THE ORGANIZATION AND
THE ANALYSIS OF THE
INPATIENT MEDICAL AID
Lecturer: Ph.D., Assosiate Professor Elena A. Abumuslimova
Inpatient medical service history
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
From Wikipedia, the free encyclopedia
specialized temple for sick patients in
291 AD on the island of Tiber.
Inpatient medical service history
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
Inpatient medical service history
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
of 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 medical care
(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.
Levels of the in-patient medical care
(2)
• 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.
Levels of the in-patient medical care
(3)
• Rural hospitals form the separate group.
They play a role of the elementary medical and
hospital centre in the remote villages.
Types of the inpatient medical care:
•Primary (general)
•Secondary (specialized)
•Tertiary ( highly tailored)
General characteristic
of the inpatient medical aid (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.
General characteristic
of the inpatient medical aid (2)
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.
Reasons for 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 using 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 Russia
(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 hightech service
Optimisation hospital services in 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.
Optimisation hospital services in Russia
(3)
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).
Optimisation hospital services in Russia
(4)
7. Improvement of the tariff policy, based on the
consideration not only of the type and amount of
medical assistance, but also on 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
of in-patient establishments (1)
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
of the in-patient establishments (2)
Depending on a kind there are:
o multifield hospitals
o specialized hospitals
o dispensaries
Classification
of the in-patient establishments (3)
Due to the regulations of hospitalization there are:
o first aid hospitals
o hospital for list hospitalization
o hospital for the general (mixed) hospitalization.
Classification
of the in-patient establishments (4)
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
of the in-patient establishments by 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 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 hospitals :
medical care of the in-patient establishments
• 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 documents
• 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 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
of 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 of
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 of
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 hospital^
parameters of bed fund use
• mean annual occupation of bed (average occupation of a bed
for municipal hospital is 330-340 days, for rural hospitals – 300310 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 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 planning
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
of 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 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.
МЕЖДУНАРОДНЫЕ ПРИНЦИПЫ ОЦЕНКИ ОБЕСПЕЧЕННОСТИ КОЙКАМИ
В СООТВЕТСТВИИ С МЕЖДУНАРОДНЫМИ И РОССИЙСКИМИ ТРЕБОВАНИЯМИ ПОКАЗАТЕЛЬ ОБЕСПЕЧЕННОСТИ КОЙКАМИ
ДОЛЖЕН УЧИТЫВАТЬ ПЛОТНОСТЬ НАСЕЛЕНИЯ И ПРОТЯЖЕННОСТЬ ТЕРРИТОРИИ СТРАНЫ (ПРИНЦИПЫ ДОСТУПНОСТИ)
ОБЕСПЕЧЕННОСТЬ КОЙКАМИ ПО МЕЖДУНАРОДНЫМ ТРЕБОВАНИЯМ:
СТРАНЫ
ПЛОТНОСТЬ НАСЕЛЕНИЯ
(ЧЕЛОВЕК НА 1 КМ2)
ОБЕСПЕЧЕННОСТЬ КОЙКАМИ
НА 10 ТЫС.*
РОССИЙСКАЯ ФЕДЕРАЦИЯ
8,4
87,8
ВЕНГРИЯ
107
71
ФРАНЦИЯ
118
72
МАЛЬТА
1 287
78
АВСТРИЯ
98
78
ГЕРМАНИЯ
230
83
ЮЖНАЯ КОРЕЯ
494
86
ЯПОНИЯ
336
139
КАНАДА
3,4
34
*ИСТОЧНИК: ДОКЛАД ВОЗ «МИРОВАЯ СТАТИСТИКА ЗДРАВООХРАНЕНИЯ», ОПУБЛИКОВАН В 2011 ГОДУ
17
МЕЖДУНАРОДНЫЕ ПРИНЦИПЫ ОЦЕНКИ ОБЕСПЕЧЕННОСТИ ВРАЧАМИ
В СООТВЕТСТВИИ С МЕЖДУНАРОДНЫМИ ТРЕБОВАНИЯМИ ПОКАЗАТЕЛЬ ОБЕСПЕЧЕННОСТИ ВРАЧАМИ
РАССЧИТЫВАЕТСЯ, ИСХОДЯ ИЗ ФАКТИЧЕСКОЙ ЧИСЛЕННОСТИ ВРАЧЕЙ КЛИНИЧЕСКИХ СПЕЦИАЛЬНОСТЕЙ
РАСЧЕТ ОБЕСПЕЧЕННОСТИ ВРАЧАМИ ПО МЕЖДУНАРОДНЫМ
ОБЕСПЕЧЕННОСТЬ
ТРЕБОВАНИЯМ:
ОБЕСПЕЧЕННОСТЬ
СТРАНЫ
РОССИЯ**
ВРАЧАМИ НА
2009 Г
10 ТЫС.*
2010 Г
СРЕДНИМ МЕДПЕРСОНАЛОМ
НА 10 ТЫС.*
2009 Г
2010 Г
26,7
26,3
67,1
63,4
ФРАНЦИЯ
37
35
81
89,4
ГЕРМАНИЯ
35
35,3
80
108,2
АВСТРИЯ
38
47,5
66
78,4
ИСПАНИЯ
38
37,1
74
51,6
ШВЕЙЦАРИЯ
40
40,7
110
159,6
ШВЕЦИЯ
36
35,8
116
115,7
КАНАДА
19
19,1
100
100,5
НОРВЕГИЯ
39
40,8
163
147,6
30,2
31
75,4
76
ПО СТРАНАМ ОЭСР
*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
В МЕЖДУНАРОДНЫЙ ПОКАЗАТЕЛЬ
ОБЕСПЕЧЕННОСТИ ВРАЧАМИ В
РЯДЕ СТРАН НЕ ВКЛЮЧАЮТСЯ:
СТОМАТОЛОГИ
ФАРМАЦЕВТЫ И КЛИНИЧЕСКИЕ
ФАРМАКОЛОГИ
ОРГАНИЗАТОРЫ ЗДРАВООХРАНЕНИЯ И
РУКОВОДИТЕЛИ МЕДИЦИНСКИХ
ОРГАНИЗАЦИЙ
ВРАЧИ САНИТАРНОЭПИДЕМИОЛОГИЧЕСКИХ СЛУЖБ И МЕДИКОСАНИТАРНОЙ ПОМОЩИ
ВРАЧИ ДИАГНОСТИЧЕСКИХ
СПЕЦИАЛЬНОСТЕЙ, НАПРИМЕР, ВРАЧИЛАБОРАНТЫ, ПАТОЛОГОАНАТОМЫ,
ЭНДОСКОПИСТЫ, РЕНТГЕНОЛОГИ,
БАКТЕРИОЛОГИ, ВРАЧИ УЛЬТРАЗВУКОВОЙ
ДИАГНОСТИКИ, СУДЕБНО-МЕДИЦИНСКИЕ
ЭКСПЕРТЫ
The organization of medical aid
to 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 organisation of
medical care for 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 to rural
population
1. Rural medical outpost or territorial medical associations
(local hospital, paramedical and obstetrical outposts, health
centers, maternity hospitals, a day nursery - kinder gardens,
etc.). At this stage rural population receive the qualified
medical aid;
2. District level, where the main establishment is the central
district hospital. Rural population receives the qualified
specialized 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 aid
on all specialities.
Structure of a primary link of medical
aid to rural population
The rural 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 medical
aid to rural population
The basic medical institution on a rural medical outpost
is the 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 doctor
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 of medical
aid to rural population
The main link in public health service of rural area is
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.).