Inpatient care to urban population in Russian Federation

CITY HOSPITAL

Nomenclature of inpatient health facilities in Russian Federation

I. HOSPITALS including:
 District
 Rayon
 City including Pediatric
 City emergency
 Central (city, rayon)
 Oblast including Pediatric (kray, republic, okrug)
II. SPECIALIZED HOSPITALS including:
 Rehabilitative including Pediatric
 Gynecological
 Geriatric
 Infectious including Pediatric
 Narcological
 Oncological
 Ophthalmological
 Psychoneurological including Pediatric
 Psychiatric including Pediatric
 Tuberculosis including Pediatric
 Spa treatment and other.
III. ANOTHER
 HOSPITALS OF ALL DESIGNATIONS (for veterans of war and other)
 MEDICO-SANITARY DEPARTMENTS including central
 HOSPITAL OF NURSING
 HOSPICE
 LEPROSARIUM.

CLASSIFICATION OF HOSPITALS
By territorial characteristic
 Oblast
 Kray
 Okrug
 Republic
 City
 Rayon
 Rural
 District
By profile
 Multi profile
 Single profile (specialized)
By way of hospitalization
 Emergency hospital
 Planned hospitalization
 Mix hospitalization
By degree of care and nursing
 Intensive therapy
 Rehabilitative treatment
 Nursing
 Medico-social help
By organization of work
 Pediatric and for adult
 Independent
 United with emergency station, polyclinic
By property
 State
 Municipal
 Private

HOSPITAL is a complex health facility rendering all kinds of medical-diagnostic

specialized inpatient care to population when most severe diseases.

BASIC TASK OF HOSPITALS is rendering of medical care:

 When treatment or complex diagnostic examinations cannot be realized in outpatient
conditions;
 If recovery or improvement of patients` health can be faster achieved under inpatient
conditions then outpatient;
 If patient stay at home is threat to other people (some infectious and venereal diseases,
mental disorders).

FUNCTIONS OF HOSPITALS (groups according to WHO):

- Rehabilitative (diagnostics, treatment, nursing, rehabilitation, urgent aid);
- Preventive (medico-sanitary work, prevention of complications, chronic and infectious
diseases, invalidity);
- Educative (training of medical staff, postgraduate specialization);
- Research.

CITY HOSPITAL is a medical establishment to provide qualified inpatient and outpatient

service (in case of unity with polyclinic) of population using advanced achievements of medical
science.
City hospital can be:
By type: multi profile or specialized;
By organization of work: united with polyclinic or not;
By volume of care: different categories (according to number of beds).

CITY HOSPITAL basic tasks:

  Rendering high qualified specialized medico-preventive care to population (inpatient and
outpatient);
 Providing prime health care of enterprise workers employed in industry and juveniles of
system of vocational training;
 Widening volume and improvement of dispensary method of population service;
 Introduction in practice of population service advanced methods of prevention,
diagnostics and treatment;
 Studying causes of general morbidity and morbidity with temporary disability of workers
and employees;
 Sanitary-hygiene education of population;
 Working out and realization of sanitary arrangements to decrease and eliminate the most
spreading diseases;
 Improvement of medical service and nursing of population, quality and culture of work.

Inpatient part of CITY HOSPITAL is intended for rendering of qualified and specialized
medical help for population.
 It realizes the interaction and continuity between polyclinic and hospital;
 applies the most modern treatment and diagnostic methods in practice;
 improve the forms and methods of work;
 takes parts in preventive measures, dispensary system and sanitary-educative work;
 Analyzes the morbidity and mortality;
 Improvement of professional skill.

CITY HOSPITAL structure:

RECEPTION
ADMINISTRATION DEPARTMENT

SPECIALIZED
POLYCLINIC INPATIENT SUBDIVISION DEPARTMENTS

SURGICAL UNIT
MEDICO-DIAGNOSTIC ADMINISTRATIVE-
SUBDIVISIONS ECONOMICAL SUBDIVISION

LABORATORY BOOK-KEEPING

X-RAY COOK UNIT

DIAGNOSTIC
LAUNDRY
ENDOSCOPY
DIAGNOSTIC
PHARMACY

FUNCTIONAL
DIAGNOSTIC STERILIZATION
DEPARTMENT

ULTRASONIC
DIAGNOSTIC ARCHIVE

GARAGE
PHYSIOTHERAPY

MORGUE
BASIC MEDICAL DOCUMENTS registering during inpatient service:

 “Register of patients` admitting and refusals in hospitalization”

 “Inpatient medical card’ (case-report) including supplementary sheets
- “Temperature list”
- “Statistical card of patient discharge from hospital”
 Medical death certificate.

STATISTICAL INDICES OF INPATIENT CARE

1. Indices of patients’ satisfaction with inpatient care

1.1. Provision of population with hospital beds =

No. of hospital beds x 10 000
Mid-year population

1.2. Structure of bed fund

No. of therapeutic (surgical, gynecological, pediatric, another) beds x 100
Total no. of hospital beds

1.3. Level of hospitalization

No. of patients admitted to hospitals for year x 100
Mid-year population

1.4. Provision of population with inpatients care

No. of days patients stayed in hospitals for year
Mid-year population

2. Indices of bed fund use in City hospital

2.1. Use of bed

No. of days patients stayed in hospital for year
Mid-year no. of beds

2.2. Average length stay

No. of days patients stayed in hospital
½ (admitted+discharged+died) patients

2.3. Turnover of bed

No. of patients treated
Mid-year no. of beds

3. Indices of staff load in the City hospital

3.1. Average no. of beds per 1 doctor

Mid-year no. of beds in therapeutic department___________
Total no. of occupied doctor posts in therapeutic department

3.2. Average no. of days per 1 doctor

No. of days patients stayed in therapeutic department
No. of occupied doctor posts in therapeutic department
4. Indices of quality of inpatient care in City hospital

4.1. Divergence of clinical and pathologic diagnoses

No. of clinical diagnoses without conformation under autopsy x 100
Total no. of autopsies

4.2. Hospital lethality

No. of patients died in hospital ________ x 100
No. of patients leaving hospital (discharged+died)

4.3. Before 24h lethality

No. of patients died during first 24h in hospital x 100
Total no. of patients admitted

4.4. Postoperative lethality

No. of patients died after operations x 100
Total no. patients were operated

5 Indices of continuity in the work of the city hospital and polyclinic

5.1. Frequency of refusals in hospitalization

No. of patients which were refused in hospitalization x100
No. of patients (discharged + died) leaving hospital +
no. of patients which were refused in hospitalization

5.2. Timeliness of hospitalization

No. of patients admitted in terms according to
protocols (standards) of patients management x 100
Total no. of patients leaving hospital (discharged +died)

EMERGENCY CARE in Russian Federation

EMERGENCY CARE (EC) is a twenty-four hour emergency medical care when sudden
diseases threatening life of patient, traumas, poisoning, premeditated self damage, labor outside
health facility and also catastrophes and natural calamities.

EMERGENCY CARE facilities:

 Emergency stations/sub-stations
 Emergency Hospitals
 Emergency departments as a part of health facilities.

BASIC TASKS of EMERGENCY STATION (sub-station, department):

- Rendering twenty-four hour emergency medical care to patients and victims outside
health facilities, when catastrophes and natural calamities;
- Realization timely transportation of patients, victims and women in childbirth to the
inpatient departments of hospitals;
- Rendering medical care to patients and victims turning for help directly at the station
(sub-station, department);
- Training and retraining of medical staff on emergency care rendering.
STRUCTURE (model) of EMERGENCY STATION (sub-station, department):
 Administration
 Operational department (controllers` office)
 Mobile teams
 Book-keeping
 Pharmacy
 Technical department:
- administrative-economical department
- communication
- computers
 Organizational-methodical department.

MOBILE TEAM is a primary functional unit of the Emergency station (sub-station, department).
MOBILE TEAM can be feldsher or medical.
Feldsher mobile team includes 2 feldshers, medical orderly and driver.
Medical mobile team includes physician, 2 feldshers (or feldsher and nurse-anaesthesist),
medical orderly and driver.
Moreover medical mobile teams are divided into:
 multi profile and
 specialized:
- pediatric
- cardiological
- psychiatric
- traumatological
- pulmonological
- reanimation and other.

EMERGENCY STATION (sub-station, department):

 does not issue documents identifying temporary disability and forensic-medical
inferences;
 does make alcohol intoxication examination.

However when it`s need ES can issue free way certificate indicating date, time, diagnosis,
examinations, medical care and recommendations of the next cure.

BASIC REGISTRATION MEDICAL DOCUMENTS

of EMERGENCY STATION (sub-station, department):
 “Register of emergency care calls”
 “Card of emergency care call”
 “Covering sheet of Emergency station with coupon”
 “Diary of Emergency station (department) work”

STATISTICAL INDICES OF EMERGENCY CARE (groups)

- Provision of population with EC;
- Timeliness of emergency mobile teams exit;
- Divergence of Emergency station and inpatient diagnoses;
- Proportion of successful reanimations;
- Proportion of lethal outcomes.