to the patient and his relatives that there is no need for emergency hospitalization. In a conflict situation, when, with the persistent demand 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 of the admission department is obliged to conduct examinations of the patient together with the head of the surgical department or the responsible surgeon on duty.

The doctor on duty of the admission department is obliged to immediately notify the relatives of patients in the following cases:

Upon admission to the hospital of a child under 18 years of age unaccompanied by parents, regardless of the severity of the disease;

Upon admission of patients in an unconscious state (if documents are available), as well as in cases where the patient, taken to the hospital, is in a state recognized as life-threatening;

When transferring a patient to another hospital directly from the admissions department;

When delivering an ambulance to a patient due to accidents;

About all patients admitted unaccompanied by relatives in the order of ambulance in case of sudden diseases outside the home;

In case of death in the emergency department;

In case of 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 register of outpatients f. 074/u.

If the patient enters the admission department of the hospital "by gravity" the doctor of the admission department is obliged:

Carry out registration of the patient in the "Journal of registration of outpatients" f. 074/y;

Make an examination of the patient, conduct a diagnostic examination, provide medical care, organize a consultation with specialists;

If there are indications for hospitalization, refer the patient to the specialized department, register in the journal f. 001 / y and "Medical record 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 care. In the "Journal of registration of outpatients" f. 074/y records the results of a medical examination, diagnostic studies, conclusions of specialists involved in the consultation, diagnosis, medical care provided, recommendations for observation in the clinic, indicating the time of examination and care of the patient. The patient is issued a certificate of the established form about his stay in the admissions department with an indication of the diagnosis, the diagnostic study performed, the amount of medical care provided, recommendations. In cases requiring dynamic supervision by 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 hospitalization.

Diagnostic beds (chambers - isolators)

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 with alcohol are hospitalized in the wards - insulators, if it is not possible to immediately resolve the issue of hospitalization.

This group of patients should be monitored hourly by a responsible doctor of the appropriate profile. For all patients hospitalized in these wards, a medical history is filled in, according to the serial number of registration in the journal f. 001 / y, but not taken into account in f. 014 (report of a medical institution).

If the patient is not hospitalized, the medical history is archived 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 in diagnostic wards during the daytime, by a specialist doctor on weekends, in the evening and at night, and, together with the head of the department of the corresponding profile, decides whether to send them to hospital departments or discharge . Patients are registered in 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 rooms and are hospitalized in specialized departments or intensive care units.

In the case of subsequent hospitalization of this patient, the medical history is entered with the same numbering, and the medical history, taken while in the diagnostic beds, is pasted into the history as an insert.

CONTENTS 1. The main regulatory orders for the organization of the work of the surgical department. 2. Organization of the work of the post of the surgical department 3. Organization of the work of the dressing room 4. Organization of the work 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 operation of bactericidal irradiators by 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 zone. 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 documents. Rules of the surgical department.

Slide 26 from the presentation "Regulations of the work of middle and junior medical personnel within the framework of the quality management system"

Dimensions: 720 x 540 pixels, format: .jpg. To download a slide for free to use in a lesson, right-click on the image and click "Save Image As...". You can download the entire presentation "Regulations of the work of middle and junior medical personnel within the framework of the quality management system.ppt" in a zip archive of 6140 KB.

Download presentation

Types of management

"Information Management" - Concept information management. Information management covers all aspects. Various informational resources and Information Systems. The meaning and role of information management in modern society. The concept of information management. The main directions of information management.

"Communication Management" - Evidence from internal research in Russian companies. Let's compare the possibilities. Project. We need a lobbyist. Manager's communication skills. Communicative literacy. Risks. Typical training. Agency. We do it ourselves or invite experts. How to involve management in communications. Data from internal studies.

"Strategic management" - Coordinate system (axes, units) Risks and compensations. Some key strategic concepts(one). Some key strategic concepts (2). I. Brodsky. Time shrinks: Firm? project, position? business trip. Strategic management Greek strategos, from stratos - army and ago - I lead. Introduction.

"Financial management of the enterprise" - Characterizes the change in indicators for reporting period. Main functions financial manager(continuation). Topic 4. Funding sources entrepreneurial activity. Regulatory legal regulation. Involved funds. Price policy. Subordinated - in demand after bonds that have an advantage in redemption.

"Quality Management System" - Regulations this document were developed taking into account the current international and European practice of certification and accreditation of regulatory documents. Russian certification systems. International certification practice. Process approach. The main stages of building a quality management system.

 

It might be useful to read:

• Resume - a step towards obtaining the position of a tourism manager Resume of an assistant tourism manager sample;
• Some standards for project activities;
• Some standards for project activities;
• Filled sample resume for system administrator, IT specialist (example) Resume for the position of system administrator example;
• Sample Veterinarian Resume General Requirements for a Veterinarian;
• Key Responsibilities of a Bartender;
• Job Responsibilities of a Bartender;
• Sample resume of a PC operator Achievements in a resume of a PC operator;