THE ORGANIZATION AND THE ANALYSIS OF THE INPATIENT MEDICAL AID Lecturer: Ph.D., Assosiate Professor Elena A. Abumuslimova

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THE ORGANIZATION AND THE ANALYSIS OF THE
INPATIENT MEDICAL AIDLecturer Ph.D., Assosiate
Professor Elena A. Abumuslimova
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Inpatient medical service history

• Inpatient care goes back to 230 BC in India
  where Ashoka the Great founded 18 hospitals.
• 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
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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
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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
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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.
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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.

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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.

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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.

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Types of the inpatient medical care

• Primary (general)
• Secondary (specialized)
• Tertiary ( highly tailored)

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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
• morbidity level among population on the
  territory
• disease structure of the population
• age-sexual structure of the population
• features of residence.

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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.
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Reasons for hospitalisation

• the case of diseases requiring a comprehensive
  approach to diagnosis and treatment
• the use of complex methods for examination
• treatment with the using of modern high-tech
  medical equipment
• surgery
• continuous round-the-clock medical supervision
  and intensive care.

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Negative reasons for inefficient using of
hospital in Russia

• inadequate extension hospital beds
• high rates of inappropriate and non-core
  hospitalization
• inadequate increase of terms of stay of the
  patient in the hospital
• hospitalization of patients in unprepared to
  provide a profile of medical aid medical
  institutions
• high frequency of transfers of patients from one
  medical facility (the unprepared or non-core) to
  another.

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Optimisation hospital services in Russia(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

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Optimisation hospital services in Russia (2)

• 2. Introduction to the clinical departments of
  hospitals
• disease management protocols and standards of
  care
• registers for hospital patients
• health care quality management system.3.
  Installation and stuffing of hospitals with
  qualified personnel according to approved
  standards.

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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).
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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 quality8.
Improvement aims of the hospital work reflecting
the quality of medical aid (lethality rate, the
degree of restoration of the disturbed functions).
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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
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Classification of the in-patient establishments
(2)

• Depending on a kind there are
• multifield hospitals
• specialized hospitals
• dispensaries

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Classification of the in-patient establishments
(3)

• Due to the regulations of hospitalization there
  are
• first aid hospitals
• hospital for list hospitalization
• hospital for the general (mixed)
  hospitalization.

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Classification of the in-patient establishments
(4)

• According to the system of their organization
  there are
• united with polyclinic hospitals
• non-united with polyclinic hospitals.
• For the district, regional and federal hospitals
  presence of polyclinic as a structural part is
  always obligatory.

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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.

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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.)

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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.

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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)

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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-prophylacti
  c establishments working in a system of OMI for
  certain year (form ? 52)
• Data about bed fund and its use for 12 month
  period

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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

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The main quantitative indicators of hospital
activity

1. Provision of the population with the hospital
   medical help
2. Load of medical personnel
3. Material-technical medical equipment
4. Indicators use bed facility
5. Indicators of staffing

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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.

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An analysis of quality of treatment in a
hospitalparameters 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 patients 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
  arent 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

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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.
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The required basic data for planning
1. Data about the level of public health2.
Information about existing network of medical
institutions, staffs and public health
establishments3. Information about economic
situation of the district, future prospects of
its development4. Assessment of
sanitary-epidemiological conditions in the region
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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
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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.
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Medical care for rural population
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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.

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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.

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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.

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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
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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).
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Duties of local hospital doctor

• Treatment of therapeutic and infectious patients
• Deliveries medical aid
• Treatment-and-prophylactic help to children
• Urgent surgical and traumatological help

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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.).
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Thank you for your attention!