The second stage of medical care for the rural population.
The main institution of the second stage of medical care for the rural population is the central district hospital (CRH). It provides the rural population with qualified treatment and preventive care, both inpatient and outpatient.
Basic tasks of the central district hospital:
providing highly qualified, specialized inpatient and outpatient care to the population of the district and regional center;
operational, organizational and methodological management and control over the activities of all healthcare institutions;
planning, financing and organizing logistics for health care institutions in the region;
development and implementation of measures aimed at improving the quality of medical care for the population of the region, reducing morbidity, disability, hospital mortality, child and general mortality and improving the health of adolescents;
timely introduction into the practice of health care facilities modern methods and means of prevention, diagnosis and treatment;
implementation of placement measures, rational use and improving professional qualifications of personnel;
carrying out activities aimed at the effective use of funds and forces, strengthening the material and technical base of the district, improving the systems of organizational, methodological and operational management, management of all health care facilities in the district, using modern achievements Sciences;
provision of ambulance and emergency care on the territory of the region.
The central district hospital, regardless of bed capacity, population size and service radius, has a hospital, a clinic, a pharmacy, a prosector, paraclinical and administrative services, an organizational and methodological office (OMK), an ambulance and emergency department.
The in-patient department of the Central District Hospital must have at least 5 departments according to specialties; therapy, surgery, pediatrics, obstetrics and gynecology, infectious diseases. In addition to the required minimum, large central district hospitals can organize departments for other specialties (neurology, otorhinolaryngology, ophthalmology, traumatology, etc.).
In the outpatient department of the Central District Hospital, specialized care is provided in 1015 specialties, and such departments often serve as inter-district specialized centers.
Patients living in an area assigned to a district hospital are served directly by the hospital. Patients living in other areas are admitted to the district hospital on the referral of doctors from local hospitals. Local doctors refer patients to the district hospital in cases where the necessary specialized care cannot be provided on site, when patients need consultation, clarification of the diagnosis, X-ray or laboratory clinical diagnostic examination. The participation of specialists from district hospitals during clinical examinations is widely used.
Rural residents turn to the district hospital following referrals from medical institutions in the rural area if they need specialized medical care, functional examination, or consultation with medical specialists.
Mobile assistance plays an important role in the work of the Central District Hospital. Mobile medical teams are formed by the chief physician and see patients in 5-7 specialties. The composition of the team’s medical specialists is determined depending on the development of the network of outpatient clinics in a given territory, its staffing with doctors and the population’s needs for the relevant types medical care. It may include doctors: therapists, pediatricians, surgeons, obstetricians-gynecologists, ophthalmologists, neurologists, etc. A visiting team is provided vehicles, including special ones, is equipped necessary equipment(mainly portable) and equipment for examining and treating patients. The leadership of the mobile medical team is entrusted to one of the qualified doctors of the team who has experience in medical and organizational work. Fluorographic and dental offices, clinical diagnostic and bacteriological laboratories regularly visit the village.
Ambulance and emergency care is provided by the relevant department, which is part of the Central District Hospital, which is responsible for providing this type of assistance to the population of the district center and the settlements assigned to it.
One of the most important structural units of the Central District Hospital is the organizational and methodological office (OMK), headed by the deputy chief physician of the Central District Hospital for medical care of the population of the district. OMK is the main assistant to the chief physician in matters of management, organization and coordination of all organizational and methodological work of the central district hospital and other medical and preventive institutions in the region.
The main tasks of OMK include:
analysis and synthesis of data on the health status of the population and the activities of health care facilities in the district;
calculation of evaluation indicators and analysis of the activities of the Central District Hospital as a whole and for individual specialized services;
compiling a summary report on the network, personnel and activities of health care facilities in the district; identifying shortcomings in the work of health care facilities and developing measures to eliminate them; development of an action plan for medical care of the entire population of the district, monitoring its implementation;
implementation of measures to improve the quality of treatment and preventive work,
advanced training of specialists,
study and dissemination of new modern forms medical work,
forward planning development of health care in the region,
organization of work on off-budget commercial activities and health insurance.
The OMK work plan is actually a plan for the organizational and methodological work of the entire central district hospital. Its mandatory sections are:
analysis of demographic indicators and reporting materials on the network, personnel and activities of health care facilities in the area and on the health status of the population;
organization and implementation of measures to provide treatment, advisory and organizational and methodological assistance to medical institutions in the region;
carrying out activities to improve the qualifications of medical workers; strengthening the material and technical base of health care facilities in the region.
assessment of the activities and effectiveness of the district’s medical institutions and departments of the Central District Hospital;
measures to improve the quality of medical care, ambulance and emergency care;
introduction of new types of diagnostics and treatment;
improvement of ethical and deontological aspects in the staff of medical institutions.
Based on a systematic analysis of the health status of the district population and the plans of district institutions, the cabinet draws up comprehensive plan measures to improve medical care and strengthen the health of the region's population.
Providing methodological guidance and control over accounting and statistical work in all institutions of the district is the most important function organizational method of the office. The duties of the offices include receiving annual reports. Based on data from reporting forms and special analysis The organizational and methodological office compiles an overview of the health status of various population groups and evaluates health indicators. Organizational and methodological rooms should contain information about regional conferences and classes with doctors and nursing staff, about seminars with the participation of district specialists, specialization and advanced training of medical workers.
The chief (district) specialists of the district, who are also heads of specialized departments of the central district hospital, work in close contact with the OMK of the Central District Hospital. Currently, in almost all regions there are regional specialists in therapy, pediatrics, surgery, obstetrics and gynecology, and phthisiology. They are appointed by the chief physician of the district in agreement with the chief regional specialists and report directly to the chief physician of the Central District Hospital or his deputy.
The main functions of district specialists are:
organizational and methodological management of the work of the relevant specialized service;
regular visits in accordance with the schedule to local hospitals, outpatient clinics and first-aid stations;
improvement of methods of diagnosis, treatment, prevention of specialized diseases;
observation and control of the dispensary population, especially persons in leading agricultural professions;
analysis of statistical reports on your service; advanced training of medical personnel.
In order to better provide specialized medical care, inter-district specialized centers (departments) equipped with modern equipment are being created. Interdistrict specialized centers provide medical and advisory assistance, carry out organizational and methodological work, improve the qualifications of medical personnel of district and local hospitals and clinics, analyze health indicators and risk factors that determine morbidity in a particular specialty
The Central District Hospital is the leading medical and preventive institution in the region. She is entrusted with the leadership of the entire healthcare network in the region. Chief physician such a hospital is also the chief physician of the district. All medical and preventive institutions located in the district are subordinate to him (with the exception of departmental and regional subordination).
The hospital must solve the following main tasks: - provide qualified specialized inpatient and outpatient medical care to the population living in the regional center and throughout the region;
- provide organizational and methodological guidance and control over the activities of all health care institutions in the district; plan, finance and organize the material and technical supply of health care institutions in the region;
- constantly develop and implement measures aimed at improving the quality of medical care for the population of the region, reducing morbidity, disability, hospital mortality, general and child mortality; improve the qualifications of doctors and paramedical workers in the region.
The central district hospital includes: a hospital with an emergency department, a polyclinic (with consultations with specialist doctors for residents of the region), diagnostic and treatment departments, offices and laboratories, an organizational and methodological office; department of emergency and emergency medical care, pathology department (morgue) and economic service.
In the organizational and methodological office of the central district hospital, the quality indicators of the activities of health care institutions in the district are constantly analyzed.
The district sanitary-epidemiological station and the central district hospital develop and carry out comprehensive anti-epidemic and sanitary-hygienic measures in the district.
The team of the central district hospital develops and implements comprehensive measures in the region for dispensary services for leading professions of state farm workers, industrial enterprises, collective farmers and the rest of the population.
The following are taken into dispensary registration:
a) healthy: machine operators, milkmaids, livestock breeders, farm managers, leaders in agricultural production, people working in unfavorable production conditions, and boys under 18 years of age;
b) patients: peptic ulcer stomach and duodenum, anacid gastritis, cardiovascular diseases, diabetes, pulmonary tuberculosis, typhoid fever and dysentery, etc.
Medical examinations are carried out by all medical institutions in the region under the guidance of doctors from the central hospital. Specialists from the central hospital, according to the schedule, go to all numbered and district hospitals in the region. There they advise patients, monitor the implementation of previously given recommendations on the organization of work, analyze the quality of medical care to the population, etc.
Giving great importance to improve the qualifications of doctors and paramedical workers, the hospital regularly holds regional conferences of doctors, paramedics and midwives. These conferences discuss current clinical and treatment issues. various diseases with a detailed discussion of them.
One of the forms of advanced training for paramedical workers is the periodic work of paramedics, nurses and midwives of local hospitals in central hospital. Thanks to this, all medical personnel of the district’s healthcare institutions are gradually undergoing advanced training.
In the central hospital, as in other hospitals, doctors work together with nurses in the hospital, in the clinic and provide care at home. The functions of nurses are essentially the same as in the urban integrated hospitals described above.
Along with the central district hospital, former district hospitals (before the consolidation of rural administrative districts) or, as they are now called, district (number) hospitals, continue to function in the region. Their activities generally do not extend beyond the former boundaries of the old district. These hospitals retain the functions of the main hospitals within the old districts. They provide specialized inpatient and outpatient care to residents of the locality in which they are located and to the entire population of the region; but mostly living in the territory of the former district.
Doctors-specialists of the numbered hospital travel on schedule to local hospitals, to paramedic and obstetric stations, providing advisory assistance to doctors and paramedics there. Just like in the central hospital, advanced training of doctors and paramedical workers of their “bush” is carried out here. The activities of local hospitals and feldsher-midwife stations are analyzed.
Second stage Providing medical care to the rural population is the central (district) territorial medical association headed by the central district hospital (CRH).
The main institution of the second stage of rural health care is central district hospital, which provides the main types of specialized qualified medical care and at the same time performs the functions of a governing body. Central District Hospital serves as the center for operational management of all healthcare institutions in the district, is responsible for the organization, delivery and quality of medical care to the population, and carries out organizational and methodological work.
The optimal capacity of the central district hospital is at least 250 beds. Part Central District Hospital includes: a hospital with departments for main specialties; a clinic with treatment and diagnostic rooms and a laboratory; emergency departments; pathology department; organizational and methodological office; auxiliary structural units (pharmacy, kitchen, medical archive, etc.).
The composition of the central district hospital depends on its capacity, but the optimal number of departments should be at least five: therapeutic, surgical with traumatology, pediatric, infectious diseases, obstetrics and gynecology (if there is no maternity hospital in the area).
The main tasks of the Central District Hospital are: providing the population of the district and regional center with qualified specialized inpatient and outpatient medical care; operational, organizational and methodological management of all healthcare institutions in the district, control over their activities; planning, financing and organization of material and technical support for health care institutions in the region; development and implementation of measures aimed at improving the quality of medical care for the population, reducing morbidity, infant and general mortality, and improving health; development and implementation of measures for the deployment, rational use, advanced training and education of medical personnel in health care institutions.
The chief physician of the Central District Hospital is the head of health care for the district. The sanitary and preventive service is led by the chief state sanitary doctor of the district, who is the chief physician of the Central State Sanitary and Epidemiological Service. The chief physician of the Central District Hospital has deputies for the main areas of activity: for medical work, for outpatient work, for organizational and methodological work (head of the organizational and methodological department), for administrative and economic work, and in areas with a population of 70 thousand or more - on childhood and obstetrics.
To provide methodological, organizational and advisory assistance to doctors of rural medical districts, the Central District Hospital allocates district specialists who, within the framework of their specialty, carry out organizational and methodological management of all medical institutions in the district. Each of them heads medical work in the region in his specialty, travels for consultations, conducts demonstration operations, examination and treatment of patients, sends teams of medical specialists to medical institutions of rural medical districts, hears reports from doctors of local hospitals, heads of first-aid posts, analyzes work plans, statistical reports, conducts scientific conferences, seminars, carries out advanced training in the workplace, etc.
In order to bring specialized medical care closer to the rural population, inter-district specialized departments (centers) equipped with modern equipment can be created in regional centers. The functions of interdistrict centers are performed by health care facilities that are capable of providing the population with specialized, highly qualified inpatient or outpatient medical care in cases where the central district hospitals of surrounding areas do not have the ability to provide specialized care in this specialty. Along with performing the functions of a structural unit of health care facilities, interdistrict specialized centers (departments) carry out: consultations in the clinic for patients referred by doctors from health care institutions of the attached districts; hospitalization of patients from assigned areas; organizational, methodological and advisory assistance (including examination of work capacity) to doctors of medical institutions of the attached areas, including through planned visits; introduction into the practice of health care institutions of modern means and methods of prevention, diagnosis and treatment of patients in the relevant specialty; conducting an analysis of the results of providing medical care to residents of the assigned districts, providing information on the work of the interdistrict medical center; holding joint control and expert commissions, thematic conferences, seminars.
The Central District Hospital clinic provides qualified medical care to the rural population in 8-10 medical specialties. The tasks of the clinic include: providing qualified outpatient care to the attached population of the district and regional center; organizational and methodological management of outpatient departments of the district, control over their activities; planning and carrying out activities aimed at preventing and reducing morbidity and disability; timely and widespread introduction into practice of all outpatient clinics in the region of modern methods and means of prevention and treatment of diseases, best practices in providing outpatient care.
The organizational and methodological office of the Central District Hospital plays an important role in the organization of treatment and preventive care in the region.
The organizational and methodological office should be staffed by the most experienced doctors and have data on the economy and sanitary condition of the region, the network and staffing of medical institutions, the provision of the population with various types of medical and social security, etc. The organizational and methodological office is headed by the head, who is also a deputy Chief Physician of the Central District Hospital.
The provision of out-of-hospital and inpatient treatment and preventive care to children in the regional center and region is entrusted to children's consultations (polyclinics) and children's departments of the Central District Hospital.
Carrying out medical examination of the population of the area.
Central District Hospital (CRH)
It is the health/security management body for the entire district. Provides assistance to residents (sites. principle):
1. residents of the district center on a precinct basis
2. living in assigned areas on a local basis. Those settlements, which are located near the central district hospital and are served by it, are called assigned areas
3. living in rural areas (advisory assistance)
The second stage of service is not carried out on a local basis, that is, you can get advice and specialized assistance. The Central District Hospital is also the organizer of the management of all medical institutions located in the district. Inter-district specialized departments will be opened on the basis of the Central District Hospital. The process of consolidation of the central district hospital is characteristic.
Structure of the Central District Hospital:
1. hospital with departments for main specialties, the number of which depends on the capacity of the central district hospital and the need
2. polyclinic with laboratory (the number of specialties depends on the capacity, there is a specialized medical care)
3. treatment and diagnostic rooms and laboratories
4. pathology department
5. organizational and methodological rooms
6. various auxiliary rooms (pharmacy, kitchen, laundry, medical archive)
7. there may be an emergency department (substation)
Based on capacity (number of hospital beds), central district hospitals are divided into categories:
2k – 300 – 350;
3k – 250 –300;
4k – 200 – 250;
5k – 150 – 200;
6k – 100 – 150.
Tasks of the Central District Hospital:
Providing for the population of the district and district.ts. qualified, specialized stationary and outpatient medical care;
Development of measures to reduce morbidity, general and child mortality;
Operational and organ-methodological management of all divisions of the district;
Improving the qualifications of medical personnel;
Planning, financing and organization of logistics. provision of all health care institutions in the area.
The management of the Central District Hospital is carried out by the heads. a doctor who is also the chief physician of the district. He has: 1 – deputy medical officer. parts (head of medicine - responsible for the work of the hospital);
2 – deputy at the clinic;
3 – deputy according to ACh;
4 – deputy according to honey serving the population of the district (head of the organizational and methodological office, 1st deputy!);
5 – deputy for the protection of motherhood and childhood (in areas with a population of more than 70,000 people; in areas with fewer, this position is performed by a district pediatrician).
4.5 – deputy chief physician of the district
1,2,3 – deputy chief physician of the Central District Hospital
Organizational and methodological office:
1. deals with the analysis of general morbidity and mortality of the population, analysis of morbidity with temporary disability, analysis of performance indicators of health care facilities in the region, quality of medical care. assistance to the population, quality of diagnostics. Based on this analysis, conferences, meetings, and analysis of medical errors are organized.
2. planning measures to improve medical qualifications. personnel, usually paramedics. personnel on the basis of the Central District Hospital, doctors carry out advanced training on the basis of the Regional Hospital.
3. planning of advisory assistance. To provide qualified assistance, specialist doctors travel to rural hospitals, where they provide consultations.
4. make calculations for planning and financing, material and technical equipment.
5. development of measures to improve the organization of MP for the population of the region
States are organized based on standards per 1000 population. Standards are determined for residents of the district center, assigned area and other residents. Depending on the capacity, the recruitment of specialists in the central district hospital may vary. Categories 1 and 2 can conduct admissions in narrow specialties. The average capacity of the central district hospital is 280 beds.
Interdistrict specialized health care facilities
Their function:
1. consultation in clinics of patients referred from health care facilities
2. hospitalization of patients from attached health care facilities
3. methodological and advisory assistance to doctors in assigned areas, including examination of work capacity
The number of beds is set depending on the population of the assigned areas and the practical volume of work.
The staff is: 1 resident for 20 – 25 beds. To approach specialized honey. Mobile specialized teams are organized to provide assistance. In addition to key specialists, it may include mountain workers. Hospitals, dispensaries, maternity hospitals.
Organization and provision of qualified medical care to the population,
– organization and implementation of the complex preventive measures aimed at reducing morbidity, disability, maternal, child and general mortality,
– organizing and conducting events for sanitary and hygienic education of the population, widespread propaganda healthy image life,
– organizing and conducting quality control of patient treatment,
– pharmaceutical activities,
– control over the circulation of narcotic and (or) psychotropic substances.
To perform the main tasks and functions, the hospital, through its employees, organizes and carries out work to provide us medical care, which we feel on ourselves when we see a doctor (for example, timely hospitalization or referral for examination, etc.).
State Healthcare Institution “Efremovskaya District Hospital” includes the following structural divisions:
· polyclinic No. 1, st. Dachnaya, 4;
· polyclinic No. 2, st. Slovak Uprising, 18;
· Women's consultation, st. Slovak Uprising, 18;
· children's clinic, st. Dachnaya, 4;
· branch of the children's clinic, st. Druzhby, 26;
· Intermunicipal diagnostic and treatment center, st. Slovak Uprising, 18;
· outpatient hemodialysis department, st. Slovak Uprising, 18;
- hospital with 325 round-the-clock beds according to the profile, including:
- surgery department
- infectious diseases department
- maternity ward
- cardiology department
- day hospital with 43 beds according to the profile;
- Stepnokhutorskaya outpatient clinic, Stepnoy Khutor village;
- Bolsheplotavskaya outpatient clinic, Bolshie rafts;
- Shilovskaya outpatient clinic, village. Shilovo;
- twenty-three FAPs;
- ambulance station
2. Purpose and objectives of the work:
Goal of the work: conducting a general assessment of the provision of outpatient care in the Efremovsky district and the associated development of measures to increase the efficiency of resource use in healthcare, aimed at preserving and improving the health of the population of the Efremovsky district.
Tasks:
1. Select indicators to assess the volume of outpatient care in the Efremovsky district for the period 2008-2012.
2. Compare the selected indicators with similar indicators in the Tula region.
3. Conduct a general assessment of indicators.
4. Draw a conclusion about the effectiveness of providing medical care to children based on the results of the data obtained.
3. Analysis of selected indicators for the work of outpatient care in the Efremovsky district and the Tula region for 2008-2012.
1. Availability of outpatient clinics (units) in the Efremovsky district of the Tula region (per 10,000 population) 2008-2012.
