the organization and the analysis of the inpatient medical aid

8/15/2019 The Organization and the Analysis of the Inpatient Medical Aid

1/45

THE ORGANIZATION ANDTHE ORGANIZATION AND

THE ANALYSIS OF THETHE ANALYSIS OF THE

INPATIENT MEDICAL AIDINPATIENT MEDICAL AID

Lecturer: Ph.D., Assosite Pro!essor E"e# A. A$u%us"i%o&Lecturer: Ph.D., Assosite Pro!essor E"e# A. A$u%us"i%o&


2/45

INPATIENT MEDICAL SERVICE

HISTORY

o Inpatient care goes back to 230 BC

in India where Ashoka the Great

founded 18 hospitals.

o he !o"ans also adopted the

concept of inpatient care b# building a

speciali$ed te"ple for sick patients in

2%1 A& on the island of iber.

From Wikipedia, the free encyclopedia

http://smb//upload.wikimedia.org/wikipedia/commons/6/60/Chakravatin.JPG


3/45

It is belie'ed the first inpatient care in (orth A"erica

was pro'ided b# the )panish in the &o"inican

!epublic in 1*02+ the

,ospital de -ess

(a$areno in /eico Cit#

was founded in 1*2 and is

still pro'iding inpatient

care.

From Wikipedia, the free encyclopedia


HISTORY


4/45

erhaps the "ost fa"ous

pro'ider of inpatient care was

lorence (ightingale who was

the leading ad'ocate for

i"pro'ing "edical care in the

"id41%th centur#. Florence Nightingale12 May 1820 – 13 August 1910


HISTORY


5/45

GENERAL CHARACTERISTIC

OF THE INPATIENT MEDICAL

AIDA hospital is a health care institution pro'iding

patient treat"ent b# speciali$ed staff and

e5uip"ent.

here are o'er 167000 hospitals in the world.


6/45

LEVELS OF THE IN-PATIENT

MEDICAL CARE

(1)• ocal le'el 9 local hospitals7 local "aternit# ho"es. here is

'e#er" t#pe of hospital "edical aid in this establish"ents.

hese hospitals ser'e onl# local population and carr# out local function. :suall# the# ha'e branches on therap#7

surger#7 obstetric7 infectious.

• &istrict le'el 9 district hospitals7 district "aternit#

ho"e. ,ere people can recei'e general and so"ekind of speciali$ed t#pe of inpatient "edical aid. here are

der"atological7 ophthal"ologic7 otolar#ngolog#7 urological

and other branches.


7/45

• !egional le'el 9 regional hospitals. here are

general7 speciali$ed and highl# tailored t#pe of inpatient

"edical aid in this establish"ents. hese hospitals carr# outlocal7 inter"ediate and regional functions7 co'er the big

territor# with wide spectru" of the speciali$ed help

;"odern cancer therap#7 chest surger#7 cardiolog#7 etc.


8/45


9/45

•ri"ar# ;general<

•)econdar# ;speciali$ed<

•ertiar# ; highl# tailored<

TYPES OF THE INPATIENT

MEDICAL CARE:


10/45


OF THE INPATIENT MEDICAL AID(1)

=rgani$ational for"s of rendering of the in4patient

ser'ices to the population7 structure of hospital

establish"ents and their acco""odation depend

on>

o %or$i(it) le'el a"ong population on the territor#+

o (isese structure of the population+

o 'e*se+u" structure of the population+

o features of residence.


11/45

he hospital "edical aid is carried out at the

hea'iest diseases de"anding application of

co"ple "ethods of diagnostics7 therapeutic

treat"ent7 operati'e inter'ention7 constant

"edical super'ision and 5ualified care.

his is the "ost epensi'e t#pe of "edical aid

but the "ost effecti'eness fro" the "edical and

social point of 'iew.


OF THE INPATIENT MEDICAL AID (2)


12/45

REASONS FOR HOSPITALISATION:

o the case of diseases re5uiring a co"prehensi'e

approach to diagnosis and treat"ent+

o the use of co"ple "ethods for ea"ination

o treat"ent with the using of "odern high4tech

"edical e5uip"ent+

o surger#+

o continuous round4the4clock "edical super'ision

and intensi'e care.


13/45

NEGATIVE REASONS FOR

INEFFICIENT USING OF

HOSPITAL IN RUSSIAo inadequate extension hospital beds

o high rates o! inappropriate and non"core hospitali#ation

o inadequate increase o! ter$s o! stay o! the patient in the

hospital

o hospitali#ation o! patients in unprepared to pro%ide a

pro!ile o! $edical aid $edical institutions

o high !requency o! trans!ers o! patients !ro$ one $edical

!acility &the unprepared or non"core' to another(


14/45

OPTIMISATION HOSPITAL

SERVICES IN RUSSIA

(1)1. I"ple"entation stages of "edical care on the

basis of rtio#" (istri$utio# o! !u#ctio#" (uties

hosit"s>

4 "unicipal ;cit# and district< 9 to pro'ide

pri"ar# care in e"ergenc# cases+

4 inter4district 4 for speciali$ed assistance7

including e"ergenc# cases and conditionsre5uiring treat"ent and rehabilitation+

4 federal 4 to pro'ide speciali$ed including high4

tech ser'ice


15/45


SERVICES IN RUSSIA (2)

2. Introduction to the clinical depart"ents of

hospitals>

o disease "anage"ent protocols and standardsof care+o registers for hospital patients+o health care 5ualit# "anage"ent s#ste".

3. Installation and stuffing of hospitals with

5ualified personnel according to appro'ed

standards.


16/45



. ?pansion of 'olu"es and the introduction of

new t#pes of high4tech "edical assistance.

*. !ound4the4clock tele"edicine links between

"unicipal and regional le'el hospitals.

@. o intensif# the work of hospital beds through

the introduction of hospital4replacing diagnostictechnologies at the outpatient le'el and

organi$ation of gradual rehabilitation ;"edical

attendance ser'ice7 the s#ste" aftercare and

rehabilitation


17/45



6. I"pro'e"ent of the tariff polic#7 based on the

consideration not onl# of the t#pe and a"ount of

"edical assistance7 but also on its 5ualit#on its 5ualit#+

8. I"pro'e"ent ai"s of the hospital work

reflecting the 5ualit# of "edical aid ;lethalit# rate7

the degree of restoration of the disturbed

functions


18/45

CLASSIFICATION

OF IN-PATIENT

ESTABLISHMENTS (1)Dee#(i#' o# $e( ccitiesDe e#(i#' o# $e( ccities hospital are di'ided into

categories.

er# large and 'er# s"all hospitals are considered to be not

included into an# categor#.

-Lisitc)# .P., /oit N.., 0123 c"ssi!ictio#4

Capacit# (u"ber of beds

I More th# 255 $e(s

II 655*255

III 755*655

I8 355*755

8 955*355


19/45

CLASSIFICATION

OF THE IN-PATIENT

ESTABLISHMENTS (2)

Dee#(i#' o# i#( there reDe e#(i#' o# i#( there re>

o %u"ti!ie"( hospitalso seci"i;e( hospitalso dispensaries


20/45

CLASSIFICATION

OF THE IN-PATIENT

ESTABLISHMENTS (3)

Due to the re'u"tio#s o! hosit"i;tio# there reDue to the re'u"tio#s o! hosit"i;tio# there re>

o !irst i( hospitalso hospital for "ist hosit"i;tio# o hospital for the 'e#er" -%i+e(4 hosit"i;tio#.


21/45

CLASSIFICATION

OF THE IN-PATIENT

ESTABLISHMENTS (4)

According to the s#ste" of their organi$ation there

are>o u#ite(


22/45

FUNCTIONS

OF THE IN-PATIENT

ESTABLISHMENTS BY WHOunction of hospital establish"ents are d#na"ic concepts and

depend on the tasks set at the gi'en stage of de'elop"ent of

public health ser'ices.

he ,= suggested to s#ste"ati$e functions of "odern hospital

in four groups>

• reh$i"ittio# = tret%e#t -(i'#ostics #( tret%e#t o!

(iseses, reh$i"ittio# #( ur'e#t %e(ic" i(4>

• re&e#ti&e, eseci"") !or hosit"s u#ite( • e(uctio# -tri#i#' o! %e(ic" erso##e" #( its ost*(i"o%

seci"i;tio#4>•

reserch.


23/45

HOSPITAL STRUCTURE

•/anage"ent depart"ent> the head4ph#sician7 his deputies ;for

"edical depart"ent7 pol#clinic7 "edical working capacit#

ea"ination


24/45

ORGANIZATION PRINCIPLES OF WOR OF

THE HOSPITALS :

MEDICAL CARE OF THE IN-PATIENT

ESTABLISHMENTS• &irect treat"ent of patients is eecuted b#

doctors 4 interns7 which basic ele"ents of work are

carr#ing out the inpatient case record7 diagnosticsand treat"ent7 ea"ination of work capacit#7

rehabilitation and regenerati'e treat"ent7

consultations.

• oad of hospital doctor is about 2042* patients.


25/45

THE BASIC REGISTRATION

DOCUMENTS• a "edical card of the inpatient ;case histor#+

registration for" 003D#<•

a discharge card ;for" 0**D#<• a register of operations ;for" 008D#<• a register of reception of patients and refusals fro"

hospitali$ation ;for" 001D#<• for" for the dail# account of patients and beds fund

;for" 006D#<• a register of "edical autops# ;for" 012D#<


26/45

THE BASIC ACCOUNTING

DOCUMENTS• &ata on treat"ent4and4proph#lactic establish"ent

;the annual report7 for" 30<•

&ata on the "edical and phar"aceutical staff ;for" 16<• &ata on acti'it# of a hospital ;for" 1<• &ata on acti'it# of the treat"ent4and4proph#lactic

establish"ents working in a s#ste" of =/I for certain

#ear ;for" *2<• &ata about bed fund and its use for 12 "onth period


27/45

AN ANALYSIS OF ACTIVITY

OF INPATIENT MEDICAL

SERVICE/ore than 100 different para"eters of inpatient "edical aid are

widel# used. All para"eters can be grouped7 since the# reflect

certain directions of functioning of hospital>

• suppl# of the population with inpatient aid+

• load of the "edical staff+

• "aterial and "edical e5uip"ent+

• use of bed fund+

• co"pleteness of "edical staff+

• 5ualit# of the inpatient "edical aid and its efficienc#


28/45

THE MAIN !UANTITATIVE

INDICATORS OF HOSPITAL

ACTIVITYI. ro'ision of the population with the hospital

"edical help

II. oad of "edical personnel

III. /aterial4technical "edical e5uip"ent

I. Indicators use bed facilit#

. Indicators of staffing


29/45

THE MAIN !UALITATIVE

INDICATORS OF HOSPITAL

ACTIVITY

1. ,ospital lethalit#

2. he proportion of patients full# or partiall#regained the functional independence and

abilit# to work a"ong all treated patients.

3. e'el of postoperati'e co"plications.

. he structure of outco"es of hospitalisation7

etc.


30/45

AN ANALYSIS OF !UALITY OF

TREATMENT IN A HOSPITAL"

PARAMETERS OF BED FUND USE• %e# ##u" occutio# o! $e( ;a'erage occupation of a bed

for "unicipal hospital is 330430 da#s7 for rural hospitals 9 3004

310 da#s+ for "unicipal "aternit# ho"es 9 3004310 da#s7 for rural

"aternit# ho"e 9 28042%0 da#s


31/45

PLANNING FOR INPATIENT CARE

,ealth planning is a well4grounded calculation of

the network of health care establish"ents7 their

staffs7 "edical network7 indicators of use of the

bed facilit#7 financial and "aterial support.


32/45

THE RE!UIRED BASIC DATA

FOR PLANNING

1. &ata about the le'el of public health+

2. Infor"ation about eisting network of "edical

institutions7 staffs and public health

establish"ents+

3. Infor"ation about econo"ic situation of the

district7 future prospects of its de'elop"ent+

. Assess"ent of sanitar#4epide"iological

conditions in the region+


33/45


OF THE INPATIENT MEDICAL

AID

Aro+i%te st#(r( !or the i#tie#t %e(ic" i(

to the ou"tio# -er 0555 eo"e4

ind of beds )tandard

Ge#er" 09,@

Thereutic @,2

Sur'ic" 5,1

O$stetric" 5,2


34/45

THE DENSITY OF HOSPITAL

BEDS

he densit# of hospital beds in the adult

population in !ussia is on a'erage of 13.2 beds

per 1000 inhabitants7 child ;up to 18 #ears< 4 %

beds per 1000 children.


35/45

17


36/45


37/45


38/45

THE ORGANIZATION OF

MEDICAL AID

TO RURAL POPULATION

he factors that deter"ined organi$ational for"s and

"ethods of work of rural "edical institutions>

•character of spreading of the population7•area of co'erage7• seasonal pre'alence of works7•influence of weather conditions at the field works7•

specific conditions of labor process7•disorder of econo"ic 4 household acti'it# and

conditions of life7•regional and national features and custo"s7• educational and cultural le'el7 etc.


39/45

FACTORS AFFECTING THE

ORGANISATION OF

MEDICAL CARE FOR RURAL

PEOPLE• the distance of "edical institutions fro" theresidence of patients7

• enough 5ualified personnel and the e5uip"ent7• • opportunities to recei'e speciali$ed "edical aid7

• opportunit# for realisation of specifications of

"edico4social securit#.


40/45

THREE STAGES OF MEDICAL

CARE TO RURAL

POPULATION1. !ural "edical outpost or territorial "edical associations

;local hospital7 para"edical and obstetrical outposts7 health

centers7 "aternit# hospitals7 a da# nurser# 4 kinder gardens7

etc.


41/45

STRUCTURE OF A PRIMARY

LINK OF MEDICAL AID TO

RURAL POPULATIONhe rural para"edical4obstetric outpostrural para"edical4obstetric outpost is a link of firstpatients contact in s#ste" of health ser'ices.

Its pri"ar# goals are rendering the pre4"edical help and

carr#ing out sanitar#4antiepide"ic actions directed onproph#lais of diseases7 decrease in "orbidit# and

trau"as7 increase of sanitar# and h#gienic culture of the

population.

ara"edical staff renders the first "edical aid at acuteconditions and trau"as7 carr# out 'accination7

ph#siotherapeutic actions7 etc.

ara"edical and obstetrical outposts are organi$ed in

settle"ents where nu"ber of inhabitants 'aries fro" 600

up to 1000


42/45

STRUCTURE OF A PRIMARY


RURAL POPULATIONhe basic "edical institutionbasic "edical institution on a rural "edical outpost

is the local hospitallocal hospital or pol#clinic.

Character and 'olu"e of "edical aid in local hospitalbasicall# are deter"ined b# its capacit#7 e5uip"ent and

presence of doctor4eperts.

he nu"ber of staff of rural hospital is depending on its

capacit#7 population and distances up to central regionalhospital7 there ha'e to be doctors of the basic

specialities ;therap#7 pediatric7 sto"atolog#7 obstetrics7

g#necolog# and surger#


43/45

DUTIES OF LOCAL HOSPITAL

DOCTOR

oreat"ent of therapeutic and infectious patients

o &eli'eries "edical aid

o reat"ent4and4proph#lactic help to children

o :rgent surgical and trau"atological help


44/45

STRUCTURE OF SECONDARY


RURAL POPULATIONhe "ain link in public health ser'ice of rural area is

central regional hospitalcentral regional hospital ;C!,


45/45

the organization and the analysis of the inpatient medical aid

Documents