inpatient medical service history

THE ORGANIZATION AND THE ORGANIZATION AND THE ANALYSIS OF THE THE ANALYSIS OF THE

INPATIENT MEDICAL AIDINPATIENT MEDICAL AID

Lecturer: Ph.D., Assosiate Professor Elena A. AbumuslimovaLecturer: Ph.D., Assosiate Professor Elena A. Abumuslimova

Inpatient medical service Inpatient medical service historyhistory

o Inpatient care goes back to 230 BC

in India where Ashoka the Great

founded 18 hospitals.

o The Romans also adopted the

concept of inpatient care by building a

specialized temple for sick patients in

291 AD on the island of Tiber.

From Wikipedia, the free encyclopedia

It is believed the first inpatient care in North America

was provided by the Spanish in the Dominican

Republic in 1502; the

Hospital de Jesús

Nazareno in Mexico City

was founded in 1524 and is

still providing inpatient

care.

From Wikipedia, the free encyclopedia


Perhaps the most famous

provider of inpatient care was

Florence Nightingale who was

the leading advocate for

improving medical care in the

mid-19th century. Florence Nightingale 12 May 1820 – 13 August 1910


General characteristic General characteristic of the inpatient medical aidof the inpatient medical aid

A hospital is a health care institution providing

patient treatment by specialized staff and

equipment.

There are over 17,000 hospitals in the world.

Levels of the in-patient Levels of the in-patient medical caremedical care

(1)(1)

• Local level – local hospitals, local maternity homes. There is general type of hospital medical aid in this establishments. These hospitals serve only local population and carry out local function. Usually they have branches on therapy, surgery, obstetric, infectious.

• District level – district hospitals, district maternity home. Here people can receive general and some kind of specialized type of inpatient medical aid. There are dermatological, ophthalmologic, otolaryngology, urological and other branches.

• Regional level – regional hospitals. There are general, specialized and highly tailored type of inpatient medical aid in this establishments. These hospitals carry out local, intermediate and regional functions, cover the big territory with wide spectrum of the specialized help (modern cancer therapy, chest surgery, cardiology, etc.).

• Federal level – medical establishments caring out only some kind of highly tailored and unique type of inpatient medical aid. Its may be scientific-research establishments, medical centers.


(2) (2)


(3) (3)

• Rural hospitals form the separate group. They play a role of the elementary medical and hospital centre in the remote villages.

•Primary (general)

•Secondary (specialized)

•Tertiary ( highly tailored)

Types of the inpatient Types of the inpatient medical care:medical care:

General characteristic General characteristic of the inpatient medical aid of the inpatient medical aid (1)(1)

Organizational forms of rendering of the in-patient

services to the population, structure of hospital

establishments and their accommodation depend

on:

o morbidity level among population on the territory;

o disease structure of the population;

o age-sexual structure of the population;

o features of residence.

The hospital medical aid is carried out at the

heaviest diseases demanding application of

complex methods of diagnostics, therapeutic

treatment, operative intervention, constant

medical supervision and qualified care.

This is the most expensive type of medical aid

but the most effectiveness from the medical and

social point of view.

General characteristic General characteristic of the inpatient medical aidof the inpatient medical aid (2)(2)

Reasons for Reasons for hospitalisation:hospitalisation:

o the case of diseases requiring a comprehensive

approach to diagnosis and treatment;

o the use of complex methods for examination

o treatment with the using of modern high-tech

medical equipment;

o surgery;

o continuous round-the-clock medical supervision

and intensive care.

Negative reasons for inefficient Negative reasons for inefficient using of hospital in Russiausing of hospital in Russia

o inadequate extension hospital beds;

o high rates of inappropriate and non-core hospitalization;

o inadequate increase of terms of stay of the patient in the

hospital;

o hospitalization of patients in unprepared to provide a

profile of medical aid medical institutions;

o high frequency of transfers of patients from one medical

facility (the unprepared or non-core) to another.

Optimisation hospital services in Optimisation hospital services in RussiaRussia

(1)(1)

1. Implementation stages of medical care on the basis of rational distribution of functional duties hospitals:

- municipal (city and district) – to provide primary care in emergency cases;- inter-district - for specialized assistance, including emergency cases and conditions requiring treatment and rehabilitation;- federal - to provide specialized including high-tech service

Optimisation hospital services in Optimisation hospital services in Russia (2)Russia (2)

2. Introduction to the clinical departments of hospitals:o disease management protocols and standards of care; o registers for hospital patients; o health care quality management system.

3. Installation and stuffing of hospitals with qualified personnel according to approved standards.


4. Expansion of volumes and the introduction of new types of high-tech medical assistance.

5. Round-the-clock telemedicine links between municipal and regional level hospitals.

6. To intensify the work of hospital beds through the introduction of hospital-replacing diagnostic technologies at the outpatient level and organization of gradual rehabilitation (medical attendance service, the system aftercare and rehabilitation).


7. Improvement of the tariff policy, based on the consideration not only of the type and amount of medical assistance, but also on its qualityon its quality;

8. Improvement aims of the hospital work reflecting the quality of medical aid (lethality rate, the degree of restoration of the disturbed functions).

Classification Classification of in-patient establishments of in-patient establishments (1)(1)

Depending on a bed capacities Depending on a bed capacities hospital are divided into categories. Very large and very small hospitals are considered to be not included into any category.

(Lisitcyn J.P., Kopit N.J., 1984 classification)

Capacity Number of beds

I More than 800 beds

II 600-800

III 500-600

IV 400-500

V 300-400

Classification Classification of the in-patient establishments of the in-patient establishments (2)(2)

Depending on a kind there areDepending on a kind there are:

o multifield hospitalso specialized hospitalso dispensaries


Due to the regulations of hospitalization there areDue to the regulations of hospitalization there are:

o first aid hospitals o hospital for list hospitalization o hospital for the general (mixed) hospitalization.


According to the system of their organization there are:o united with polyclinic hospitals o non-united with polyclinic hospitals.

For the district, regional and federal hospitals presence of polyclinic as a structural part is always obligatory.

Functions Functions of the in-patient establishments of the in-patient establishments by WHOby WHO

Function of hospital establishments are dynamic concepts and depend on the tasks set at the given stage of development of public health services.

The WHO suggested to systematize functions of modern hospital in four groups:

• rehabilitation & treatment (diagnostics and treatment of diseases, rehabilitation and urgent medical aid);• preventive, especially for hospitals united with a polyclinic (medical-improving activity, prevention of infectious and chronic diseases, disablement);• education (training of medical personnel and its post-diploma specialization);•research.

Hospital structureHospital structure

•Management department: the head-physician, his deputies (for medical department, polyclinic, medical working capacity examination), medical statistics department, medical archive, accounts department, library, etc.• reception department• medical (curative) department (surgical, therapeutic, neurological, urological, etc.)• the specialized medical departments (physiotherapeutic, exercise therapy, massage, etc.), • separate diagnostic services (it includes different laboratories, rooms – electrocardiographic, x-ray, etc.)• drugstore,• department of morbid anatomy,• maintenance department (nutrition unit, storehouses, laundry, technical department, transport, etc.)

Organization principles of work of the Organization principles of work of the

hospitals :hospitals :

medical care of the in-patient medical care of the in-patient

establishmentsestablishments

• Direct treatment of patients is executed by doctors - interns, which basic elements of work are carrying out the inpatient case record, diagnostics and treatment, examination of work capacity, rehabilitation and regenerative treatment, consultations.

• Load of hospital doctor is about 20-25 patients.

The basic registration The basic registration

documentsdocuments

• a medical card of the inpatient (case history; registration form № 003/y)• a discharge card (form № 055/y)• a register of operations (form № 008/y)• a register of reception of patients and refusals from hospitalization (form № 001/y)• form for the daily account of patients and beds fund (form № 007/y)• a register of medical autopsy (form № 012/y)

The basic accounting documentsThe basic accounting documents

• Data on treatment-and-prophylactic establishment (the annual report, form № 30)• Data on the medical and pharmaceutical staff (form № 17)• Data on activity of a hospital (form № 14)• Data on activity of the treatment-and-prophylactic establishments working in a system of OMI for certain year (form № 52)• Data about bed fund and its use for 12 month period

An analysis of activity An analysis of activity

of inpatient medical serviceof inpatient medical service

More than 100 different parameters of inpatient medical aid are

widely used. All parameters can be grouped, since they reflect

certain directions of functioning of hospital:

• supply of the population with inpatient aid;

• load of the medical staff;

• material and medical equipment;

• use of bed fund;

• completeness of medical staff;

• quality of the inpatient medical aid and its efficiency

The main quantitative indicators The main quantitative indicators of hospital activityof hospital activity

I. Provision of the population with the hospital

medical help

II. Load of medical personnel

III. Material-technical medical equipment

IV. Indicators use bed facility

V. Indicators of staffing

The main qualitative indicators The main qualitative indicators of hospital activityof hospital activity

1. Hospital lethality

2. The proportion of patients fully or partially regained the functional independence and ability to work among all treated patients.

3. Level of postoperative complications.

4. The structure of outcomes of hospitalisation, etc.

An analysis of quality of treatment in a An analysis of quality of treatment in a

hospital^hospital^

parameters of bed fund useparameters of bed fund use

• mean annual occupation of bed (average occupation of a bed for municipal hospital is 330-340 days, for rural hospitals – 300-310 days; for municipal maternity homes – 300-310 days, for rural maternity home – 280-290 days);

• mean duration of patient’s stay in a hospital – from 17 to 19 days (causes of long-lasting treatment in a hospital: severity of disease, late diagnostics of diseases, cases when patients aren’t prepared for hospitalization – not examined, etc.);

• bed turnover is one of the major parameter of efficiency of bed fund use (mean number of patient is 17-20 and more patients)

• a mean idle time of a bed;• dynamics of bed fund

Planning for inpatient carePlanning for inpatient care

Health planning is a well-grounded calculation of

the network of health care establishments, their

staffs, medical network, indicators of use of the

bed facility, financial and material support.

The required basic data for The required basic data for planningplanning

1. Data about the level of public health;

2. Information about existing network of medical

institutions, staffs and public health

establishments;

3. Information about economic situation of the

district, future prospects of its development;

4. Assessment of sanitary-epidemiological

conditions in the region;

General characteristic General characteristic of the inpatient medical aidof the inpatient medical aid

Approximate standard for the inpatient medical aid to the population (per 1000 people)

Kind of beds Standard

General 13,2

Therapeutic 2,8

Surgical 0,9

Obstetrical 0,8

The density of hospital bedsThe density of hospital beds

The density of hospital beds in the adult population in Russia is on average of 13.2 beds per 1000 inhabitants, child (up to 18 years) - 9 beds per 1000 children.

17

МЕЖДУНАРОДНЫЕ ПРИНЦИПЫ ОЦЕНКИ ОБЕСПЕЧЕННОСТИ КОЙКАМИ

РОССИЙСКАЯ ФЕДЕРАЦИЯ

ВЕНГРИЯ

ФРАНЦИЯ

МАЛЬТА

АВСТРИЯ

ГЕРМАНИЯ

ЮЖНАЯ КОРЕЯ

ЯПОНИЯ

СТРАНЫ ПЛОТНОСТЬ НАСЕЛЕНИЯ

(ЧЕЛОВЕК НА 1 КМ2)ОБЕСПЕЧЕННОСТЬ КОЙКАМИ НА 10 ТЫС.*

8,4

107

118

1 287

98

230

494

336

87,8

71

72

78

78

83

86

139

В СООТВЕТСТВИИ С МЕЖДУНАРОДНЫМИ И РОССИЙСКИМИ ТРЕБОВАНИЯМИ ПОКАЗАТЕЛЬ ОБЕСПЕЧЕННОСТИ КОЙКАМИ ДОЛЖЕН УЧИТЫВАТЬ ПЛОТНОСТЬ НАСЕЛЕНИЯ И ПРОТЯЖЕННОСТЬ ТЕРРИТОРИИ СТРАНЫ (ПРИНЦИПЫ ДОСТУПНОСТИ)

:ТРЕБОВАНИЯМ МЕЖДУНАРОДНЫМ ПО КОЙКАМИ БЕСПЕЧЕННОСТЬО

*ИСТОЧНИК: ДОКЛАД ВОЗ «МИРОВАЯ СТАТИСТИКА ЗДРАВООХРАНЕНИЯ», ОПУБЛИКОВАН В 2011 ГОДУ

КАНАДА 3,4 34

МЕЖДУНАРОДНЫЕ ПРИНЦИПЫ ОЦЕНКИ ОБЕСПЕЧЕННОСТИ ВРАЧАМИ

В СООТВЕТСТВИИ С МЕЖДУНАРОДНЫМИ ТРЕБОВАНИЯМИ ПОКАЗАТЕЛЬ ОБЕСПЕЧЕННОСТИ ВРАЧАМИ РАССЧИТЫВАЕТСЯ, ИСХОДЯ ИЗ ФАКТИЧЕСКОЙ ЧИСЛЕННОСТИ ВРАЧЕЙ КЛИНИЧЕСКИХ СПЕЦИАЛЬНОСТЕЙ

РОССИЯ**

ФРАНЦИЯ

ГЕРМАНИЯ

АВСТРИЯ

ИСПАНИЯ

ШВЕЙЦАРИЯ

ПО СТРАНАМ ОЭСР

СТРАНЫ

ОБЕСПЕЧЕННОСТЬ ВРАЧАМИ НА 10 ТЫС.*

2009 Г 2010 Г

26,7

37

35

38

38

40

30,2

В МЕЖДУНАРОДНЫЙ ПОКАЗАТЕЛЬ ОБЕСПЕЧЕННОСТИ ВРАЧАМИ В РЯДЕ СТРАН НЕ ВКЛЮЧАЮТСЯ:

РАСЧЕТ ОБЕСПЕЧЕННОСТИ ВРАЧАМИ ПО МЕЖДУНАРОДНЫМ ТРЕБОВАНИЯМ:

СТОМАТОЛОГИ

ФАРМАЦЕВТЫ И КЛИНИЧЕСКИЕ ФАРМАКОЛОГИ

ОРГАНИЗАТОРЫ ЗДРАВООХРАНЕНИЯ И РУКОВОДИТЕЛИ МЕДИЦИНСКИХ ОРГАНИЗАЦИЙ

ВРАЧИ САНИТАРНО-ЭПИДЕМИОЛОГИЧЕСКИХ СЛУЖБ И МЕДИКО-САНИТАРНОЙ ПОМОЩИ

ВРАЧИ ДИАГНОСТИЧЕСКИХ СПЕЦИАЛЬНОСТЕЙ, НАПРИМЕР, ВРАЧИ-ЛАБОРАНТЫ, ПАТОЛОГОАНАТОМЫ, ЭНДОСКОПИСТЫ, РЕНТГЕНОЛОГИ, БАКТЕРИОЛОГИ, ВРАЧИ УЛЬТРАЗВУКОВОЙ ДИАГНОСТИКИ, СУДЕБНО-МЕДИЦИНСКИЕ ЭКСПЕРТЫ

КАНАДА 19

ОБЕСПЕЧЕННОСТЬ

СРЕДНИМ МЕДПЕРСОНАЛОМ НА 10 ТЫС.*

2009 Г 2010 Г

67,1

81

80

66

74

110

75,4

100

ШВЕЦИЯ 36 116

НОРВЕГИЯ 39 163

26,3

35

35,3

47,5

37,1

40,7

31

19,1

35,8

40,8

63,4

89,4

108,2

78,4

51,6

159,6

76

100,5

115,7

147,6

*ИСТОЧНИК: ДОКЛАД ВОЗ «МИРОВАЯ СТАТИСТИКА ЗДРАВООХРАНЕНИЯ», 2010, 2011 ГОДЫ

** РАСЧЕТ ПРОИЗВЕДЕН В СООТВЕТСТВИИ С МЕЖДУНАРОДНЫМИ ДАННЫМИ ПО ОБЕСПЕЧЕННОСТИ ВРАЧАМИ, ИСХОДЯ ИЗ ФАКТИЧЕСКОЙ ЧИСЛЕННОСТИ ВРАЧЕЙ КЛИНИЧЕСКИХ СПЕЦИАЛЬНОСТЕЙ

The organization of medical The organization of medical aid aid to rural populationto rural population

The factors that determined organizational forms and methods of work of rural medical institutions:

•character of spreading of the population, •area of coverage,• seasonal prevalence of works, •influence of weather conditions at the field works, •specific conditions of labor process, •disorder of economic - household activity and conditions of life, •regional and national features and customs,• educational and cultural level, etc.

Factors affecting the Factors affecting the organisation of medical care organisation of medical care for rural peoplefor rural people

• the distance of medical institutions from the residence of patients,

• enough qualified personnel and the equipment, • • opportunities to receive specialized medical aid,

• opportunity for realisation of specifications of medico-social security.

Three stages of medical care Three stages of medical care to rural populationto rural population

1. Rural medical outpost or territorial medical associations (local hospital, para medical and obstetrical outposts, health centers, maternity hospitals, a day nursery - kinder gardens, etc.). At this stage rural population receive the the qualified medical aidqualified medical aid;

2. District level, where the main establishment is the central district hospital. Rural population receives the qualified qualified specialized medical aid of basic kindsspecialized medical aid of basic kinds.

3. Regional hospital, clinics, dentist polyclinic, regional territorial sanitary-epidemic management establishment, etc. At this stage is implemented a highly skilled medical highly skilled medical aid on all specialitiesaid on all specialities.

Structure of a primary link of Structure of a primary link of medical aid to rural medical aid to rural populationpopulation

The rural paramedical-obstetric outpostrural paramedical-obstetric outpost is a link of first patients contact in system of health services.Its primary goals are rendering the pre-medical help and carrying out sanitary-antiepidemic actions directed on prophylaxis of diseases, decrease in morbidity and traumas, increase of sanitary and hygienic culture of the population.

Paramedical staff renders the first medical aid at acute conditions and traumas, carry out vaccination, physiotherapeutic actions, etc.Paramedical and obstetrical outposts are organized in settlements where number of inhabitants varies from 700 up to 1000

Structure of a primary link of Structure of a primary link of medical aid to rural medical aid to rural populationpopulation

The basic medical institution basic medical institution on a rural medical outpost is the local hospital local hospital or polyclinic.

Character and volume of medical aid in local hospital basically are determined by its capacity, equipment and presence of doctor-experts.

The number of staff of rural hospital is depending on its capacity, population and distances up to central regional hospital, there have to be doctors of the basic specialities (therapy, pediatric, stomatology, obstetrics, gynecology and surgery).

Duties of local hospital Duties of local hospital doctordoctor

oTreatment of therapeutic and infectious patients

o Deliveries medical aid

o Treatment-and-prophylactic help to children

o Urgent surgical and traumatological help

Structure of secondary link Structure of secondary link of medical aid to rural of medical aid to rural populationpopulation

The main link in public health service of rural area is central regional hospital central regional hospital (CRH), which carries out the specialized medical aid by its basic kinds and an organizational - methodical management of all medical institutions of area.

In its structure CRH has the following divisions: hospital with the basic specialized branches, polyclinic with advisory receptions of doctors - experts, medical - diagnostic branches, organizational -methodical cabinet and other structural divisions (mortuary, mess, pharmacy, etc.).