Qualification categories of doctors: description and rules for obtaining. General requirements for the execution of a certification report for the assignment of a qualification category in diagnostic specialties Manual method of pre-sterilization processing

Bed fund of the therapeutic department. Compliance with the sanitary and epidemiological regime in the department, wards, department premises. Nursing records management. Distribution of medicines. Caring for and monitoring patients.

Medical Unit of the Main Internal Affairs Directorate for the Chelyabinsk Region

CERTIFICATION WORK

for 2009 ward nurse1sttherapeutic department of the hospitalHospital №1Makeeva Maria Feodorovnathe confirmationthe highest qualification category in the specialty "Nursing"

Chelyabinsk 2010

1. Professional route

2. Characteristics of the institution

3. Characteristics of the unit, workplace

bed fund

l structure of patients

l staffing

4. The main sections of the work

functional responsibilities

l list of manipulations

collection of material for analysis

participation in research

5. Related professions

6. Emergencies

7. Sanitary and epidemiological regime at the workplace

l regulatory orders

used disinfectants

l infectious safety of healthcare workers

l tool processing

l quality control of pre-sterilization treatment

8. Hygienic education of the population

9. Analysis of work for the reporting period

10. Conclusions

11. Tasks

Professional routeT

I, Makeeva Maria Fedorovna, in 1973 graduated from the Zlatoust Medical School of the Ministry of Railways with a degree in Nurse - diploma No. 778717 dated June 29, 1973, registration No. 736. According to the distribution, she was sent to the Second Road Clinical Hospital of the city of Chelyabinsk, South Ural Railway. Admitted by a nurse in the 3rd surgical department (oncology). According to the principle of interchangeability, she mastered the work of a nurse in a procedural and dressing room. In 1977, she was dismissed of her own free will.

In the Hospital with a polyclinic of the Medical Department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee, she was enrolled as a nurse in the therapeutic department in 1977.

In 1984, she was called up for military service in military unit No. 7438 as a company medical instructor. At the end of the contract in 1988, she was dismissed from the ranks of the Soviet Army.

In 1988, she was accepted as a nurse in the neurological department of the Hospital with a polyclinic of the Medical Department of the Chelyabinsk Regional Executive Committee. In 1990, she passed certification at the medical department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee and by order of the medical department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee, she was awarded the first qualification category, certificate No. 53 of 06/21/1990.

In August 1993, she was appointed to the position of senior nurse of the therapeutic department. On June 20, 1995, the certification commission at the medical subdivision of the Internal Affairs Directorate of the Chelyabinsk region and the order for the medical subdivision of June 22, 1995 No. 34 awarded the highest qualification category of a hospital nurse. In 2000, at the Chelyabinsk Regional Basic School for Advanced Studies of Workers with Secondary Medical and Pharmaceutical Education, she attended a series of lectures on the program "Modern Aspects of Health Management and Economics" - certificate No. 4876 dated November 24, 2000, protocol No. 49 - awarded the highest qualification category in the specialty "Sisterhood". In February 2003 voluntarily transferred to the position of ward nurse of the therapeutic department. In 2005 improved her qualifications at the State educational institution additional professional education "Chelyabinsk Regional Center for Additional Professional Education of Healthcare Professionals" in the cycle of improvement "Nursing in Therapy" - certificate No. 2690/05 dated 10/18/2005. No. 373l.

In 2010 improved her qualifications at the Chelyabinsk State Medical Academy of Roszdrav in the advanced training cycle "Nursing in Therapy" - certificate registration number 1946/122 dated 20.02.2010.

33 years of experience in healthcare.

37 years of nursing experience.

Characteristics of the institution

The medical and sanitary unit of the Central Internal Affairs Directorate for the Chelyabinsk Region was organized to provide medical, preventive and diagnostic assistance to employees working in the system of the Ministry of Internal Affairs, in accordance with order No. 895 dated November 8, 2006. "On approval of the regulation on the organization of medical care and sanitary-resort treatment in medical institutions of the system of the Ministry of Internal Affairs of Russia." The medical unit is located in a typical five-story building, three floors of which are occupied by a polyclinic and two floors by a hospital. The polyclinic is designed for 650 visits per day, where medical care is provided by local therapists and narrow specialists: an oculist, a dermatologist, a urologist, a gynecologist, a gynecologist, an ENT specialist, a cardiologist, a psychiatrist, a surgeon, and a neurologist.

The following services have been established in the polyclinic to conduct a diagnostic examination:

1. Radiological - conducts radiological and fluoroscopic examinations chest, gastrointestinal tract, musculoskeletal system, skull, intravenous urography, irrigoscopy, fluorographic examinations.

2. Branch functional diagnostics- performs the following examinations: ECG, HM-BP, HM-ECG, ECHO-cardiography, bicycle ergometry, transesophageal electrical stimulation, neurophysiology: EEG, REG; Ultrasound diagnostics of the abdominal organs, pelvic organs, thyroid gland, mammary glands, lumbar spine, ultrasound of vessels; Endoscopy room performs EGD of the stomach.

3. Laboratory department - conducts a full range of clinical, biochemical and bacteriological research blood, urine, feces, sputum and other biological media. All laboratories are equipped with appropriate equipment, including modern analyzers and reagents.

4. Physiotherapy department - carries out treatment with high-frequency currents, inductotherapy, magnetotherapy, UHF, laser therapy, UFO. The department has a massage room, an office physiotherapy exercises, inhalation, shower-massage.

5. Dental service.

Subdivision characteristics

The hospital of the Medical and Sanitary Unit is located on the 4th and 5th floors of the building and is designed for 100 beds: 40 beds in the neurological department and 60 beds in the therapeutic department.

bedfund of the therapeutic department:

Table No. 1

The staff of the therapeutic department

In the therapeutic department of the hospital there is an office of the head of the department, an office of the chief nurse of the Medical and Sanitary Unit, a treatment room, a staff room, a manipulation room, where patients are prepared for diagnostic examinations, shower rooms for patients and medical staff, men's and women's toilets, toilet for staff. There is a lounge with upholstered furniture and a TV for patients to relax. The department has two medical posts with the necessary equipment: desktops with a set of documentation: job descriptions ward nurse, algorithm for fulfilling medical appointments, work journals; a medical cabinet for storing medicines in accordance with standard requirements, a cabinet for storing medical supplies, a cabinet for storing disinfectants and containers for disinfection. The treatment room consists of two blocks: the first - for subcutaneous, intramuscular, intradermal and intravenous injections and blood sampling for biochemical and bacteriological analysis; the second - for infusion therapy. There are also cabinets for medicines, a refrigerator for storing thermolabile drugs (vitamins, hormones, chondroprotectors, insulins), a cabinet for storing sterile solutions, a bactericidal irradiator, containers for disinfecting disposable medical items that are to be disposed of (syringes, systems for infusion of infusion solutions ), couches, cleaning equipment. IN treatment room there are syndromic emergency kits and an Anti-AIDS first aid kit.

The main sections of the work

In my work, as a ward nurse, I rely on regulatory documentation, orders of the Ministry of Health of the Russian Federation, resolutions of the Ministry of Health of the Russian Federation, San PiNy. I try to conscientiously and efficiently fulfill my job descriptions, which include:

· Caring for and supervising patients.

· Timely and high-quality execution of medical appointments.

· Thermometry of patients with subsequent mark in the medical history.

Monitoring of hemodynamics: blood pressure, heart rate, respiratory rate.

Compliance with the sanitary and epidemiological regime in the department, wards, premises of the department.

· Implementation of the sampling of material for laboratory research (preparation of referrals, utensils, conversation with patients about the objectives of the study, about the correct preparation and technique for collecting tests).

· Compliance with the medical and protective regime in the department.

· Familiarization of newly admitted patients with the internal regulations.

Preparation of patients for X-ray, endoscopic and ultrasound examinations.

Maintaining nursing records

Journal of the movement of patients in the department,

Journal of one-time medical appointments,

Magazine of consultations of narrow specialists,

Journal of appointments of diagnostic examinations,

Journal of registration of medicinal products subject to subject-quantitative accounting,

shift log,

· Drawing up a portion requirement, according to the diet prescribed by the doctor, in accordance with the order of the Ministry of Health of the RSFSR No. 330 of 08/05/2003. "On measures to improve medical nutrition in LPU of the Russian Federation.

Obtaining the necessary amount of medicines from the head nurse of the department. All medicines are arranged in groups in lockable cabinets. Everything medicines must be in the original industrial packaging, labeled outward and have instructions for the use of this drug, according to the orders:

Order No. 377 of November 13, 1996 "On approval of requirements for the organization of storage of various groups of medicines and medical devices."

Order of the Ministry of Health of the RSFSR dated September 17, 1976 No. No. 471 "Memo to a medical worker on the storage of medicines in the departments of medical institutions."

According to the order of the Ministry of Health of the USSR No. 747 of 2.06.1987. "On the approval of the instructions for accounting for medicines, dressings and medical devices in medical facilities" and the Ministry of Health of the Chelyabinsk Region letter dated 06/04/2008. No. 01/4183 "On the organization of accounting for medicines and medical supplies", a strict accounting of medicines subject to subject-quantitative accounting is maintained.

Distribution of medicines. Carried out in accordance with the patient's prescription sheet, which indicates the name of the drug, its dosage, frequency and mode of administration. All appointments are signed by the doctor with the date of appointment and cancellation. At the end of treatment, the appointment sheet is pasted into the patient's medical history. I distribute medicines in strict accordance with the time of appointment and adherence to the regimen (during meals, before or after meals, at night). The patient must take medication only in my presence. I distribute medicines to bedridden patients in the ward. Be sure to warn patients about possible side effects drug, reactions of the body to taking the drug (discoloration of urine, feces) containing iron, carbolene, bismuth. Narcotic drugs, psychotropic and potent drugs of list “A” are given to the patient separately from other medicines in the presence of a nurse. In order to avoid mistakes, before opening the package and ampoule, it is necessary to read the name of the drug, its dosage aloud and check with the doctor's prescription.

Examination for pediculosis. Order of the Ministry of Health of the Russian Federation No. 342 dated November 26, 1998. "On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis."

· If the first signs of an infectious disease are detected in a patient, I immediately inform the attending physician, isolate the patient and carry out current disinfection in accordance with San PiN 2.1.3.263010 dated 09.08.2010. "Sanitary and epidemiological requirements for organizations engaged in medical activities"

Transfer of the shift according to the instructions of the ward nurse: the number of patients on the list with the indication of the ward, case history number, diet; medical supplies: thermometers, heating pads, beakers; devices: nebulizer, glucometer, tonometer; medical preparations. If there are seriously ill patients in the department, the changeover is carried out at the patient's bedside.

Related professions

During her work, she mastered such related professions as a nurse in a therapeutic, neurological department, emergency room and treatment room. I know the technique of taking material for research:

Clinical (blood, urine, sputum, feces),

Biochemical (blood),

Bacteriological (blood, sputum, urine, feces, swab from the nose and throat).

I know the technique of applying aseptic dressings, warming compresses, using an ice pack, catheterization Bladder soft catheter, cleansing, hypertonic, oil and therapeutic enemas. I know the technique of taking an electrocardiogram on a portable electrocardiograph EK1T - 07. I also know the technique indirect massage heart, artificial lung ventilation. She mastered the technique of blood transfusion and blood substitutes, infusion therapy and injections: subcutaneous, intradermal, intramuscular and intravenous.

Emergency conditions

Diseases of the cardiovascular system, respiratory organs can be complicated by acute severe conditions:

Anaphylactic shock,

acute myocardial infarction,

Hypertensive crisis,

status asthmaticus,

Pulmonary edema.

To provide emergency medical care in the treatment room there are syndromic sets of medicines and a nurse's action algorithm. All kits are checked in a timely manner and replenished with the necessary drugs.

The technology for providing first aid in emergency conditions is as follows:

Anaphylactic shock

1. Information to suspect anaphylactic shock:

On the background or immediately after the introduction medicinal product, serum, insect bite, weakness, dizziness, shortness of breath, feeling of lack of air, anxiety, feeling of heat in the whole body appeared,

The skin is pale, cold, moist, breathing is frequent, superficial, systolic pressure is 90 mm Hg. and below. In severe cases, depression of consciousness and breathing.

2. Tactics of a nurse:

3. Prepare equipment and tools:

Intravenous infusion system, syringes, needles for intramuscular and subcutaneous injections, ventilator, intubation kit, Ambu bag.

Standard set of drugs "Anaphylactic shock".

4. Evaluation of what has been achieved: restoration of consciousness, stabilization of blood pressure, heart rate.

myocardial infarction(typical pain form)

1. Information to suspect an emergency:

Severe retrosternal pain, often radiating to the left (right) shoulder, forearm, shoulder blades or neck, lower jaw, epigastric region.

Perhaps suffocation, shortness of breath, heart rhythm disturbance.

Taking nitroglycerin does not relieve pain.

2. Nurse tactics:

3. Prepare equipment and tools:

As prescribed by the doctor: fentanyl, droperidol, promedol.

system for intravenous administration, tourniquet.

Electrocardiograph, defibrillator, heart monitor, Ambu bag.

4. Evaluation of what has been achieved: the patient's condition has not worsened.

Bronchial asthma

1.Information: the patient suffers from bronchial asthma

Suffocation, shortness of breath, difficulty exhaling, dry whistling rales, audible at a distance, participation in breathing of auxiliary muscles.

Forced position - sitting or standing with support on hands.

2. Nurse tactics:

3. Prepare equipment and tools: intravenous system, syringes, tourniquet, Ambu bag.

4. Evaluation of what has been achieved: reduction of shortness of breath, consolidated sputum discharge, reduction of wheezing in the lungs.

Sanitary and epidemic regime

In my work on the implementation of the sanitary and epidemiological regime in the department, I am guided by the following orders:

Order No. 288 of the Ministry of Health of the USSR dated March 23, 1976. "On the approval of instructions on the sanitary and anti-epidemic regime of hospitals and on the procedure for the implementation by the bodies and institutions of the sanitary and epidemiological service of state supervision of the sanitary condition of healthcare facilities."

Order No. 720 dated 31.07.1978 Ministry of Health of the USSR "On improving medical care for patients with purulent surgical diseases and improving measures to combat nosocomial infections."

Law of the Russian Federation No. 52 dated March 30, 1997 No. "On the sanitary and epidemiological well-being of the population."

· OST 42-21-2-85 "Sterilization and disinfection of medical devices".

Order No. 342 dated November 26, 1998. Ministry of Health of the Russian Federation "On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis."

San PiN 2.1.7.728-99 of 01/22/1992 "Rules for the collection, storage and disposal of waste from medical institutions."

· San PiN 1.1.1058-01 "Organization and implementation of production control over compliance with sanitary rules and the implementation of sanitary and anti-epidemic (preventive) measures."

· San PiN 3.5.1378-03 "Sanitary and epidemic requirements for the organization and implementation of disinfection activities."

· Order No. 408 dated 12.07.1983. Ministry of Health of the USSR "On measures to reduce the incidence of viral hepatitis in the country".

· San PiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities."

After performing the manipulations, all instruments are subject to processing. Disposable medical items are subject to disinfection and disposal, multiple use - processing in 3 stages: disinfection, pre-sterilization cleaning and sterilization in accordance with OST 42.21.2.85. for the use of disinfectants in the department, you must have the following document:

1. License,

2. Certificate of state registration,

3. Certificate,

4. Guidelines.

When disinfecting instruments and treating working surfaces, we use an oxygen-containing 30% Peroximed solution, which is also used for pre-sterilization cleaning, state registration certificate No. 002704 dated 18.01.1996. during repeated bacteriological examination of the treatment room (tank, air inoculation and washings from working surfaces), a negative result was obtained, therefore, disinfection work is based on the use of this disinfectant. Since the microflora has become more stable in the external environment, it is recommended to replace the disinfectant every 6 months. For this purpose, disinfectants such as Clorsept, Javelin are used.

Table number 2

Disinfection modes

At the workplace, for the disinfection of medical devices (thermometers, beakers, spatulas, tips), we use a 3% solution of Peroximed. All containers are clearly labeled with the disinfectant, its concentration and date of preparation. I prepare the solutions, guided by the guidelines, using personal protective equipment. For the treatment of hands when performing various manipulations in the department, antiseptics are used - Cutasept and Lizhen.

Infection safety of medical workers

Infectious safety is a system of measures that ensures the protection of health workers from infectious diseases, which includes immunization, the use of protective clothing, compliance with instructions and rules when performing procedures, compliance with the rules of personal prevention, annual medical examination in accordance with order No. 90 of the Ministry of Health of the Russian Federation dated March 14, 1996. "On the procedure for conducting preliminary and periodic examinations of medical workers and medical regulations and admission to work." In the context of the increasing spread of HIV infection among the population, all patients must be considered as potentially infected with HIV and other infections transmitted by blood contact, therefore, when working with blood and other biological fluids, 7 safety rules must be observed:

1. Wash hands before and after patient contact.

2. Consider the patient's blood and other body fluids as potentially infectious, so it is necessary to work with gloves.

3. Immediately after use and disinfection, place the used instrument in special yellow bags - Class B waste. San PiN 2.1.7.728-99 "Rules for the collection, storage and disposal of waste in healthcare facilities."

4. Use eye protection (glasses, protective screen) and masks to avoid contact of blood and other biological fluids with the skin and mucous membranes of the medical staff.

5. Treat all linens contaminated with blood as potentially infectious.

6. Use special waterproof clothing to protect the body from droplets of blood and other body fluids.

7. Treat all laboratory specimens as potentially infectious material.

In order to prevent infection with HIV infection and viral hepatitis, I am guided by the infection safety rules recommended in the orders:

Order of the Ministry of Health of the Russian Federation No. 170 dated 16.08.1994. "On measures to improve the prevention and treatment of HIV infection in the Russian Federation."

Order of the Ministry of Health of the Russian Federation No. 408 dated 12.07.1989. "On measures to reduce the incidence of viral hepatitis in the country."

Order of the Ministry of Health of the Russian Federation No. 254 dated 3.09.1991. "On the development of disinfection in the country"

· Order of the Ministry of Health of the Russian Federation No. 295 dated October 30, 1995 “On the Enactment of the Rules for Mandatory Medical Examination for HIV and the List of Employees of Certain Professions, Industries, Enterprises, Institutions and Organizations Who Undergo Mandatory Medical Examination for HIV”.

· Instructive-methodical instructions of the Ministry of Health of the Russian Federation "Organization of measures for the prevention and control of AIDS in the RSFSR" dated 22.08.1990.

San PiN 3.1.958-00 “Prevention of viral hepatitis. General requirements for epidemiological surveillance of viral hepatitis”.

In case of contact with biological fluid on open areas of the skin, it is necessary:

Treat with 70% alcohol

Wash hands with soap and water

Re-treat with 70% alcohol

In case of contact with the mucous membrane of the eyes, it should be:

treat (wash abundantly) with a 0.01% solution of potassium permanganate.

In case of contact with the nasal mucosa:

rinse with 0.05% potassium permanganate solution or 70% alcohol.

For cuts and injections, you must:

Wash gloved hands with soap and running water

Remove gloves

Put on a clean glove on an uninjured hand

Squeeze out the blood from the wound

Wash your hands with soap

Treat the wound with 5% iodine solution. Don't rub!

Table No. 3

The composition of the first-aid kit "Anti-AIDS"

The Anti AIDS first aid kit is located in the treatment room and is always available. Expired medications are replaced in a timely manner. The algorithm for the action of a health worker in emergency situations during procedures is also in the treatment room. emergency situations, as well as preventive actions are subject to registration in the journal "Emergency situations on contamination with biological fluids". In cases of contamination, the head of the department should be informed and immediately contact the center for the prevention and control of AIDS at Cherkasskaya, 2. During the reporting period emergencies did not have.

Processing of medical instruments

Processing of medical instruments is carried out in 3 stages:

Processing steps

disinfectionpre-sterilizationsterilization

treatment

Disinfection- a set of measures aimed at the destruction of pathogenic and opportunistic microorganisms in the external environment in order to interrupt the transmission routes of pathogens of infectious diseases.

Disinfection methods

physicalchemical

drying, airhighapplicationdisinfectants

temperatures, exposure to steamfunds

With the chemical method of disinfection, the disassembled used instruments are completely immersed in a disinfectant using a drowner for 60 minutes.

Pre-sterilizationcleaning - this is the removal of protein, fat, medicinal contaminants and residues of disinfectants from medical devices.

Manual pre-sterilization treatment:

Stage 1 - washing the instrument under running water for 30 seconds.

Stage 2 - complete immersion of products in a 0.5% washing solution for 15 minutes. at a temperature of 50*

cleaning solution ingredients:

Hydrogen peroxide

Synthetic detergent (Progress, Lotus, Aina, Astra)

Table No. 4

The ratio of components in the cleaning solution

The washing solution can be used during the day, heated up to 6 times, if the solution has not changed color.

Stage 3 - washing each instrument in the same solution for 30 seconds.

Stage 4 - rinsing with running water for 5 minutes.

Stage 5 - rinsing each instrument in distilled water for 30 seconds.

Quality control of pre-sterilization treatment is carried out in accordance with the order of the Ministry of Health of the Russian Federation No. 254 of 09/03/1991. "On the development of disinfection in the country." Control is subjected to 1% of the total number of tools, but not less than 3-5 products of the same name.

Azopyram test - reveals the remains of blood and chlorine-containing oxidizing agents. A working solution consisting of equal proportions of azopyram and a 3% hydrogen peroxide solution is applied to the instrument and the result is evaluated in a minute. The appearance of purple coloration indicates the presence of blood residues on the instrument.

Phenolphthaleicsample - allows you to detect detergent residues. A 1% alcohol solution of phenolphthalein is evenly applied to the product. If a pink coloration appears, it means that there are detergent residues on the product. In this case, the entire tool is re-machined. If the test result is negative, the treated material must be sterilized. Pre-sterilization processing of medical instruments in our department is not carried out, because. we work with single-use medical supplies that are disinfected and disposed of in accordance with San PiN 3.1.2313-08 dated 15.01.2008. "Requirements for the disinfection, destruction and disposal of single-use injection syringes."

Sterilization - This is a method that ensures the death of all vegetative and spore forms of pathogenic and non-pathogenic microorganisms.

All instruments in contact with the wound surface, in contact with blood or injectable drugs, as well as diagnostic equipment in contact with the patient's mucosa, are sterilized.

Table No. 5

Sterilization Methods

Sterilization control:

1. Visual - for the operation of the equipment;

2. Thermal indicators of sterility.

3. Temperature control with technical thermometers.

4. Biological - with the help of biotests.

Chemical method of sterilization - the use of chemicals for the prevention of infectious diseases during endoscopic manipulations. For sterilization of endoscopes, Lysofarmin 3000 8% solution is used at a temperature of 40 *, exposure for 60 minutes, then washed twice with sterile water, dried with a sterile napkin, and the channels are purged. Store endoscopes in a sterile napkin. For sterilization of metal products (burs) and plastics (enema tips), hydrogen peroxide 6% is used.

At a temperature of 18 * - 360 min.,

At a temperature of 50 * - 180 min.

Then they are washed twice with sterile water and stored in a sterile bix lined with a sterile sheet.

Guyhygiene education of the population

Hygienic education of the population is one of the forms of disease prevention. A healthy lifestyle: giving up bad habits, playing sports improves health, which helps to avoid diseases of the respiratory system, cardiovascular system, and the musculoskeletal system. Compliance with the regime of work, rest and nutrition reduces the risk of exacerbation of diseases of the gastrointestinal tract. Maintaining good personal hygiene prevents transmission of infections such as HIV, hepatitis B, C. I work on hygienic education among patients while on duty in the form of conversations.

Table No. 6

Conversation Topics

Staffing and organizational structure of the department of medical statistics
The functional subdivision of the health facility responsible for the organization of statistical accounting and reporting is the department of medical statistics, which is structurally part of the organizational and methodological department. The department is headed by the head statistician.

The structure of the department may include the following functional units, depending on the form of health care facilities:

1. department of statistics in the polyclinic - responsible for the collection and processing of information received from the outpatient service;
2. department of statistics of the hospital - is responsible for the collection and processing of information received from the departments of the clinical hospital;
3. medical archive - is responsible for the collection, accounting, storage of medical documentation, its selection and issuance according to requirements.

The department of statistics should be equipped with automated workstations connected to the local network of health facilities. Based on the data obtained, the organizational and methodological department develops proposals and measures to improve the quality of medical care, organizes statistical accounting and reporting in all health facilities of the region, trains staff on these issues and carries out statistical audits.

Accounting and statistics offices in health care facilities carry out work on the organization of the primary accounting system, are responsible for the current, registration of activities, the correct maintenance of records and providing the management of the institution with the necessary operational and final statistical information. They prepare reports and work with primary documentation.

A feature of statistical work is that there are several streams of patient financing - budgetary (attached contingent), direct contracts, voluntary health insurance, paid and compulsory health insurance.

Statistical accounting and reporting are organized in accordance with the basics of statistical accounting and reporting adopted in the healthcare facilities of the Russian Federation, based on the requirements of guidelines, guidelines of the CSB, the Ministry of Health of the Russian Federation and additional instructions from the administration.

Department of Medical Statistics of the Polyclinic
The department of medical statistics of the polyclinic carries out work on the collection, processing of primary accounting documentation and the preparation of appropriate reporting forms for the work of the polyclinic. The main primary accounting document is the "Statistical coupon of an outpatient", coming in the form of a generally accepted form No. 025-6 / y-89.

Every day, after checking and sorting statistical coupons, they are processed. Information from coupons is processed manually or entered into a computer database through a program local network according to the following parameters:

• the reason for the appeal;
• diagnosis;
• service category;
• belonging to the main production or work with occupational hazard (for the attached contingent).

Coupons from workshop polyclinics and health centers are processed according to the same parameters.

Monthly, quarterly reports are prepared on the results of the work of the polyclinic:

• information on attendance by incidence with distribution by departments of the polyclinic, by doctors and by funding streams (budget, CHI, VHI, contractual, paid);
• data on attendance by incidence of day hospitals, hospitals at home, an outpatient surgery center and other types of hospital-replacing types of medical care in a similar form;
• information on attendance by incidence of shop polyclinics and health centers in the same form;
• information on the attendance of attached contingents with distribution by enterprises and categories (working, non-working, pensioners, war veterans, beneficiaries, employees, etc.);
• a summary table of attendance by morbidity with distribution by departments of the outpatient service and funding streams.

At the end of the year, annual reports of state statistical forms are formed.

Dispensary groups of doctors from polyclinics are being processed with the preparation of an appropriate report. Reports (general morbidity, attendance in the XXI class (form No. 12), morbidity in the XIX class (form No. 57)). A report in the form No. 16-VN can be generated in a special program.

Department of Medical Statistics of the Hospital
In the department of medical statistics of the hospital, work is carried out to collect and process primary accounting documentation and draw up appropriate reporting forms based on the results of the work of the clinical hospital. The main primary accounting forms are the medical card of an inpatient (form No. 003 / y), the card of a person who left the hospital (form No. 066 / y), a sheet for registering the movement of patients and hospital beds (form No. 007 / y). The department receives primary accounting forms from the admission department and clinical departments. Processing of received forms of several types is carried out daily.

1. The movement of patients in departments and in the hospital as a whole:
   1. verification of the reliability of the data specified in the form No. 007 / y;
   2. correction of data in the summary table of the movement of patients (form No. 16 / y);
   3. surname registration of the movement of patients in multidisciplinary departments, intensive care units and cardioreanimation;
   4. entering data on the movement of patients per day in a summary table using statistics software;
   5. transmission of the report to the city hospitalization bureau.
2. Entering data into the journal of oncological patients with the issuance of appropriate registration forms (No. 027-1 / y, No. 027-2 / y).
3. Entering data into the register of deceased patients.
4. Statistical processing of forms No. 003/y, 003-1/y, 066/y.
   1. registration of case histories coming from departments in f. No. 007/y, specifying the profile and terms of treatment;
   2. verification of the reliability and usefulness of filling out forms No. 066 / y;
   3. withdrawal from the history of coupons to the accompanying sheet of the SSMP (f. No. 114 / y);
   4. verification of compliance of the cipher of the medical history (funding flows) with the order of receipt, the availability of a referral, the tariff agreement with the TFOMS;
   5. coding of case histories indicating data codes (such as department profile, patient age, admission dates (for emergency surgery, transfers and deceased), discharge date, number of bed days, ICD-X disease code, operation code indicating the number of days before and after the operation and its indefiniteness in emergency surgery, the level of comfort of the ward, the category of complexity of the operation, the level of anesthesia, the number of consultations of doctors);
   6. sorting case histories by funding streams (compulsory health insurance, voluntary health insurance, paid services or direct contracts financed from two sources).
5. Entering information into a computer network: for CMI and VHI patients and for patients financed from several sources, is carried out under direct contracts, letters of guarantee. After processing the information, it is transferred to the financial group for further generation of invoices to the relevant payers.
6. Analysis of the processed case histories with the withdrawal of form No. 066 / y and their sorting by department profiles and discharge dates. Delivery of case histories to the medical archive.
7. Constant monitoring of the timeliness of the delivery of case histories from clinical departments according to the sheets of records of the movement of patients with a periodic report to the head of the department.

Based on the results of the work of the departments and the hospital as a whole, statistical data processing is carried out with the formation of reports. The data from the card of the person who left the hospital is processed with filling in the sheets for the distribution of patients by funding streams for each profile and the sheet for the distribution of patients by attached enterprises. The cards are sorted by diagnosis for each profile. Based on the grouped information, reports are generated:

• report on the movement of patients and beds (form N 16 / y);
• report on the distribution of patients by departments, profiles and funding streams
• report on the distribution of retired patients by attached enterprises;
• report on the surgical activities of the hospital by types of operations;
• report on emergency surgical care;
• report on the surgical work of the departments and the hospital as a whole;
• abortion report.

These reporting forms are compiled quarterly, for half a year, for 9 months and a year. According to the results of the work for the year, national statistical forms No. 13, 14, 30 are compiled.

Based on statistical studies, the department:

1. provides the administration with operational and final statistical information for making optimal management decisions and improving the organization of work, including in matters of planning and forecasting;
2. conducts an analysis of the activities of units and individual services that are part of the medical facility, based on statistical reports using methods for assessing variability, a typical value of a sign, qualitative and quantitative methods for the reliability of differences and methods for studying the relationship between signs;
3. ensures the reliability of statistical accounting and reporting and provides organizational and methodological guidance on medical statistics;
4. carries out the preparation of annual and other periodic and summary reports;
5. determines the policy in the field of correct execution of medical documentation;
6. participates in the development and implementation of computer programs in the work of the department.

Medical archive is designed to collect, record and store medical records, select and issue requested documents for work. The medical archive is located in a room designed for long-term storage of documentation. The archive receives case histories of retired patients, which are recorded in the journals, marked, sorted by departments and alphabetically. In the archive, the selection and issuance of case histories per month on applications and, accordingly, the return of previously requested ones are carried out. At the end of the year, the records of retired patients, case histories of deceased patients, and case histories of outpatients are accepted for storage, accounting, and sorting; final sorting and packing of case histories for long-term storage are carried out.

It is the duty of any practicing physician to increase the level of knowledge and skills. Certification is considered one of the ways of training, which has its own requirements and features, according to the results of which specialists are assigned the appropriate category. Each of the categories of doctors occupies a certain step in the hierarchy of the medical sphere.

Goal and tasks

Participation in the certification process is voluntary. In the process, the personal viability of a specialist, the level of his knowledge, practical skills, compliance with the position held, and professionalism are assessed.

Certification of doctors for the category carries a certain interest:

1. It's prestigious. Allows you to occupy a higher position in allows you to draw the attention of management to yourself. Quite often, the categories of doctors are indicated on the signs at the entrance to their office.
2. In some cases, the highest category allows you to reduce the moral or physical responsibility to the patient's relatives. Like, if such a person could not solve the problem, then it is difficult to think what would have happened if a less experienced doctor had been in his place.
3. material side. The medical categories of doctors and the increase in the levels of the medical hierarchy make it possible to increase the increase in the basic salary.

Types of attestations

The legislation distinguishes several types of certification activities:

• conferring the title of "specialist" after determining theoretical and practical skills;
• qualification category of doctors (receipt);
• category confirmation.

Determining the level of knowledge for the assignment of "specialist" is a mandatory measure before appointment to the position of a doctor. Conducted by special commissions in institutions of postgraduate education. The following candidates are to be considered:

• after internship, magistracy, residency, postgraduate studies, if there is no diploma "specialist doctor";
• those who have not worked for more than 3 years in a narrow specialty;
• those who did not pass certification in a timely manner to obtain qualifications;
• persons who are denied the opportunity to receive the second category for objective reasons.

Each doctor has the right to receive a category in several specialties at the same time, if they are related. The main requirement is work experience in the required specialization. The general practitioner category is an exception.

Basic rules and requirements

Distinguish between second, first and the highest category doctors. In receiving, the sequence rule applies, but there are exceptions. The requirements are listed in the table.

Validity periods

According to the old orders, there were certain circumstances that were classified as social benefits and made it possible to extend the term of the current qualification. These included:

• pregnancy and caring for a child under 3 years;
• a month after being fired due to layoffs;
• business trip;
• state of temporary disability.

Benefits are currently not valid. The attestation commission may decide to extend the period of validity at the request of the head physician of the medical institution. If a doctor refuses to appear on the commission, his category is removed automatically after a five-year period from the date of assignment.

The documents

A report on the work done over the past few years, approved by the head physician of the health facility and the personnel department where the certified person works, is also filled out. Copies of documents on education, work book and assignment of current qualifications are also sent to the commission.

Attestation report

The introduction includes data on the identity of the doctor and the medical institution where he holds his position. The characteristics of the department, its equipment and staff structure, the performance of the department in the form of statistical data are described.

The main part consists of the following items:

• characteristics of the contingent undergoing treatment in the department;
• the possibility of carrying out diagnostic measures;
• carried out medical work with the indicated results for profile diseases;
• fatal cases in the last 3 years and their analysis;
• introduction of innovations.

The conclusion of the report consists of summarizing the results, indicating possible problems and examples of their solutions, opportunities for improvement. If there are published materials, a copy of them is attached. Indicated and studied over the past few years.

Upgrade Points

Each specialist receives points that are involved in making a decision on qualifications. They are awarded for attending conferences, including international congresses, lecturing colleagues or nurses, distance learning with a final certificate, and taking courses.

Additional points are awarded for the following achievements:

• publishing house of a textbook, manuals, monographs;
• publication of the article;
• obtaining a patent for an invention;
• presentation at symposia with a report;
• performance in institutions and mass media;
• obtaining a title;
• defense of the thesis;
• awards by public authorities.

Composition of the commission

The commission consists of a committee, whose work takes place between meetings, and an expert group of a narrow focus, which directly certifies a specialist (exam, testing). Both the committee and the expert group are composed of persons holding the following positions:

1. The chairman, who oversees the work and shares the obligations between the members of the commission.
2. The Deputy Chairman shall perform the functions of the Chairman in full in his absence.
3. The secretary is engaged in registration of incoming documents, forms materials for the work of the commission, fixes decisions.
4. The Deputy Secretary replaces the Secretary and performs his duties during his absence.

Each expert group includes specialists from related specialties. For example, the category of a dentist and its receipt / confirmation requires being in the group of a periodontist, orthodontist, pediatric dentist, therapist.

Meeting order

Certification is appointed no later than three months from the date of receipt of data about the specialist by the committee. If the data does not match the requirements for the latter, a refusal to accept documentation is received (no later than 2 weeks from the date of receipt). The secretary of the committee agrees with the chairman of the expert group of the required specialization on the date of the examination.

Members of the expert group review the certification for the category, filling out a review for each of them, displaying the following data:

• the level of practical skills of a specialist;
• participation in social projects related to the medical field;
• availability of published materials;
• self-education of the certified person;
• correspondence of knowledge and skills to the declared category of doctors.

The review must take place within two weeks of receipt of the report. The result of the review is an indicator of the possible outcome of the certification. The secretary informs the specialist of the date of the meeting, including the interview and testing. More than 70% of correct answers allow us to consider the test passed. The interview takes place by questioning the certified person according to theory and practice, knowledge of which must correspond to the requested qualification.

The meeting is accompanied by the execution of the protocol, which is signed by the members of the expert group and the chairman. The final decision is noted in the qualification sheet. The specialist receives the right to retake the exam only after a year. Within 7 days, the certified person receives a document confirming the increase, decrease or refusal to assign a category.

Extreme measures

The administration of the medical institution can send a request to the commission so that the doctor is deprived of his qualifications or promoted ahead of schedule. In this case, documents are sent to justify the decision. The commission considers the issue in the presence of a specialist. Failure to appear without a valid reason allows a decision to be made in his absence.

Protest

From the date of the decision, a doctor or a medical institution may appeal the result within a month. To do this, it is necessary to issue an application specifying the reasons for disagreement and send it to the commission under the Ministry of Health.

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Lecture number 3. Medical health statistics

1. Organization of the statistical work of a medical institution

statistical medical hospital

Health statistics help the heads of the institution to efficiently manage their facility, and doctors of all specialties - to judge the quality and effectiveness of treatment and prevention work.

The intensification of the work of medical workers in the conditions of budgetary insurance health care imposes increased requirements on scientific and organizational factors. Under these conditions, the role and importance of medical statistics in the scientific and practical activities of a medical institution is increasing.

Healthcare leaders constantly use statistical data in operational and prognostic work. Only a qualified analysis of statistical data, evaluation of events and appropriate conclusions make it possible to make the right managerial decision, contribute to better organization of work, more accurate planning and forecasting. Statistics help to control the activities of the institution, to manage it promptly, to judge the quality and effectiveness of treatment and preventive work. When drawing up current and long-term work plans, the leader should be based on the study and analysis of trends and patterns in the development of both health care and the health status of the population of his district, city, region, etc.

The traditional statistical system in health care is based on the receipt of data in the form of reports, which are compiled in grass-roots institutions and then summarized at intermediate and higher levels. The reporting system has not only advantages (a single program, ensuring comparability, indicators of the amount of work and use of resources, simplicity and low cost of collecting materials), but also certain disadvantages (low efficiency, rigidity, inflexible program, a limited set of information, uncontrolled accounting errors, etc. .).

Analysis, generalization of the work done should be carried out by doctors not only on the basis of existing reporting documentation, but also through specially conducted selective statistical studies.

The plan of statistical research is drawn up on the organization of work in accordance with the planned program. The main points of the plan are:

1) definition of the object of observation;

2) determination of the period of work at all stages;

3) indication of the type of statistical observation and method;

4) determining the place where observations will be made;

5) finding out by what forces and under whose methodological and organizational leadership the research will be carried out.

The organization of statistical research is divided into several stages:

1) the stage of observation;

2) statistical grouping and summary;

3) counting processing;

4) scientific analysis;

5) literary and graphic design of the research data.

2. Organization of statistical accounting and reporting

Staffing and organizational structure of the department of medical statistics

The functional subdivision of the health facility responsible for the organization of statistical accounting and reporting is the department of medical statistics, which is structurally part of the organizational and methodological department. The head of the department is a statistician.

The structure of the department may include the following functional units, depending on the form of health care facilities:

1) the department of statistics in the polyclinic - is responsible for the collection and processing of information received from the outpatient service;

2) department of statistics of the hospital - is responsible for the collection and processing of information received from the departments of the clinical hospital;

3) medical archive - is responsible for the collection, accounting, storage of medical documentation, its selection and issuance according to requirements.

The department of statistics should be equipped with automated workstations connected to the local network of health facilities.

Based on the received data, the OMO develops proposals and measures to improve the quality of medical care, organizes statistical accounting and reporting in all health facilities of the region, trains staff on these issues and carries out statistical audits.

Accounting and statistics offices in health care facilities carry out work on organizing a primary accounting system, are responsible for the current registration of activities, the correct maintenance of records and providing the management of the institution with the necessary operational and final statistical information. They prepare reports and work with primary documentation.

A feature of statistical work is that there are several streams of patient financing - budgetary (attached contingent), direct contracts, voluntary health insurance, paid and compulsory health insurance.

Department of Medical Statistics of the Polyclinic

The department of medical statistics of the polyclinic carries out work on the collection, processing of primary accounting documentation and the preparation of appropriate reporting forms for the work of the polyclinic. The main primary accounting document is the “Outpatient Statistical Coupon”, received in the form of a generally accepted form No. 025-6 / y-89.

Every day, after checking and sorting statistical coupons, they are processed. Information from coupons is processed manually or entered into a computer database through a local network program according to the following parameters:

1) the reason for the appeal;

2) diagnosis;

4) belonging to the main production or work with occupational hazard (for the attached contingent).

Coupons from workshop polyclinics and health centers are processed according to the same parameters.

Monthly, quarterly reports are prepared on the results of the work of the polyclinic:

1) data on attendance by incidence with distribution by departments of the polyclinic, by doctors and by funding streams (budget, CHI, VHI, contractual, paid);

2) information on attendance by incidence of day hospitals, hospitals at home, an outpatient surgery center and other types of hospital-replacing types of medical care in a similar form;

3) information on attendance by incidence of shop polyclinics and health centers in the same form;

4) information on the attendance of attached contingents with distribution by enterprises and categories (working, non-working, pensioners, war veterans, beneficiaries, employees, etc.);

5) a summary table of attendance by morbidity with distribution by departments of the outpatient service and funding streams.

At the end of the year, annual reports of state statistical forms No. 7, 8, 9, 10, 11, 12, 15, 16, 16-VN, 30, 33, 34, 35, 36, 37, 57, 63, 01-C are formed.

Dispensary groups of doctors from polyclinics are being processed with the preparation of an appropriate report. Reports (general morbidity, attendance in the XXI class (form No. 12), morbidity in the XIX class (form No. 57)). A report in the form No. 16-VN can be generated in a special program. Reports on the work of workshop polyclinics and health centers, as well as a report f. No. 01-C are formed by manual processing.

Department of Medical Statistics of the Hospital

In the department of medical statistics of the hospital, work is carried out to collect and process primary accounting documentation and draw up appropriate reporting forms based on the results of the work of the clinical hospital. The main primary accounting forms are the medical card of an inpatient (form No. 003 / y), the card of a person who left the hospital (form No. 066 / y), a sheet for registering the movement of patients and hospital beds (form No. 007 / y). The department receives primary accounting forms from the admission department and clinical departments. Processing of received forms of several types is carried out daily.

1. The movement of patients in departments and in the hospital as a whole:

1) verification of the accuracy of the data specified in the form No. 007 / y;

2) correction of data in the summary table of the movement of patients (form No. 16/y);

3) surname registration of the movement of patients in multidisciplinary departments, intensive care units and cardioreanimation;

4) entering data on the movement of patients per day in a summary table using statistics software;

5) transfer of the report to the city hospitalization bureau.

2. Entering data into the journal of oncological patients with the issuance of appropriate registration forms (No. 027-1 / y, No. 027-2 / y).

3. Entering data into the journal of deceased patients.

4. Statistical processing of forms No. 003/y, 003-1/y, 066/y:

1) registration of case histories coming from departments in f. No. 007/y, specifying the profile and terms of treatment;

2) checking the accuracy and completeness of filling out forms No. 066 / y;

3) withdrawal from the history of coupons to the accompanying sheet of the SSMP (f. No. 114 / y);

4) verification of the compliance of the cipher of the medical history (flows of financing) with the order of receipt, the availability of a referral, the tariff agreement with the TF CHI;

5) coding of case histories with indication of data codes (such as department profile, age of the patient, dates of admission (for emergency surgery, transfer and deceased), date of discharge, number of hospital days, ICD-X disease code, operation code indicating the number of days before and after the operation and its indefiniteness in emergency surgery, the level of comfort of the ward, the category of complexity of the operation, the level of anesthesia, the number of consultations of doctors);

6) sorting of case histories by funding streams (compulsory health insurance, voluntary health insurance, paid services or direct contracts funded from two sources).

5. Entering information into a computer network: for CMI and VHI patients and for patients financed from several sources, it is carried out under direct contracts, letters of guarantee. After processing the information, it is transferred to the financial group for further generation of invoices to the relevant payers.

6. Analysis of the processed case histories with the withdrawal of form No. 066 / y and their sorting by department profiles and discharge dates. Delivery of case histories to the medical archive.

7. Continuous monitoring of the timeliness of the delivery of case histories from clinical departments according to the sheets of records of the movement of patients with a periodic report to the head of the department.

Based on the results of the work of the departments and the hospital as a whole, statistical data processing is carried out with the formation of reports. The data from the card of the person who left the hospital is processed with filling in the sheets for the distribution of patients by funding streams for each profile and the sheet for the distribution of patients by attached enterprises. The cards are sorted by diagnosis for each profile. Based on the grouped information, reports are generated in a spreadsheet editor:

1) report on the movement of patients and beds (form No. 16/y);

2) a report on the distribution of patients by departments, profiles and funding streams;

3) a report on the distribution of retired patients by attached enterprises;

4) report on the surgical activities of the hospital by types of operations;

5) report on emergency surgical care;

6) a report on the surgical work of the departments and the hospital as a whole;

7) report on abortions.

These reporting forms are compiled quarterly, for half a year, for 9 months and a year.

Based on the results of the work for the year, national statistical forms No. 13, 14, 30 are compiled.

Statistical accounting and reporting should be organized in accordance with the basics of statistical accounting and reporting adopted in healthcare facilities of the Russian Federation, based on the requirements of guidelines, methodological recommendations of the CSB, the Ministry of Health of the Russian Federation and additional instructions from the administration.

The activities of health facilities are taken into account by the primary statistical documentation, divided into seven groups:

1) used in a hospital;

2) for polyclinics;

3) used in a hospital and clinic;

4) for other medical and preventive institutions;

5) for institutions of forensic medical examination;

6) for laboratories;

7) for sanitary and preventive institutions.

Based on statistical studies, the department:

1) provides the administration with operational and final statistical information for making optimal management decisions and improving the organization of work, including in matters of planning and forecasting;

2) analyzes the activities of departments and individual services that are part of the health care facility, based on the materials of statistical reports using methods for assessing variability, the typical value of a sign, qualitative and quantitative methods for the reliability of differences and methods for studying the relationship between signs;

3) ensures the reliability of statistical accounting and reporting and provides organizational and methodological guidance on medical statistics;

4) carries out the preparation of annual and other periodic and summary reports;

5) determines the policy in the field of correct execution of medical documentation;

6) participates in the development and implementation of computer programs in the work of the department.

Medical archive is designed to collect, record and store medical records, select and issue requested documents for work. The medical archive is located in a room designed for long-term storage of documentation. The archive receives the case histories of retired patients, which are taken into account in the journals, marked, sorted by departments and alphabetically. In the archive, the selection and issuance of case histories per month on applications and, accordingly, the return of previously requested ones are carried out. At the end of the year, the records of retired patients, case histories of deceased patients, and case histories of outpatients are accepted for storage, accounting, and sorting; final sorting and packing of case histories for long-term storage are carried out.

3. Medical and statistical analysis of medical institutions

Analysis of the activities of health facilities is carried out according to the annual report on the basis of state statistical reporting forms. The statistical data of the annual report are used to analyze and evaluate the activities of the health facility as a whole, its structural divisions, assess the quality of medical care and preventive measures.

The annual report (f. 30 "Report of the medical institution") is compiled on the basis of the data of the current accounting of the elements of the work of the institution and the forms of primary medical documentation. The report form is approved by the Central Statistical Bureau of the Russian Federation and is the same for all types of institutions. Each of them fills in the part of the report that relates to its activities. Features of medical care for individual contingents (children, pregnant women and women in childbirth, patients with tuberculosis, malignant neoplasms, etc.) are given in annexes to the main report in the form of insert reports (there are 12 of them).

In the summary tables of reporting forms 30, 12, 14, information is given in absolute terms, which are of little use for comparison and completely unsuitable for analysis, evaluation and conclusions. Thus, absolute values ​​are needed only as initial data for calculating relative values ​​(indicators), according to which statistical and economic analysis of the activities of a medical institution is carried out. Their reliability is influenced by the type and method of observation and the accuracy of absolute values, which depends on the quality of registration of accounting documents.

When developing primary documentation, various indicators are calculated that are used in the analysis and evaluation of the institution's activities. The value of any indicator depends on many factors and causes and is associated with various performance indicators. Therefore, when evaluating the activities of the institution as a whole, one should keep in mind the various influences of various factors on the results of the work of health care institutions and the range of the relationship between performance indicators.

The essence of the analysis lies in assessing the value of the indicator, comparing and comparing it in dynamics with other objects and groups of observations, in determining the relationship between indicators, their dependence on various factors and causes, in interpreting data and conclusions.

The performance indicators of health care facilities are evaluated based on comparison with norms, standards, official guidelines, optimal and achieved indicators, comparisons with other institutions, teams, aggregates in dynamics by years, months of the year, days, followed by determination of work efficiency.

In the analysis, indicators are combined into groups that characterize a particular function of a health facility, a section of work, a division or a serviced contingent. The generalized scheme of analysis includes the following sections.

1. general characteristics.

2. Organization of work.

3. Specific performance indicators.

4. Quality of medical care.

5. Continuity in the work of institutions.

Consolidated Hospital Annual Report consists of the following main sections:

1) general characteristics of the institution;

3) activities of the polyclinic;

4) operation of the hospital;

5) activities of paraclinical services;

6) sanitary and educational work.

Economic analysis of the activities of health care facilities in the conditions of insurance medicine, it should be carried out in parallel in the following main areas:

1) use of fixed assets;

2) use of the bed fund;

3) use of medical equipment;

4) the use of medical and other personnel (see "Economics of Health Care").

Below is a methodology for analyzing the activities of health care facilities using the example of an integrated hospital, but this scheme can be used to analyze the work of any medical institution.

4. Methodology for analyzing the annual report of the joint hospital

Based on the reporting data, indicators are calculated that characterize the work of the institution, according to which the analysis of each section of the work is carried out. Using the data obtained, the head physician of the institution writes an explanatory note in which he gives a complete and detailed analysis of all indicators and the activities of the institution as a whole.

Section 1. General characteristics of the hospital and its area of ​​activity

The general characteristics of the hospital are given on the basis of the passport part of the report, which indicates the structure of the hospital, its capacity and category (Table 10), lists the medical and auxiliary and diagnostic services included in it, the number of medical sites (therapeutic, shop, etc.) , equipment of the institution. Knowing the number of the population served by the polyclinic, it is possible to calculate the average number of the population in one area and compare it with the calculated standards.

Section 2. Hospital States

In the "States" section, the states of the polyclinic and hospital, the number of occupied positions of doctors, middle and junior medical personnel are indicated. According to the report table (f. 30), absolute values ​​in the columns of the report “States”, “Employed”, “Individuals” are considered as initial data.

The column of the reporting form No. 30 "States" is controlled and must correspond to the staffing table; the column "Employed" during control must correspond to the payroll; in the column "Individuals" absolute number individuals should correspond to the number of work books of employees of the institution in the personnel department.

In the "States" column, the numbers can be greater than in the "Employed" column, or equal to them. "Employed" should never exceed the number of full-time positions.

Staffing with doctors

number of occupied medical positions (individuals) x 100 / number of full-time medical positions (normally (N) = 93.5).

Staffing with paramedical personnel (by positions and individuals):

number of occupied positions (individuals) of paramedical staff x 100 / number of full-time positions of paramedical staff (N= 100%).

Staffing of junior medical personnel (by positions and individuals):

number of occupied positions (individuals) of junior medical staff x 100 / number of full-time positions of junior medical staff.

Compatibility coefficient (CS):

the number of occupied medical positions / the number of physical. persons in positions.

Example: the number of occupied medical positions - 18, the number of physical. persons in occupied positions - 10 K.S. \u003d 18 / 10 \u003d 1.8.

The optimal indicator should be equal to one, the higher it is, the lower the quality of medical care.

Section 3. Activities of the polyclinic

Comprehensive analysis and objective assessment of the work of the polyclinic are the basis for effective management of its activities, making optimal management decisions, timely control, clear, targeted planning and, ultimately, an effective means of improving the quality of medical support for attached contingents.

The activities of the polyclinic are analyzed in the following main areas:

1) analysis of the staffing of the polyclinic, the state of its material and technical base and the provision of medical equipment, the compliance of the organizational and staffing structure of its divisions with the volume and nature of the tasks to be solved;

2) state of health, morbidity, hospitalization, labor losses, mortality;

3) dispensary work, the effectiveness of ongoing medical and recreational activities;

4) medical and diagnostic work in the following sections:

a) medical work of departments of therapeutic and surgical profile;

b) the work of the hospital department (day hospital);

c) the work of diagnostic units;

d) the work of auxiliary medical departments and polyclinic rooms (physiotherapy department, exercise therapy rooms, reflexology, manual therapy, etc.);

e) organization and condition of emergency medical care and home care, preparation of patients for planned hospitalization;

f) organization of rehabilitation treatment;

g) defects in the provision of medical care to prehospital stage, the reasons for discrepancies in diagnoses between the clinic and the hospital;

5) organization and conduct of an advisory and expert commission and medical and social expertise;

6) preventive work;

7) financial, economic and economic work.

The analysis is based on an objective and complete accounting of all the work carried out in the clinic and compliance with established methods for calculating indicators, which ensures reliable and comparable results.

An essential element of the analysis is to identify the dynamics (positive or negative) of the indicators and the reasons that led to its change.

The scope of the analysis of the work of the clinic is set depending on its frequency. The most profound and comprehensive analysis is carried out during the year when compiling the annual medical report and an explanatory note to it. In the period between annual reports, an interim analysis is carried out on a quarterly basis with a cumulative total. Operational analysis, reflecting the main issues of the polyclinic, should be performed daily, weekly and monthly.

Such periodicity allows the management of the clinic to know the state of work in the clinic and to correct it in a timely manner. In the course of the analysis, both positive results and shortcomings are determined, their assessment is given, and necessary measures to eliminate deficiencies and improve the work of the clinic.

Analysis of the work of the polyclinic for the month, quarter, six months and nine months is carried out in the same areas of activity of the polyclinic. Additionally, the implementation of therapeutic and preventive measures for the contingents attached to the medical support of the clinic is analyzed. All performance indicators are compared with similar indicators for the corresponding period of the previous year.

Analysis of the work of the clinic for the year. All areas of activity of the clinic are analyzed. At the same time, recommendations and methods for calculating medical and statistical indicators are used, which are set out in the guidelines for compiling an annual medical report and an explanatory note to it.

In order to draw objective conclusions from the analysis of the work for the year, it is necessary to conduct comparative analysis performance indicators of the polyclinic for the reporting and previous years with the performance of other polyclinics, with average indicators for the city (region, district). Inside the polyclinic, the performance of departments with similar profiles is compared.

Particular attention should be paid to the analysis of the effectiveness of introducing new modern medical technologies into the practice of diagnostics and treatment, including hospital replacements, as well as the implementation of proposals to improve the material and technical base.

The degree of fulfillment of the tasks set by the departments of the polyclinic and the institution as a whole is assessed, the correspondence of the forces and means available in the polyclinic to the nature and characteristics of the tasks it solves is reflected.

Statistical analysis is carried out according to the scheme:

1) general information about the clinic;

2) organization of work of the polyclinic;

3) preventive work of the polyclinic;

4) quality of medical diagnostics.

To calculate the performance indicators of the polyclinic, the source of information is the annual report (f. 30).

Provision of the population with polyclinic care is determined by the average number of visits per 1 inhabitant per year:

number of medical visits in the polyclinic (at home) / number of population served.

In the same way, it is possible to determine the provision of the population with medical care in general and in individual specialties. This indicator is analyzed in dynamics and compared with other polyclinics.

The indicator of the load of doctors for 1 hour of work:

total number of visits during the year / total number of hours of admission during the year.

Estimated workload rates for doctors are presented in Table 11.

Table 11. Estimated norms of the function of a medical position with different options for work schedules

Note. The head physician has the right to change the norms reception in the polyclinic and home care, however, the annual planned function of the posts in the whole institution must be fulfilled

The function of a medical position (FVD) is the number of visits to one doctor working at the same rate per year. Distinguish FVD actual and planned:

1) The actual FVD is obtained from the amount of visits for the year according to the doctor's diary (f. 039 / y). For example, 5678 visits per year to a therapist;

2) The planned PVD should be calculated taking into account the standard workload of a specialist for 1 hour at the reception and at home according to the formula:

FVD \u003d (a x 6 x c) + (a1 x b1 x c1),

where (a x b x c) - work at the reception;

(a1 x b1 x c1) - work at home;

a - the load of the therapist for 1 hour at the reception (5 people per hour);

b - number of hours at the reception (3 hours);

c - the number of working days of health facilities per year (285);

b1 - the number of hours of work at home (3 hours);

в1 - the number of working days of health facilities in a year.

The degree of implementation of the FVD - this is the percentage of the actual FVD to the planned one:

HPF actual x 100 / HPF planned.

The value of the actual FVD and the degree of fulfillment are influenced by:

1) the accuracy of registration of the accounting form 039 / y;

2) work experience and qualifications of the doctor;

3) reception conditions (equipment, staffing with medical personnel and paramedical personnel);

4) the need of the population for outpatient care;

5) mode and work schedule of a specialist;

6) the number of days worked by a specialist in a year (may be less due to the doctor's illness, business trips, etc.).

This indicator is analyzed for each specialist, taking into account the factors affecting its value (standards for the function of the main medical positions). The function of a medical position depends not so much on the doctor's workload at the reception or at home, but on the number of days worked during the year, employment and staffing of medical positions.

Structure of visits by specialties (on the example of a therapist, %). The structure of visits to the polyclinic depends on the staffing of its specialists, their workload and the quality of registration form 039 / y:

number of visits to a therapist x 100 / number of visits to doctors of all specialties (in N = 30 - 40%).

Thus, for each specialist, the proportion of his visits to the total number of visits to all doctors per year is determined, with an indicator of 95%, specialized medical care was not provided.

The share of rural residents in the total number of visits to the polyclinic (%):

number of visits to polyclinic doctors by rural residents x 100 / total number of visits to the polyclinic.

This indicator is calculated both for the clinic as a whole and for individual specialists. Its reliability depends on the quality of filling in the primary accounting documentation (f. 039 / y).

Structure of visits by types of requests (on the example of a therapist,%):

1) the structure of visits for diseases:

number of visits to a specialist for diseases x 100 / / total number of visits to this specialist;

2) the structure of visits for medical examinations:

number of visits for preventive examinations x 100 / total number of visits to this specialist.

This indicator makes it possible to see the main direction in the work of doctors of certain specialties. The ratio of preventive visits for diseases to individual doctors is compared with their workload and employment in time during the month.

With properly organized work, visits for diseases to therapists make up 60%, to surgeons - 70 - 80%, to obstetrician-gynecologists - 30 - 40%.

Home visiting activity (%):

number of home doctor visits made actively x 100 / total number of home doctor visits.

The indicator of activity, depending on the ratio of primary and repeated visits, the number of which is determined by the dynamics and nature of diseases (severity, seasonality), as well as the possibility of hospitalization, ranges from 30 to 60%.

When analyzing the indicator calculated using the above formula, it should be borne in mind that it characterizes the volume of active visits to patients at home (an active visit should be understood as a visit made on the initiative of a doctor). For a more accurate characterization of the activity of this type of visits, it is necessary to differentiate primary and repeated visits and calculate this indicator only in relation to repeated visits, which makes it possible to conduct an in-depth analysis based on the data contained in the Book of Calling Doctors at Home (f. 031 / y ).

It is advisable to calculate this indicator in relation to patients with pathology requiring active monitoring (croupous pneumonia, hypertension, etc.). It indicates the degree of attention of doctors to patients. The reliability of this indicator depends both on the quality of keeping records of active visits in the registration form 039 / y and the staffing of doctors, and on the structure of diseases at the site. With proper organization of work, its value ranges from 85 to 90 %.

District public services

One of the main forms of polyclinic services for the population is the territorial-district principle in the provision of medical care to the population. The reliability of the indicators characterizing the district service to the population, to a large extent depends on the quality of the design of the doctor's diary (f. 039 / y).

Average population in the area (therapeutic, pediatric, obstetric-gynecological, workshop, etc.):

average annual adult population assigned to the polyclinic / number of sites (eg therapeutic) in the polyclinic.

Currently, one territorial therapeutic site in the Russian Federation accounts for an average of 1,700 people of the adult population, for pediatrics - 800 children, for obstetrics and gynecology - about 3,000 women (of which 2,000 women of childbearing age), for a workshop - 1,500 - 2,000 workers. Service rates for doctors in outpatient clinics are shown in Table 12.

Table 12. Estimated service rates for doctors of outpatient clinics

The rate of visits to a district doctor at an appointment in a polyclinic (%) is one of the leading indicators:

number of visits to the local doctor by residents of their area x 100 / total number of visits to the local doctors during the year.

The indicator of the locality at the reception characterizes the organization of the work of doctors in the polyclinic and indicates the degree of compliance with the district principle of providing medical care to the population, one of the advantages of which is that the patients of the district should be served by one, “their” doctor (“their” doctor should be considered a district therapist in the event that he constantly works at the site or replaces another doctor for at least 1 month).

From this point of view, the indicator of division, with the correct organization of work, equal to 80 - 85%, can be considered optimal. It practically cannot reach 100%, because due to the absence of their district doctor for objective reasons, residents of this district visit other doctors. At a lower indicator, one should look for the causes and factors that influence it (inconvenient for the population, the schedule of admission, the absence of a doctor, etc.).

Home care coverage:

number of home visits made by your GP x 100 / total number of home visits.

With reliable registration f. 039 / for this indicator, as a rule, is high and reaches 90 - 95% with sufficient staffing. To analyze the state of medical care at home in order to correct it during the year, it can be calculated for individual district doctors and for months.

With a decrease in district coverage below 50 - 60%, one can make an assumption about a low level of work organization or understaffing, which negatively affects the quality of outpatient services for the population.

Compliance with the district largely depends on the accurate work of the registry, the ability to correctly distribute patients, correctly draw up a schedule for the work of doctors, and the population in the area.

Using the data contained in the doctor's diary (f. 039 / y), you can determine repetition of outpatient visits:

number of return visits to doctors / number of initial visits to the same doctors.

If this indicator is high (5 - 6%), one can think about the groundlessness of repeated visits prescribed by doctors due to an insufficiently thoughtful attitude towards patients; a very low rate (1.2 - 1.5%) indicates insufficiently qualified medical care in the clinic and that the main goal of repeated visits to patients is to mark a disability certificate.

Dispensary care of the population

The source of information on periodic inspections is the "Map subject to periodic inspection" (f. 046 / y).

To assess the preventive work of the clinic, the following indicators are calculated.

Completeness of coverage of the population with preventive examinations(%):

number actually inspected x 100 / number to be inspected according to the plan.

This indicator is calculated for all contingents (f. 30-zdrav, section 2, subsection 5 “Preventive examinations conducted by this institution). The size of the indicator is usually high and approaches 100%.

Frequency of detected diseases (“pathological lesion”) is calculated for all diagnoses that are indicated in the report for 100, 1000 examined:

number of diseases detected during professional examinations x 1000 / total number of examined persons.

This indicator reflects the quality of preventive examinations and indicates how often the identified pathology occurs in the “environment” of those examined or in the “environment” of the population of the area where the polyclinic operates.

More detailed results of preventive examinations can be obtained by developing "Dispensary observation cards" (f. 030 / y). This allows you to examine this contingent of patients by sex, age, profession, length of service, duration of observation; in addition, to evaluate the participation in examinations of doctors of various specialties, the performance of the required number of examinations per person, the effectiveness of examinations and the nature of the measures taken to improve and examine these contingents.

To obtain a reliable indicator, it is important to timely correctly issue statistical coupons at professional examinations (f. 025-2 / y). The quality of examinations depends on the detection of pathology and its timely registration in accounting and reporting documents. Per 1000 examined, the detection rate hypertension is 15, chronic bronchitis- 13, thyrotoxicosis - 5, rheumatism - 2.

Dispensary observation of patients

For the analysis of dispensary work, three groups of indicators are used:

1) dispensary observation coverage indicators;

2) indicators of the quality of dispensary observation;

3) indicators of the effectiveness of dispensary observation.

The data necessary to calculate these indicators can be obtained from accounting and reporting documents (f. 12, 030 / y, 025 / y, 025-2 / y).

Dispensary observation coverage indicators are as follows.

In this group, indicators of the frequency and structure of coverage by dispensary observation (“D” observation) are distinguished.

1. Frequency indicators.

Coverage of the population by medical examination (per 1000 inhabitants):

is on "D"-observation during the year x 1000 / total population served.

The structure of patients under "D"-observation, according to nosological forms(%):

number of patients under “D” supervision for this disease x 100 / total number of dispensary patients.

2. Indicators of the quality of clinical examination.

Timeliness of taking patients on "D"-account (%) (for all diagnoses):

number of patients newly diagnosed and taken under “D” observation x 100 / total number of newly diagnosed patients.

The indicator characterizes the work on early taking on the "D"-registration, therefore it is calculated from the totality of diseases from the first time in life established diagnosis according to individual nosological forms. With proper organization of work, this indicator should approach 100%: hypertension - 35%, peptic ulcer - 24%, coronary artery disease - 19%, diabetes- 14.5%, rheumatism - 6.5%.

Completeness of coverage of "D"-observation of patients (%):

the number of patients on the “D”-registration at the beginning of the year + those newly taken under the “D”-observation - never showed up x 100 / the number of registered patients in need of the “D”-registration.

This indicator characterizes the activity of doctors in the organization and conduct of medical examinations and should be 90 - 100%. It can be calculated both for the entire dispensary contingent of patients, and separately for those nosological forms, information about which is available in the report.

Frequency of visits:

number of visits to the doctor made by patients of the dispensary group / number of persons in the dispensary group. Compliance with the terms of dispensary examinations(scheduled observation), %:

the number of prophylactic patients who met the terms of appearance for "D"-observation x 100 / total number of prophylactic patients.

The percentage of "come off" (never came to the doctor for a year) is normally acceptable from 1.5 to 3%.

Completeness of medical and recreational activities (%):

underwent this type of treatment (recovery) x 100 / needed this type of treatment (recovery) during the year.

Indicators of the effectiveness of dispensary observation

The effectiveness of dispensary observation is assessed by indicators that characterize the achievement of the goal of medical examination, its final results. It depends not only on the efforts and qualifications of the doctor, the level of organization of dispensary observation, the quality of medical and recreational activities, but also on the patient himself, his material and living conditions, working conditions, socio-economic and environmental factors.

It is possible to evaluate the effectiveness of clinical examination based on the study of the completeness of the examination, the regularity of observation, the implementation of a complex of medical and recreational activities and its results. This requires an in-depth analysis of the data contained in the "Medical record of the outpatient" (f. 025 / y) and the "Control card for dispensary observation" (f. 030 / y).

The main criteria for the effectiveness of prophylactic medical examinations are shifts in the state of health of patients (improvement, deterioration, no change), the presence or absence of relapses, indicators of disability, a decrease in morbidity and mortality in the dispensary group, as well as access to disability and the results of rehabilitation and re-examination of disabled people who are "D" - account. To assess these changes, a so-called milestone epicrisis is compiled for each patient once a year, which is recorded in the "Medical record of the outpatient". In a milestone epicrisis, the patient's subjective state, objective examination data, therapeutic and preventive measures taken, as well as employment measures are briefly recorded. It is recommended to evaluate the effectiveness of prophylactic medical examination in dynamics for 3-5 years.

Evaluation of the effectiveness of clinical examination should be carried out separately by groups:

1) healthy;

2) persons who have undergone acute diseases;

3) patients with chronic diseases.

The criteria for the effectiveness of prophylactic medical examinations of healthy people (I group "D"-observations) are the absence of diseases, the preservation of health and ability to work, that is, the absence of transfer to the group of patients.

The criteria for the effectiveness of clinical examination of persons who have had acute illnesses (Group II "D"-observation) are complete recovery and transfer to the healthy group.

The indicators characterizing the effectiveness of medical examination of chronic patients are as follows.

The proportion of patients removed from the "D"-registration in connection with recovery:

the number of persons removed from the "D"-registration in connection with the recovery x 100 / the number of patients on the "D"-registration.

The proportion of patients removed from the “D”-registration in connection with recovery is normally acceptable for hypertension - 1%, peptic ulcer- 3%, rheumatism - 2%.

The share of patients removed from the "D"-registration due to death (for all diagnoses):

the number of patients removed from the "D"-registration due to death x 100 / the number of patients on the "D"-registration.

The proportion of relapses in the dispensary group:

the number of exacerbations (relapses) in the dispensary group x 100 / the number of people with this disease undergoing treatment.

This indicator is calculated and analyzed for each nosological form separately.

The proportion of patients on "D"-observation who did not have temporary disability during the year (VUT):

the number of patients in the dispensary group who did not have TD during the year x 100 / the number of employees in the dispensary group.

The proportion of newly taken on the "D"-registration among those under observation:

the number of newly taken patients on the "D"-registration with this disease x 100 / the number of patients on the "D"-registration at the beginning of the year + newly taken patients in this year.

This indicator gives an idea of ​​the systematic work on clinical examination in the clinic. It should not be high, otherwise it will indicate a decrease in the quality of detection of a particular pathology in previous years. If the indicator is above 50%, we can conclude that there is insufficient work on medical examination. It is recommended to analyze this indicator for individual nosological forms, since in long-term diseases it is less than 30%, and in rapidly curable diseases it can be much higher.

Morbidity with temporary disability (TS) in cases and days for specific diseases, for which patients are taken to the "D"-registration (per 100 medical examinations):

the number of cases (days) of morbidity with VUT with a given disease among those who were prophylactic in a given year x 100 / the number of prophylactic patients with this disease.

The effectiveness of clinical examination is confirmed by a decrease in the value of this indicator when compared with the indicator for the previous year (or several years).

The indicator of primary disability consisting on the "D"-registration for the year (per 10,000 medical examinations):

recognized as disabled for the first time in a given year for this disease out of those on the “D”-registration x 1000 / the number of those on the “D”-registration during the year for this disease.

Mortality among patients on the "D"-registration (per 100 medical examinations):

the number of deaths among those on the "D"-registration x 1000 / the total number of persons on the "D"-registration.

The average number of patients registered at the dispensary in the therapeutic area: it is considered optimal when the district doctor is registered with 100-150 patients with various diseases.

Statistical indicators of incidence

General frequency (level) of primary morbidity (‰):

number of all initial applications x 1000 / average annual number of attached population.

Frequency (level) of primary morbidity by classes (groups, separate forms) of diseases (‰):

number of initial visits for diseases x 1000 / average annual attached population.

The structure of primary morbidity by classes (groups, separate forms) of diseases (%):

number of initial visits for diseases x 100 / number of initial visits for all classes of diseases.

Statistical indicators of labor losses

Overall frequency of cases (days) of labor loss (‰):

the number of all cases (or days) of labor loss x 1000 / the average annual number of the attached population.

Frequency of cases (days) of labor losses by classes (groups, separate forms) of diseases (‰):

number of cases (days) of labor loss due to all diseases x 1000 / average annual number of attached population.

Structure of cases (days) of labor losses by classes (groups, individual forms) of diseases (%):

the number of cases (days) of labor losses by classes (groups, separate forms) of diseases x 100 / the number of cases (or days) of labor losses by all classes of diseases.

Average duration of cases of labor loss by classes (groups, individual forms) of diseases (days):

the number of days of labor loss by classes (groups, separate forms) of diseases / the number of cases of labor loss due to skin diseases (trauma, influenza, etc.).

Day hospital performance indicators

The structure of patients treated in the day hospital by class (groups, individual forms of diseases) (%):

number of patients treated by classes (groups, separate forms) of diseases x 100 / total number of patients treated in a day hospital.

The average duration of treatment of patients in a day hospital (days):

number of treatment days spent in the day hospital by all treated patients / total number of patients treated in the day hospital.

The average duration of treatment in a day hospital by classes (groups, separate forms) of diseases (days):

number of days of treatment of patients in a day hospital by classes (groups, separate forms) of diseases / number of patients treated in a day hospital, by classes (groups, separate forms) of diseases.

Number of days of treatment in a day hospital per 1000 attached population(‰):

number of hospital days x 1000 / total attached population.

Hospitalization rates

Overall frequency (level) of hospitalization (‰):

number of all hospitalized patients x 1000 / average annual fixed population.

Frequency (level) of hospitalization by classes (groups, individual forms) of diseases (‰):

number of hospitalized by classes (groups, individual forms) of diseases x 1000 / average annual number of attached population.

The structure of hospitalization by classes (groups, separate forms) of diseases (%):

number of hospitalized by classes (groups, separate forms) of diseases x 100 / number of all hospitalized.

Section 4. Operation of the hospital

Statistical data on the work of the hospital are presented in the annual report (form 30-zdrav.) in Section 3 "Beds and its use" and in the "Report on the activities of the hospital for the year" (form 14). These data make it possible to determine the indicators necessary to assess the use of hospital beds and the quality of treatment.

However, the assessment of hospital performance should not be limited to these sections of the report. A detailed analysis is possible only when using, studying and correctly filling out the primary accounting documentation:

1) a medical card of an inpatient (f. 003 / y);

2) a journal for registering the movement of patients and hospital beds (f. 001 / y);

3) a consolidated monthly record of the movement of patients and bed capacity in a hospital (department, bed profile) (f. 016 / y);

4) a statistical card of the person who left the hospital (f. 066 / y).

The assessment of the work of the hospital is given on the basis of the analysis of two groups of indicators:

1) bed fund and its use;

2) the quality of medical and diagnostic work.

Use of hospital beds

Rational use of the actually deployed bed fund (in the absence of overload) and compliance with the required period of treatment in departments, taking into account the specialization of beds, diagnosis, severity of pathology, concomitant diseases, are of great importance in organizing the work of a hospital.

To assess the use of the bed fund, the following most important indicators are calculated:

1) provision of the population with hospital beds;

2) average annual hospital bed occupancy;

3) the degree of use of the bed fund;

4) turnover of a hospital bed;

5) the average duration of the patient's stay in bed.

Provision of the population with hospital beds (per 10,000 population):

total hospital beds x 10,000 / population served.

Average annual employment (work) of a hospital bed:

number of bed days actually spent by patients in the hospital / average annual number of beds.

Average annual number of hospital beds is defined as follows:

number of actually occupied beds per month of the year in hospital / 12 months.

This indicator can be calculated both for the hospital as a whole and for departments. Its assessment is made by comparison with the calculated standards for departments of various profiles.

Analyzing this indicator, it should be taken into account that the number of actually spent hospital days includes days spent by patients on the so-called side beds, which are not counted among the average annual beds; Therefore, the average annual bed occupancy may be more than the number of days in a year (over 365 days).

The work of a bed less or more than the standard indicates, respectively, an underload or an overload of the hospital.

Approximately this figure is 320 - 340 days a year for city hospitals.

Degree of use of beds (fulfillment of the plan for bed days):

number of actual hospital days spent by patients x 100 / planned number of hospital days.

The planned number of bed days per year is determined by multiplying the average annual number of beds by the standard bed occupancy per year (Table 13).

Table 13. Average number of days of use (occupancy) of a bed per year

This indicator is calculated for the hospital as a whole and for departments. If the average annual bed occupancy is within the norm, then it approaches 30%; if the hospital is overloaded or underloaded, the indicator will be respectively higher or lower than 100%.

Hospital bed turnover:

number of discharged patients (discharged + deceased) / average annual number of beds.

This indicator indicates how many patients were "served" by one bed during the year. The speed of bed turnover depends on the duration of hospitalization, which, in turn, is determined by the nature and course of the disease. At the same time, a decrease in the length of stay of a patient in a bed and, consequently, an increase in the turnover of a bed largely depend on the quality of diagnosis, the timeliness of hospitalization, care and treatment in the hospital. The calculation of the indicator and its analysis should be carried out both for the hospital as a whole and for departments, bed profiles, and nosological forms. In accordance with the planned standards for city hospitals general type bed turnover is considered optimal within 25 - 30, and for dispensaries - 8 - 10 patients per year.

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Health statistics help the heads of the institution to quickly manage their facility, and doctors of all specialties - to judge the quality and effectiveness of treatment and preventive work.

The intensification of the work of medical workers in the conditions of budgetary insurance health care imposes increased requirements on scientific and organizational factors. Under these conditions, the role and importance of medical statistics in the scientific and practical activities of a medical institution is increasing.

Healthcare leaders constantly use statistical data in operational and prognostic work. Only a qualified analysis of statistical data, evaluation of events and appropriate conclusions make it possible to make the right managerial decision, contribute to better organization of work, more accurate planning and forecasting. Statistics help to control the activities of the institution, to manage it promptly, to judge the quality and effectiveness of treatment and preventive work. When drawing up current and long-term work plans, the leader should be based on the study and analysis of trends and patterns in the development of both health care and the health status of the population of his district, city, region, etc.

The traditional statistical system in health care is based on the receipt of data in the form of reports, which are compiled in grass-roots institutions and then summarized at intermediate and higher levels. The reporting system has not only advantages (a single program, ensuring comparability, indicators of the amount of work and use of resources, simplicity and low cost of collecting materials), but also certain disadvantages (low efficiency, rigidity, inflexible program, a limited set of information, uncontrolled accounting errors, etc. .).

Analysis, generalization of the work done should be carried out by doctors not only on the basis of existing reporting documentation, but also through specially conducted selective statistical studies.

The plan of statistical research is drawn up on the organization of work in accordance with the planned program. The main points of the plan are:

1) definition of the object of observation;

2) determination of the period of work at all stages;

3) indication of the type of statistical observation and method;

4) determining the place where observations will be made;

5) finding out by what forces and under whose methodological and organizational leadership the research will be carried out.

The organization of statistical research is divided into several stages:

1) the stage of observation;

2) statistical grouping and summary;

3) counting processing;

4) scientific analysis;

5) literary and graphic design of the research data.

The functional subdivision of the health facility responsible for the organization of statistical accounting and reporting is the department of medical statistics, which is structurally part of the organizational and methodological department. The head of the department is a statistician.

The structure of the department may include the following functional units, depending on the form of health care facilities:

1) department of statistics in the polyclinic - is responsible for the collection and processing of information received from the outpatient service;

2) department of statistics of the hospital - is responsible for the collection and processing of information received from the departments of the clinical hospital;

3) medical archive - responsible for the collection, accounting, storage of medical documentation, its selection and issuance according to requirements.

The department of statistics should be equipped with automated workstations connected to the local network of health facilities.

Based on the received data, the OMO develops proposals and measures to improve the quality of medical care, organizes statistical accounting and reporting in all health facilities of the region, trains staff on these issues and carries out statistical audits.

Accounting and statistics offices in health care facilities carry out work on organizing a primary accounting system, are responsible for the current registration of activities, the correct maintenance of records and providing the management of the institution with the necessary operational and final statistical information. They prepare reports and work with primary documentation.

A feature of statistical work is that there are several streams of patient financing - budgetary (attached contingent), direct contracts, voluntary health insurance, paid and compulsory health insurance.

The department of medical statistics of the polyclinic carries out work on the collection, processing of primary accounting documentation and the preparation of appropriate reporting forms for the work of the polyclinic. The main primary accounting document is the “Outpatient Statistical Coupon”, received in the form of a generally accepted form No. 025-6 / y-89.

Every day, after checking and sorting statistical coupons, they are processed. Information from coupons is processed manually or entered into a computer database through a local network program according to the following parameters:

1) the reason for the appeal;

2) diagnosis;

4) belonging to the main production or work with occupational hazard (for the attached contingent).

Coupons from workshop polyclinics and health centers are processed according to the same parameters.

Monthly, quarterly reports are prepared on the results of the work of the polyclinic:

1) data on attendance by incidence with distribution by departments of the polyclinic, by doctors and by funding streams (budget, CHI, VHI, contractual, paid);

2) information on attendance by incidence of day hospitals, hospitals at home, an outpatient surgery center and other types of hospital-replacing types of medical care in a similar form;

3) information on attendance by incidence of shop polyclinics and health centers in the same form;

4) information on the attendance of attached contingents with distribution by enterprises and categories (working, non-working, pensioners, war veterans, beneficiaries, employees, etc.);

5) a summary table of attendance by morbidity with distribution by departments of the outpatient service and funding streams.

At the end of the year, annual reports of state statistical forms No. 7, 8, 9, 10, 11, 12, 15, 16, 16-VN, 30, 33, 34, 35, 36, 37, 57, 63, 01-C are formed.

Dispensary groups of doctors from polyclinics are being processed with the preparation of an appropriate report. Reports (general morbidity, attendance in the XXI class (form No. 12), morbidity in the XIX class (form No. 57)). A report in the form No. 16-VN can be generated in a special program. Reports on the work of workshop polyclinics and health centers, as well as a report f. No. 01-C are formed by manual processing.

In the department of medical statistics of the hospital, work is carried out to collect and process primary accounting documentation and draw up appropriate reporting forms based on the results of the work of the clinical hospital. The main primary accounting forms are the medical card of an inpatient (form No. 003 / y), the card of a person who left the hospital (form No. 066 / y), a sheet for registering the movement of patients and hospital beds (form No. 007 / y). The department receives primary accounting forms from the admission department and clinical departments. Processing of received forms of several types is carried out daily.

1. The movement of patients in departments and in the hospital as a whole:

1) verification of the accuracy of the data specified in the form No. 007 / y;

2) correction of data in the summary table of the movement of patients (form No. 16/y);

3) surname registration of the movement of patients in multidisciplinary departments, intensive care units and cardioreanimation;

4) entering data on the movement of patients per day in a summary table using statistics software;

5) transfer of the report to the city hospitalization bureau.

2. Entering data into the journal of oncological patients with the issuance of appropriate registration forms (No. 027-1 / y, No. 027-2 / y).

3. Entering data into the journal of deceased patients.

4. Statistical processing of forms No. 003/y, 003-1/y, 066/y:

1) registration of case histories coming from departments in f. No. 007/y, specifying the profile and terms of treatment;

2) checking the accuracy and completeness of filling out forms No. 066 / y;

3) withdrawal from the history of coupons to the accompanying sheet of the SSMP (f. No. 114 / y);

4) verification of the compliance of the cipher of the medical history (flows of financing) with the order of receipt, the availability of a referral, the tariff agreement with the TF CHI;

5) coding of case histories with indication of data codes (such as department profile, age of the patient, dates of admission (for emergency surgery, transfer and deceased), date of discharge, number of hospital days, ICD-X disease code, operation code indicating the number of days before and after the operation and its indefiniteness in emergency surgery, the level of comfort of the ward, the category of complexity of the operation, the level of anesthesia, the number of consultations of doctors);

6) sorting of case histories by funding streams (compulsory health insurance, voluntary health insurance, paid services or direct contracts funded from two sources).

5. Entering information into a computer network: for CMI and VHI patients and for patients financed from several sources, it is carried out under direct contracts, letters of guarantee. After processing the information, it is transferred to the financial group for further generation of invoices to the relevant payers.

6. Analysis of the processed case histories with the withdrawal of form No. 066 / y and their sorting by department profiles and discharge dates. Delivery of case histories to the medical archive.

7. Continuous monitoring of the timeliness of the delivery of case histories from clinical departments according to the sheets of records of the movement of patients with a periodic report to the head of the department.

Based on the results of the work of the departments and the hospital as a whole, statistical data processing is carried out with the formation of reports. The data from the card of the person who left the hospital is processed with filling in the sheets for the distribution of patients by funding streams for each profile and the sheet for the distribution of patients by attached enterprises. The cards are sorted by diagnosis for each profile. Based on the grouped information, reports are generated in a spreadsheet editor:

1) report on the movement of patients and beds (form No. 16/y);

2) a report on the distribution of patients by departments, profiles and funding streams;

3) a report on the distribution of retired patients by attached enterprises;

4) report on the surgical activities of the hospital by types of operations;

5) report on emergency surgical care;

6) a report on the surgical work of the departments and the hospital as a whole;

7) report on abortions.

These reporting forms are compiled quarterly, for half a year, for 9 months and a year.

Based on the results of the work for the year, national statistical forms No. 13, 14, 30 are compiled.

Statistical accounting and reporting should be organized in accordance with the basics of statistical accounting and reporting adopted in healthcare facilities of the Russian Federation, based on the requirements of guidelines, methodological recommendations of the CSB, the Ministry of Health of the Russian Federation and additional instructions from the administration.

The activities of health facilities are taken into account by the primary statistical documentation, divided into seven groups:

1) used in a hospital;

2) for polyclinics;

3) used in a hospital and clinic;

4) for other medical and preventive institutions;

5) for institutions of forensic medical examination;

6) for laboratories;

7) for sanitary and preventive institutions.

Based on statistical studies, the department:

1) provides the administration with operational and final statistical information for making optimal management decisions and improving the organization of work, including in matters of planning and forecasting;

2) analyzes the activities of departments and individual services that are part of the health care facility, based on the materials of statistical reports using methods for assessing variability, the typical value of a sign, qualitative and quantitative methods for the reliability of differences and methods for studying the relationship between signs;

3) ensures the reliability of statistical accounting and reporting and provides organizational and methodological guidance on medical statistics;

4) carries out the preparation of annual and other periodic and summary reports;

5) determines the policy in the field of correct execution of medical documentation;

6) participates in the development and implementation of computer programs in the work of the department.

Medical archive is designed to collect, record and store medical records, select and issue requested documents for work. The medical archive is located in a room designed for long-term storage of documentation. The archive receives the case histories of retired patients, which are taken into account in the journals, marked, sorted by departments and alphabetically. In the archive, the selection and issuance of case histories per month on applications and, accordingly, the return of previously requested ones are carried out. At the end of the year, the records of retired patients, case histories of deceased patients, and case histories of outpatients are accepted for storage, accounting, and sorting; final sorting and packing of case histories for long-term storage are carried out.

Analysis of the activities of health facilities is carried out according to the annual report on the basis of state statistical reporting forms. The statistical data of the annual report are used to analyze and evaluate the activities of the health facility as a whole, its structural divisions, assess the quality of medical care and preventive measures.

The annual report (f. 30 "Report of the medical institution") is compiled on the basis of the data of the current accounting of the elements of the work of the institution and the forms of primary medical documentation. The report form is approved by the Central Statistical Bureau of the Russian Federation and is the same for all types of institutions. Each of them fills in the part of the report that relates to its activities. Features of medical care for individual contingents (children, pregnant women and women in childbirth, patients with tuberculosis, malignant neoplasms, etc.) are given in annexes to the main report in the form of insert reports (there are 12 of them).

In the summary tables of reporting forms 30, 12, 14, information is given in absolute terms, which are of little use for comparison and completely unsuitable for analysis, evaluation and conclusions. Thus, absolute values ​​are needed only as initial data for calculating relative values ​​(indicators), according to which statistical and economic analysis of the activities of a medical institution is carried out. Their reliability is influenced by the type and method of observation and the accuracy of absolute values, which depends on the quality of registration of accounting documents.

When developing primary documentation, various indicators are calculated that are used in the analysis and evaluation of the institution's activities. The value of any indicator depends on many factors and causes and is associated with various performance indicators. Therefore, when evaluating the activities of the institution as a whole, one should keep in mind the various influences of various factors on the results of the work of health care institutions and the range of the relationship between performance indicators.

The essence of the analysis lies in assessing the value of the indicator, comparing and comparing it in dynamics with other objects and groups of observations, in determining the relationship between indicators, their dependence on various factors and causes, in interpreting data and conclusions.

The performance indicators of health care facilities are evaluated based on comparison with norms, standards, official guidelines, optimal and achieved indicators, comparisons with other institutions, teams, aggregates in dynamics by years, months of the year, days, followed by determination of work efficiency.

In the analysis, indicators are combined into groups that characterize a particular function of a health facility, a section of work, a division or a serviced contingent. The generalized scheme of analysis includes the following sections.

1. General characteristics.

2. Organization of work.

3. Specific performance indicators.

4. Quality of medical care.

5. Continuity in the work of institutions.

Consolidated Hospital Annual Report consists of the following main sections:

1) general characteristics of the institution;

3) activities of the polyclinic;

4) operation of the hospital;

5) activities of paraclinical services;

6) sanitary and educational work.

Economic analysis of the activities of health care facilities in the conditions of insurance medicine, it should be carried out in parallel in the following main areas:

1) use of fixed assets;

2) use of the bed fund;

3) use of medical equipment;

4) the use of medical and other personnel (see "Economics of Health Care").

Below is a methodology for analyzing the activities of health care facilities using the example of an integrated hospital, but this scheme can be used to analyze the work of any medical institution.

Based on the reporting data, indicators are calculated that characterize the work of the institution, according to which the analysis of each section of the work is carried out. Using the data obtained, the head physician of the institution writes an explanatory note in which he gives a complete and detailed analysis of all indicators and the activities of the institution as a whole.

The general characteristics of the hospital are given on the basis of the passport part of the report, which indicates the structure of the hospital, its capacity and category (Table 10), lists the medical and auxiliary and diagnostic services included in it, the number of medical sites (therapeutic, shop, etc.) , equipment of the institution. Knowing the number of the population served by the polyclinic, it is possible to calculate the average number of the population in one area and compare it with the calculated standards.

Table 10

In the "States" section, the states of the polyclinic and hospital, the number of occupied positions of doctors, middle and junior medical personnel are indicated. According to the report table (f. 30), absolute values ​​in the columns of the report “States”, “Employed”, “Individuals” are considered as initial data.

The column of the reporting form No. 30 "States" is controlled and must correspond to the staffing table; the column "Employed" during control must correspond to the payroll; in the column "Individuals" the absolute number of individuals must correspond to the number of work books of employees of the institution in the personnel department.

In the "States" column, the numbers can be greater than in the "Employed" column, or equal to them. "Employed" should never exceed the number of full-time positions.

Staffing with doctors

number of occupied medical positions (individuals) x 100 / number of full-time medical positions (normally (N) = 93.5).

Staffing with paramedical personnel (by positions and individuals):

number of occupied positions (individuals) of paramedical staff x 100 / number of full-time positions of paramedical staff (N= 100%).

Staffing of junior medical personnel (by positions and individuals):

number of occupied positions (individuals) of junior medical staff x 100 / number of full-time positions of junior medical staff.

Compatibility coefficient (CS):

the number of occupied medical positions / the number of physical. persons in positions.

Example: the number of occupied medical positions - 18, the number of physical. persons in occupied positions - 10 K.S. \u003d 18 / 10 \u003d 1.8.

The optimal indicator should be equal to one, the higher it is, the lower the quality of medical care.

Comprehensive analysis and objective assessment of the work of the polyclinic are the basis for effective management of its activities, making optimal management decisions, timely control, clear, targeted planning and, ultimately, an effective means of improving the quality of medical support for attached contingents.

The activities of the polyclinic are analyzed in the following main areas:

1) analysis of the staffing of the polyclinic, the state of its material and technical base and the provision of medical equipment, the compliance of the organizational and staffing structure of its divisions with the volume and nature of the tasks to be solved;

2) state of health, morbidity, hospitalization, labor losses, mortality;

3) dispensary work, the effectiveness of ongoing medical and recreational activities;

4) medical and diagnostic work in the following sections:

a) medical work of departments of therapeutic and surgical profile;

b) the work of the hospital department (day hospital);

c) the work of diagnostic units;

d) the work of auxiliary medical departments and polyclinic rooms (physiotherapy department, exercise therapy rooms, reflexology, manual therapy, etc.);

e) organization and condition of emergency medical care and home care, preparation of patients for planned hospitalization;

f) organization of rehabilitation treatment;

g) defects in the provision of medical care at the prehospital stage, the reasons for discrepancies in diagnoses between the clinic and the hospital;

5) organization and conduct of an advisory and expert commission and medical and social expertise;

6) preventive work;

7) financial, economic and economic work.

The analysis is based on an objective and complete accounting of all the work carried out in the clinic and compliance with established methods for calculating indicators, which ensures reliable and comparable results.

An essential element of the analysis is to identify the dynamics (positive or negative) of the indicators and the reasons that led to its change.

The scope of the analysis of the work of the clinic is set depending on its frequency. The most profound and comprehensive analysis is carried out during the year when compiling the annual medical report and an explanatory note to it. In the period between annual reports, an interim analysis is carried out on a quarterly basis with a cumulative total. Operational analysis, reflecting the main issues of the polyclinic, should be performed daily, weekly and monthly.

Such periodicity allows the management of the clinic to know the state of work in the clinic and to correct it in a timely manner. In the course of the analysis, both positive results and shortcomings are determined, their assessment is given, the necessary measures are outlined to eliminate shortcomings and improve the work of the polyclinic.

Analysis of the work of the polyclinic for the month, quarter, six months and nine months is carried out in the same areas of activity of the polyclinic. Additionally, the implementation of therapeutic and preventive measures for the contingents attached to the medical support of the clinic is analyzed. All performance indicators are compared with similar indicators for the corresponding period of the previous year.

Analysis of the work of the clinic for the year. All areas of activity of the clinic are analyzed. At the same time, recommendations and methods for calculating medical and statistical indicators are used, which are set out in the guidelines for compiling an annual medical report and an explanatory note to it.

In order to draw objective conclusions from the analysis of work for the year, it is necessary to conduct a comparative analysis of the performance of the polyclinic for the reporting and previous years with the performance of other clinics, with average indicators for the city (region, district). Inside the polyclinic, the performance of departments with similar profiles is compared.

Particular attention should be paid to the analysis of the effectiveness of introducing new modern medical technologies into the practice of diagnostics and treatment, including hospital replacements, as well as the implementation of proposals to improve the material and technical base.

The degree of fulfillment of the tasks set by the departments of the polyclinic and the institution as a whole is assessed, the correspondence of the forces and means available in the polyclinic to the nature and characteristics of the tasks it solves is reflected.

Statistical analysis is carried out according to the scheme:

1) general information about the clinic;

2) organization of work of the polyclinic;

3) preventive work of the polyclinic;

To calculate the performance indicators of the polyclinic, the source of information is the annual report (f. 30).

Provision of the population with polyclinic care is determined by the average number of visits per 1 inhabitant per year:

number of medical visits in the polyclinic (at home) / number of population served.

In the same way, it is possible to determine the provision of the population with medical care in general and in individual specialties. This indicator is analyzed in dynamics and compared with other polyclinics.

The indicator of the load of doctors for 1 hour of work:

total number of visits during the year / total number of hours of admission during the year.

Estimated workload rates for doctors are presented in Table 11.

Table 11

Estimated norms of the function of a medical position with different options for work schedules

Note. The head physician has the right to change the norms reception in the polyclinic and home care, however, the annual planned function of the posts in the whole institution must be fulfilled

The function of a medical position(FVD) is the number of visits to one doctor working at the same rate per year. Distinguish FVD actual and planned:

1) The actual FVD is obtained from the amount of visits for the year according to the doctor's diary (f. 039 / y). For example, 5678 visits per year to a therapist;

2) The planned PVD should be calculated taking into account the standard workload of a specialist for 1 hour at the reception and at home according to the formula:

FVD \u003d (a x 6 x c) + (a1 x b1 x c1),

where (a x b x c) - work at the reception;

(a1 x b1 x c1) - work at home;

a - the load of the therapist for 1 hour at the reception (5 people per hour);

b - the number of hours at the reception (3 hours);

c - the number of working days of health facilities per year (285);

b1 - the number of hours of work at home (3 hours);

в1 - the number of working days of health facilities in a year.

The degree of implementation of the FVD - this is the percentage of the actual FVD to the planned one:

HPF actual x 100 / HPF planned.

The value of the actual FVD and the degree of fulfillment are influenced by:

1) the accuracy of registration of the accounting form 039 / y;

2) work experience and qualifications of the doctor;

3) reception conditions (equipment, staffing with medical personnel and paramedical personnel);

4) the need of the population for outpatient care;

5) mode and work schedule of a specialist;

6) the number of days worked by a specialist in a year (may be less due to the doctor's illness, business trips, etc.).

This indicator is analyzed for each specialist, taking into account the factors affecting its value (standards for the function of the main medical positions). The function of a medical position depends not so much on the doctor's workload at the reception or at home, but on the number of days worked during the year, employment and staffing of medical positions.

Structure of visits by specialties (on the example of a therapist, %). The structure of visits to the polyclinic depends on the staffing of its specialists, their workload and the quality of registration form 039 / y:

number of visits to a therapist x 100 / number of visits to doctors of all specialties (in N = 30-40%).

Thus, for each specialist, the proportion of his visits to the total number of visits to all doctors per year is determined, with an indicator of 95%, specialized medical care was not provided.

The share of rural residents in the total number of visits to the polyclinic (%):

number of visits to polyclinic doctors by rural residents x 100 / total number of visits to the polyclinic.

This indicator is calculated both for the clinic as a whole and for individual specialists. Its reliability depends on the quality of filling in the primary accounting documentation (f. 039 / y).

Structure of visits by types of requests (on the example of a therapist,%):

1) the structure of visits for diseases:

number of visits to a specialist for diseases x 100 / / total number of visits to this specialist;

2) the structure of visits for medical examinations:

number of visits for preventive examinations x 100 / total number of visits to this specialist.

This indicator makes it possible to see the main direction in the work of doctors of certain specialties. The ratio of preventive visits for diseases to individual doctors is compared with their workload and employment in time during the month.

With properly organized work, visits for diseases to therapists make up 60%, to surgeons - 70 - 80%, to obstetrician-gynecologists - 30 - 40%.

Home visiting activity (%):

number of home doctor visits made actively x 100 / total number of home doctor visits.

The indicator of activity, depending on the ratio of primary and repeated visits, the number of which is determined by the dynamics and nature of diseases (severity, seasonality), as well as the possibility of hospitalization, ranges from 30 to 60%.

When analyzing the indicator calculated using the above formula, it should be borne in mind that it characterizes the volume of active visits to patients at home (an active visit should be understood as a visit made on the initiative of a doctor). For a more accurate characterization of the activity of this type of visits, it is necessary to differentiate primary and repeated visits and calculate this indicator only in relation to repeated visits, which makes it possible to conduct an in-depth analysis based on the data contained in the Book of Calling Doctors at Home (f. 031 / y ).

It is advisable to calculate this indicator in relation to patients with pathology requiring active monitoring (croupous pneumonia, hypertension, etc.). It indicates the degree of attention of doctors to patients. The reliability of this indicator depends both on the quality of keeping records of active visits in the registration form 039 / y and the staffing of doctors, and on the structure of diseases at the site. With proper organization of work, its value ranges from 85 to 90 %.

One of the main forms of polyclinic services for the population is the territorial-district principle in the provision of medical care to the population. The reliability of the indicators characterizing the district service to the population, to a large extent depends on the quality of the design of the doctor's diary (f. 039 / y).

Average population in the area(therapeutic, pediatric, obstetric-gynecological, workshop, etc.):

average annual adult population assigned to the polyclinic / number of sites (eg therapeutic) in the polyclinic.

Currently, one territorial therapeutic site in the Russian Federation accounts for an average of 1700 people of the adult population, for pediatrics - 800 children, for obstetrics and gynecology - about 3000 women (of which 2000 women of childbearing age), for the workshop - 1500 - 2000 workers. Service rates for doctors in outpatient clinics are shown in Table 12.

Table 12

Estimated service rates for doctors of outpatient clinics

The rate of visits to a district doctor at an appointment in a polyclinic (%) is one of the leading indicators:

number of visits to the local doctor by residents of their area x 100 / total number of visits to the local doctors during the year.

The indicator of the locality at the reception characterizes the organization of the work of doctors in the polyclinic and indicates the degree of compliance with the district principle of providing medical care to the population, one of the advantages of which is that the patients of the district should be served by one, “their” doctor (“their” doctor should be considered a district therapist in the event that he constantly works at the site or replaces another doctor for at least 1 month).

From this point of view, the indicator of district coverage, with the correct organization of work, equal to 80 - 85%, can be considered optimal. It practically cannot reach 100%, because due to the absence of their district doctor for objective reasons, residents of this district visit other doctors. At a lower indicator, one should look for the causes and factors that influence it (inconvenient for the population, the schedule of admission, the absence of a doctor, etc.).

Home care coverage:

number of home visits made by your GP x 100 / total number of home visits.

With reliable registration f. 039 / for this indicator, as a rule, is high and reaches 90 - 95% with sufficient staffing. To analyze the state of medical care at home in order to correct it during the year, it can be calculated for individual district doctors and for months.

With a decrease in district coverage below 50–60%, one can make an assumption about a low level of work organization or understaffing, which negatively affects the quality of outpatient and polyclinic services for the population.

Compliance with the district largely depends on the accurate work of the registry, the ability to correctly distribute patients, correctly draw up a schedule for the work of doctors, and the population in the area.

Using the data contained in the doctor's diary (f. 039 / y), you can determine repetition of outpatient visits:

number of return visits to doctors / number of initial visits to the same doctors.

If this figure is high (5 - 6%), one can think about the groundlessness of repeated visits prescribed by doctors due to an insufficiently thoughtful attitude towards patients; a very low rate (1.2 - 1.5%) indicates insufficiently qualified medical care in the clinic and that the main goal of repeated visits to patients is to mark a sick leave.

The source of information on periodic inspections is the "Map subject to periodic inspection" (f. 046 / y).

To assess the preventive work of the clinic, the following indicators are calculated.

Completeness of coverage of the population with preventive examinations (%):

number actually inspected x 100 / number to be inspected according to the plan.

This indicator is calculated for all contingents (f. 30-zdrav, section 2, subsection 5 “Preventive examinations conducted by this institution). The size of the indicator is usually high and approaches 100%.

Frequency of detected diseases (“pathological lesion”) is calculated for all diagnoses that are indicated in the report for 100, 1000 examined:

number of diseases detected during professional examinations x 1000 / total number of examined persons.

This indicator reflects the quality of preventive examinations and indicates how often the identified pathology occurs in the “environment” of those examined or in the “environment” of the population of the area where the polyclinic operates.

More detailed results of preventive examinations can be obtained by developing "Dispensary observation cards" (f. 030 / y). This allows you to examine this contingent of patients by sex, age, profession, length of service, duration of observation; in addition, to evaluate the participation in examinations of doctors of various specialties, the performance of the required number of examinations per person, the effectiveness of examinations and the nature of the measures taken to improve and examine these contingents.

To obtain a reliable indicator, it is important to timely correctly issue statistical coupons at professional examinations (f. 025-2 / y). The quality of examinations depends on the detection of pathology and its timely registration in accounting and reporting documents. Per 1000 examined, the frequency of detection of hypertension is 15, chronic bronchitis - 13, thyrotoxicosis - 5, rheumatism - 2.

For the analysis of dispensary work, three groups of indicators are used:

1) dispensary observation coverage indicators;

2) indicators of the quality of dispensary observation;

3) indicators of the effectiveness of dispensary observation.

The data necessary to calculate these indicators can be obtained from accounting and reporting documents (f. 12, 030 / y, 025 / y, 025-2 / y).

Dispensary observation coverage indicators are as follows.

In this group, indicators of the frequency and structure of coverage by dispensary observation (“D” observation) are distinguished.

1. Frequency indicators.

Coverage of the population by medical examination (per 1000 inhabitants):

is on "D"-observation during the year x 1000 / total population served.

The structure of patients under "D"-observation, according to nosological forms (%):

number of patients under “D” supervision for this disease x 100 / total number of dispensary patients.

2. Indicators of the quality of clinical examination.

Timeliness of taking patients on "D"-account (%) (for all diagnoses):

number of patients newly diagnosed and taken under “D” observation x 100 / total number of newly diagnosed patients.

The indicator characterizes the work on early taking on the "D"-registration, therefore it is calculated from the totality of diseases with a diagnosis established for the first time in life according to individual nosological forms. With proper organization of work, this indicator should approach 100%: hypertension - 35%, peptic ulcer - 24%, coronary artery disease - 19%, diabetes mellitus - 14.5%, rheumatism - 6.5%.

Completeness of coverage of "D"-observation of patients (%):

the number of patients on the “D”-registration at the beginning of the year + those newly taken under the “D”-observation - who never appeared x 100 / the number of registered patients who need the “D”-registration.

This indicator characterizes the activity of doctors in organizing and conducting medical examinations and should be 90-100%. It can be calculated both for the entire dispensary contingent of patients, and separately for those nosological forms, information about which is available in the report.

Frequency of visits:

number of visits to the doctor made by patients of the dispensary group / number of persons in the dispensary group. Compliance with the terms of dispensary examinations (scheduled observation), %:

the number of prophylactic patients who met the terms of appearance for "D"-observation x 100 / total number of prophylactic patients.

The percentage of "come off" (never came to the doctor for a year) is normally acceptable from 1.5 to 3%.

Completeness of medical and recreational activities (%):

underwent this type of treatment (recovery) x 100 / needed this type of treatment (recovery) during the year.

The effectiveness of dispensary observation is assessed by indicators that characterize the achievement of the goal of medical examination, its final results. It depends not only on the efforts and qualifications of the doctor, the level of organization of dispensary observation, the quality of medical and recreational activities, but also on the patient himself, his material and living conditions, working conditions, socio-economic and environmental factors.

It is possible to evaluate the effectiveness of clinical examination based on the study of the completeness of the examination, the regularity of observation, the implementation of a complex of medical and recreational activities and its results. This requires an in-depth analysis of the data contained in the "Medical record of the outpatient" (f. 025 / y) and the "Control card for dispensary observation" (f. 030 / y).

The main criteria for the effectiveness of prophylactic medical examinations are shifts in the state of health of patients (improvement, deterioration, no change), the presence or absence of relapses, indicators of disability, a decrease in morbidity and mortality in the dispensary group, as well as access to disability and the results of rehabilitation and re-examination of disabled people who are "D" - account. To assess these changes, a so-called milestone epicrisis is compiled for each patient once a year, which is recorded in the "Medical record of the outpatient". In a milestone epicrisis, the patient's subjective state, objective examination data, therapeutic and preventive measures taken, as well as employment measures are briefly recorded. It is recommended to evaluate the effectiveness of clinical examination in dynamics for 3-5 years.

Evaluation of the effectiveness of clinical examination should be carried out separately by groups:

1) healthy;

2) persons who have had acute illnesses;

3) patients with chronic diseases.

The criteria for the effectiveness of prophylactic medical examinations of healthy people (I group "D"-observations) are the absence of diseases, the preservation of health and ability to work, that is, the absence of transfer to the group of patients.

The criteria for the effectiveness of clinical examination of persons who have had acute illnesses (Group II "D"-observation) are complete recovery and transfer to the healthy group.

The indicators characterizing the effectiveness of medical examination of chronic patients are as follows.

The proportion of patients removed from the "D"-registration in connection with recovery:

the number of persons removed from the "D"-registration in connection with the recovery x 100 / the number of patients on the "D"-registration.

The proportion of patients removed from the "D"-registration in connection with recovery is normally acceptable for hypertension - 1%, peptic ulcer - 3%, rheumatism - 2%.

The share of patients removed from the "D"-registration due to death (for all diagnoses):

the number of patients removed from the "D"-registration due to death x 100 / the number of patients on the "D"-registration.

The proportion of relapses in the dispensary group:

the number of exacerbations (relapses) in the dispensary group x 100 / the number of people with this disease undergoing treatment.

This indicator is calculated and analyzed for each nosological form separately.

The proportion of patients on "D"-observation who did not have temporary disability during the year(VUT):

the number of patients in the dispensary group who did not have TD during the year x 100 / the number of employees in the dispensary group.

The proportion of newly taken on the "D"-registration among those under observation:

the number of newly taken patients on the "D"-registration with this disease x 100 / the number of patients on the "D"-registration at the beginning of the year + newly taken patients in this year.

This indicator gives an idea of ​​the systematic work on clinical examination in the clinic. It should not be high, otherwise it will indicate a decrease in the quality of detection of a particular pathology in previous years. If the indicator is above 50%, we can conclude that there is insufficient work on medical examination. It is recommended to analyze this indicator for individual nosological forms, since in long-term diseases it is less than 30%, and in rapidly curable diseases it can be much higher.

Morbidity with temporary disability (TS) in cases and days for specific diseases, for which patients are taken to the "D"-registration(per 100 medical examinations):

the number of cases (days) of morbidity with VUT with a given disease among those who were prophylactic in a given year x 100 / the number of prophylactic patients with this disease.

The effectiveness of clinical examination is confirmed by a decrease in the value of this indicator when compared with the indicator for the previous year (or several years).

The indicator of primary disability consisting on the "D"-registration for the year (per 10,000 medical examinations):

recognized as disabled for the first time in a given year for this disease out of those on the “D”-registration x 1000 / the number of those on the “D”-registration during the year for this disease.

Mortality among patients on the "D"-registration (per 100 medical examinations):

the number of deaths among those on the "D"-registration x 1000 / the total number of persons on the "D"-registration.

The average number of patients registered at the dispensary in the therapeutic area: it is considered optimal when the district doctor is registered with 100 - 150 patients with various diseases.

General frequency (level) of primary morbidity (‰):

number of all initial applications x 1000 / average annual number of attached population.

Frequency (level) of primary morbidity by classes (groups, separate forms) of diseases (‰):

number of initial visits for diseases x 1000 / average annual attached population.

The structure of primary morbidity by classes (groups, separate forms) of diseases (%):

number of initial visits for diseases x 100 / number of initial visits for all classes of diseases.

Overall frequency of cases (days) of labor loss (‰):

the number of all cases (or days) of labor loss x 1000 / the average annual number of the attached population.

Frequency of cases (days) of labor losses by classes (groups, separate forms) of diseases (‰):

number of cases (days) of labor loss due to all diseases x 1000 / average annual number of attached population.

Structure of cases (days) of labor losses by classes (groups, individual forms) of diseases (%):

the number of cases (days) of labor losses by classes (groups, separate forms) of diseases x 100 / the number of cases (or days) of labor losses by all classes of diseases.

Average duration of cases of labor loss by classes (groups, individual forms) of diseases (days):

the number of days of labor loss by classes (groups, separate forms) of diseases / the number of cases of labor loss due to skin diseases (trauma, influenza, etc.).

The structure of patients treated in the day hospital by class (groups, individual forms of diseases) (%):

number of patients treated by classes (groups, separate forms) of diseases x 100 / total number of patients treated in a day hospital.

The average duration of treatment of patients in a day hospital (days):

number of treatment days spent in the day hospital by all treated patients / total number of patients treated in the day hospital.

The average duration of treatment in a day hospital by classes (groups, separate forms) of diseases (days):

number of days of treatment of patients in a day hospital by classes (groups, separate forms) of diseases / number of patients treated in a day hospital, by classes (groups, separate forms) of diseases.

Number of days of treatment in a day hospital per 1000 attached population (‰):

number of hospital days x 1000 / total attached population.

Overall frequency (level) of hospitalization (‰):

number of all hospitalized patients x 1000 / average annual fixed population.

Frequency (level) of hospitalization by classes (groups, individual forms) of diseases (‰):

number of hospitalized by classes (groups, individual forms) of diseases x 1000 / average annual number of attached population.

The structure of hospitalization by classes (groups, separate forms) of diseases (%):

number of hospitalized by classes (groups, separate forms) of diseases x 100 / number of all hospitalized.

Statistical data on the work of the hospital are presented in the annual report (form 30-zdrav.) in Section 3 "Beds and its use" and in the "Report on the activities of the hospital for the year" (form 14). These data make it possible to determine the indicators necessary to assess the use of hospital beds and the quality of treatment.

However, the assessment of hospital performance should not be limited to these sections of the report. A detailed analysis is possible only when using, studying and correctly filling out the primary accounting documentation:

1) a medical card of an inpatient (f. 003 / y);

2) a journal for registering the movement of patients and hospital beds (f. 001 / y);

3) a consolidated monthly record of the movement of patients and bed capacity in a hospital (department, bed profile) (f. 016 / y);

4) a statistical card of the person who left the hospital (f. 066 / y).

The assessment of the work of the hospital is given on the basis of the analysis of two groups of indicators:

1) bed fund and its use;

2) the quality of medical and diagnostic work.

Rational use of the actually deployed bed fund (in the absence of overload) and compliance with the required period of treatment in departments, taking into account the specialization of beds, diagnosis, severity of pathology, concomitant diseases, are of great importance in organizing the work of a hospital.

To assess the use of the bed fund, the following most important indicators are calculated:

1) provision of the population with hospital beds;

2) average annual hospital bed occupancy;

3) the degree of use of the bed fund;

4) turnover of a hospital bed;

5) the average duration of the patient's stay in bed.

Provision of the population with hospital beds (per 10,000 population):

total hospital beds x 10,000 / population served.

Average annual employment (work) of a hospital bed:

number of bed days actually spent by patients in the hospital / average annual number of beds.

Average annual number of hospital beds is defined as follows:

number of actually occupied beds per month of the year in hospital / 12 months.

This indicator can be calculated both for the hospital as a whole and for departments. Its assessment is made by comparison with the calculated standards for departments of various profiles.

Analyzing this indicator, it should be taken into account that the number of actually spent hospital days includes days spent by patients on the so-called side beds, which are not counted among the average annual beds; Therefore, the average annual bed occupancy may be more than the number of days in a year (over 365 days).

The work of a bed less or more than the standard indicates, respectively, an underload or an overload of the hospital.

Approximately this figure is 320 - 340 days a year for city hospitals.

Degree of use of beds (fulfillment of the plan for bed days):

number of actual hospital days spent by patients x 100 / planned number of hospital days.

The planned number of bed days per year is determined by multiplying the average annual number of beds by the standard bed occupancy per year (Table 13).

Table 13

Average number of days of use (occupancy) of a bed per year

This indicator is calculated for the hospital as a whole and for departments. If the average annual bed occupancy is within the norm, then it approaches 30%; if the hospital is overloaded or underloaded, the indicator will be respectively higher or lower than 100%.

Hospital bed turnover:

number of discharged patients (discharged + deceased) / average annual number of beds.

This indicator indicates how many patients were "served" by one bed during the year. The speed of bed turnover depends on the duration of hospitalization, which, in turn, is determined by the nature and course of the disease. At the same time, a decrease in the length of stay of a patient in a bed and, consequently, an increase in the turnover of a bed largely depend on the quality of diagnosis, the timeliness of hospitalization, care and treatment in the hospital. The calculation of the indicator and its analysis should be carried out both for the hospital as a whole and for departments, bed profiles, and nosological forms. In accordance with the planned standards for city hospitals of a general type, the bed turnover is considered optimal within the range of 25-30, and for dispensaries - 8-10 patients per year.

Average length of stay of a patient in a hospital (average bed day):

number of hospital days spent by patients per year / number of discharged patients (discharged + deceased).

Like the previous indicators, it is calculated both for the hospital as a whole and for departments, bed profiles, and individual diseases. Tentatively, the standard for general hospitals is 14-17 days, taking into account the profile of beds, it is much higher (up to 180 days) (Table 14).

Table 14

Average number of days a patient stays in bed

The average bed day characterizes the organization and quality of the treatment and diagnostic process, indicates the reserves for increasing the use of the bed fund. According to statistics, reducing the average length of stay in bed by only one day would allow more than 3 million additional patients to be hospitalized.

The value of this indicator largely depends on the type and profile of the hospital, the organization of its work, the quality of treatment, etc. One of the reasons for the long stay of patients in the hospital is insufficient examination and treatment in the clinic. Reducing the duration of hospitalization, freeing up additional beds, should be carried out primarily taking into account the condition of patients, since premature discharge can lead to re-hospitalization, which ultimately will not reduce, but increase the indicator.

A significant decrease in the average hospital stay compared to the standard may indicate insufficient justification for reducing the duration of hospitalization.

The proportion of rural residents among hospitalized patients (Section 3, subsection 1):

the number of rural residents hospitalized in a hospital for the year x 100 / the number of all admitted to the hospital.

This indicator characterizes the use of city hospital beds by rural residents and affects the indicator of provision of the rural population of a given territory with inpatient medical care. In city hospitals, it is 15 - 30%.

To assess the quality of diagnosis and treatment in a hospital, the following indicators are used:

1) the composition of patients in the hospital;

2) the average duration of treatment of a patient in a hospital;

3) hospital mortality;

4) quality of medical diagnostics.

The composition of patients in the hospital for certain diseases (%):

the number of patients who left the hospital with a specific diagnosis x 100 / the number of all patients who left the hospital.

This indicator is not a direct characteristic of the quality of treatment, but indicators of this quality are associated with it. Calculated separately for departments.

The average duration of treatment of a patient in a hospital (for individual diseases):

number of hospital days spent by discharged patients with a certain diagnosis / number of discharged patients with a given diagnosis.

To calculate this indicator, in contrast to the indicator of the average length of stay of a patient in a hospital, not discharged (discharged + deceased) patients are used, but only discharged, and it is calculated by disease separately for discharged and deceased patients.

There are no standards for the average duration of treatment, and when assessing this indicator for a given hospital, it is compared with the average duration of treatment for various diseases prevailing in a given city or region.

When analyzing this indicator, the average duration of treatment of patients transferred from department to department, as well as those re-admitted to the hospital for examination or follow-up care, is considered separately; for surgical patients, the duration of treatment before and after surgery is calculated separately.

When evaluating this indicator, it is necessary to take into account various factors that affect its value: the timing of the examination of the patient, the timeliness of diagnosis, the appointment effective treatment, the presence of complications, the correctness of the examination of working capacity. Also of great importance is the organizational issues, in particular, the provision of the population with inpatient care and the level of outpatient care (selection and examination of patients for hospitalization, the ability to continue treatment after discharge from the hospital in the clinic).

Evaluation of this indicator presents significant difficulties, since its value is influenced by many factors that do not directly depend on the quality of treatment (cases started at the prehospital stage, irreversible processes, etc.). The level of this indicator to a large extent also depends on the age, sex composition of patients, the severity of the disease, the duration of hospitalization, and the level of pre-hospital treatment.

This information, which is necessary for a more detailed analysis of the average duration of a patient's treatment in a hospital, is not contained in the annual report; they can be obtained from primary medical documents: "Medical record of an inpatient" (f. 003 / y) and "Statistical card of a person who left the hospital" (f. 066 / y).

Hospital mortality (per 100 patients, %):

number of deceased patients x 100 / number of discharged patients (discharged + deceased).

This indicator is one of the most important and frequently used to assess the quality and effectiveness of treatment. It is calculated both for the hospital as a whole and separately for departments and nosological forms.

Daily lethality (per 100 patients, intensive rate):

the number of deaths before 24 hours of hospital stay x 100 / the number of those admitted to the hospital.

The formula can be calculated like this: share of all deaths on the first day in the total number of deaths (extensive indicator):

number of deaths before 24 hours of hospital stay x 100 / number of all deaths in hospital.

Death on the first day indicates the severity of the disease and, therefore, the special responsibility of medical personnel in relation to the correct organization of emergency care. Both indicators complement the characteristics of the organization and quality of treatment of patients.

In an integrated hospital, in-hospital mortality rates cannot be considered in isolation from home-based mortality, as selection for hospitalization and pre-hospital mortality can have a large impact on in-hospital mortality, reducing or increasing it. In particular, low hospital mortality with a large proportion of deaths at home may indicate defects in referral to a hospital, when seriously ill patients were denied hospitalization due to a lack of beds or for some other reason.

In addition to the indicators listed above, indicators characterizing the activities of the surgical hospital are also calculated separately. These include the following: The structure of surgical interventions (%):

number of patients operated on for this disease x 100 / total number of operated patients for all diseases.

Postoperative mortality (per 100 patients):

number of patients who died after surgery x 100 / number of operated patients.

It is calculated as a whole for the hospital and for individual diseases requiring emergency surgical care.

The frequency of complications during operations (per 100 patients):

number of operations in which complications were observed x 100 / number of operated patients.

When evaluating this indicator, it is necessary to take into account not only the level of the frequency of complications during various operations, but also the types of complications, information about which can be obtained when developing the “Statistical Cards of the Discharged from the Hospital” (f. 066 / y). This indicator should be analyzed together with the duration of hospital treatment and mortality (both general and postoperative).

The quality of emergency surgical care is determined by the speed of admission of patients to the hospital after the onset of the disease and the timing of operations after admission, measured in hours. The higher the percentage of patients delivered to the hospital in the first hours (up to 6 hours from the onset of the disease), the better the ambulance and urgent care and the higher the quality of diagnostics of local doctors. Cases of delivery of patients later than 24 hours from the onset of the disease should be considered as a big drawback in the organization of the work of the clinic, since the timeliness of hospitalization and surgical intervention is crucial for a successful outcome and recovery of patients in need of emergency care.

One of the most important tasks of a doctor is to make an early correct diagnosis, allowing timely initiation of appropriate treatment. The causes of misdiagnosis are diverse, and their analysis can improve the quality of diagnosis, treatment, and the effectiveness of medical care. The quality of medical diagnostics is considered on the basis of the coincidence or discrepancy between the diagnoses made by the doctors of the polyclinic and the hospital or the doctors of the hospital and pathologists.

To assess the quality of medical diagnosis in medical statistics, a more accurate interpretation of the concept of "incorrect diagnosis" is used:

1) misdiagnosis;

2) diagnoses that are not confirmed; when corrected, they reduce the totality of cases of a given disease;

3) diagnosed diagnoses - diagnoses that are established in a hospital against the background of other diseases; they increase the total number of cases of a given disease;

4) incorrect diagnoses - the sum of erroneous and overlooked diagnoses for a particular disease;

5) matched diagnoses for all diseases - the sum of diagnoses that matched in the hospital with those established in the clinic;

6) mismatched diagnoses - the difference between the total number of hospitalized patients and patients in whom the hospital diagnosis coincided with the outpatient diagnosis.

The assessment of the quality of medical diagnostics in the clinic is carried out by comparing the diagnoses of patients made when they were sent for hospitalization with the diagnoses established in the hospital. The reporting data does not contain information on this issue, therefore the source of information is the "Statistical card of the person who left the hospital" (f. 066 / y). As a result of comparison of the received data, proportion of incorrect diagnoses:

the number of polyclinic diagnoses that were not confirmed in the hospital x 100 / the total number of patients referred for hospitalization with this diagnosis.

This indicator serves as the basis for a more detailed analysis of errors in the diagnosis of patients referred for inpatient treatment, which may be due to both difficulties differential diagnosis, and gross miscalculations of doctors of the clinic.

Evaluation of the quality of medical diagnostics in a hospital is carried out on the basis of a comparison of clinical (vital) and pathoanatomical (sectional) diagnoses. In this case, the source of information is the “Medical records of an inpatient” (f. 003 / y) and the results of autopsies of the dead.

The indicator of coincidence (discrepancy) of diagnoses (%):

number of diagnoses confirmed (not confirmed) at autopsy x 100 / total number of autopsies for this cause.

The rate of coincidence of clinical diagnoses with pathoanatomical diagnoses can be calculated from the data of the annual report (Section "Autopsy of the dead in the hospital") for individual diseases.

The discrepancy between clinical and pathoanatomical diagnoses of the underlying disease is about 10%. This indicator is also calculated for individual nosological forms that caused death; in this case, it is necessary to take into account erroneous diagnoses and overlooked diagnoses.

The reasons for the discrepancy between clinical and pathoanatomical diagnoses can be divided into two groups.

1. Defects in medical work:

1) brevity of observation of the patient;

2) incompleteness and inaccuracy of the survey;

3) underestimation and overestimation of anamnestic data;

4) lack of necessary X-ray and laboratory studies;

5) absence, underestimation or overestimation of the consultant's opinion.

2. Organizational defects in the work of the clinic and hospital:

1) late hospitalization of the patient;

2) insufficient staffing of medical and nursing staff of medical and diagnostic departments;

3) shortcomings in the work of certain services of the hospital (admission department, diagnostic rooms, etc.);

4) incorrect, careless record keeping.

A detailed analysis of discrepancies between clinical and anatomical diagnoses based on views and errors is possible only on the basis of a special development of the “Statistical Cards of the Exited from the Hospital” (f. 066 / y), as well as epicrises filled in for deceased patients.

The analysis of the epicrises of the dead is far from being exhausted by comparing the diagnoses - intravital and pathoanatomical. Even with complete coincidence of diagnoses, it is necessary to assess the timeliness of the intravital diagnosis. In this case, it may turn out that the correct final diagnosis is only the last stage of many incorrect, mutually exclusive diagnostic assumptions of the doctor during the entire period of observation of the patient. If the intravital diagnosis is made correctly, then it is necessary to find out whether there were any defects in the treatment that would be directly or indirectly related to the death of the patient.

To compare clinical and pathoanatomical diagnoses and analyze the epicrises of the dead in the hospital, clinical and anatomical conferences are periodically organized with the analysis of each case of discrepancies in diagnoses, which contributes to the improvement of diagnosis, proper treatment and monitoring patients.

Quantitative indicators (coefficients) characterizing the ILC based on the results of the examination and questioning

1. Integral intensity factor (K i) - the derivative of the coefficients of medical performance (K p), social satisfaction (K s), the amount of work performed (K about) and the ratio of costs (K s):

K and \u003d K r x K with x K about x K s

At the first stages of work, due to possible difficulties in conducting economic calculations, when determining Kz, one can limit oneself to three coefficients

K and \u003d K r x K with x K vol.

2. Medical success rate (K p) - the ratio of the number of cases with an achieved medical result (P d) to the total number of assessed cases of medical care (P):

If the level Kr is also taken into account, then

K p \u003d? P i 3 a i / P,

where? is the summation sign;

Р i - the level of the result obtained (complete recovery, improvement, etc.);

a i is a scoring of the level of the result obtained (complete cure - 5 points, partial improvement - 4 points, no change - 3 points, significant deterioration - 1 point).

This coefficient can also be considered as a quality coefficient (Kk):

K k = number of cases of full compliance with adequate technologies / total number of cases of medical care being assessed, as well as indicators of the structure of the reasons for the wrong choice of technology or their non-compliance.

Kp for the institution as a whole is defined as the quotient of the corresponding indicators (Pd and P) for the treatment units.

3. Social Satisfaction Ratio (K c) - the ratio of the number of cases of customer (patient, staff) satisfaction (Y) to the total number of assessed cases of medical care (N).

If satisfaction is also taken into account, then

K p \u003d? Y i x a i / P,

where Yi is the number of respondents who answered positively to the i-th question (completely satisfied, not satisfied, etc.);

and i is the scoring of the level of the result obtained.

When determining this coefficient, only information about the satisfaction of patients with the medical care provided to them is taken into account. Provided that in all points of the questionnaire it is noted “I find it difficult to answer”, then such a questionnaire is not included in the calculation. If at least one of the points has a negative assessment of the patient, it should be considered dissatisfied with the assistance provided.

Kc for the medical institution as a whole is defined as the quotient of the corresponding indicators for the medical units of the institution.

4. Work done ratio (K about) is one of the most important indicators of the effectiveness of the activities of a medical institution and its divisions.

K about \u003d O f / O p,

where О f is the number of actually performed medical services;

О n is the number of planned medical services.

The number of completed cases of outpatient or inpatient treatment, studies performed, etc. can be used as indicators characterizing the activities of an institution or its divisions to calculate K. physicians can improve this indicator due to unreasonable appointment of visits.

5. Individual load factor (K in) - takes into account the number of patients in comparison with the standard for the position of a doctor of the corresponding clinical profile and category of curation (operation) complexity:

K in \u003d N f x 100 / N n,

where Hf is the actual load indicator,

N n is an indicator of the standard load.

This indicator serves to assess the contribution of each individual medical specialist and assess the quality of care provided by him. In the case when the actual number of patients is below the standard for the position of a doctor, a reserve of working time is formed. A doctor can develop a reserve by providing advisory assistance, on duty, monitoring the ILC and providing other additional services.

The head of the health care facility has the right to change the workload of an individual doctor, taking into account the nature of the diseases and the severity of the condition of the patients he manages. In addition, the management of the institution, together with the head of the department, should plan the workload for doctors by type in order to distribute it evenly and meet the standard indicators.

6. Cost ratio (K z) - the ratio of standard costs (Z n) to the actual costs incurred for the estimated cases of medical care (Zf):

7. Surgical Activity Ratio (K ha) - the ratio of the number of operated patients by a particular doctor (N op) to the number of patients treated by this doctor (N l):

K ha \u003d N op / N l.

This indicator serves to evaluate the activities of surgical specialists.

8. In the role of a qualitative criterion for evaluating the activities of nursing staff can be used medical technology compliance ratio (K st), which is calculated by the formula:

K st \u003d N - N d / N,

where N is the number of expert assessments;

N d - the number of expert assessments with identified defects in the technology of medical care.

When evaluating the value of the indicators obtained, it is recommended to proceed from:

1) a "reference" indicator to which all medical workers should strive;

2) the average indicator for the territory (institution, subdivision), by the deviation from which the level of medical care provided by a particular medical worker, subdivision is assessed;

3) the dynamics of this indicator for a particular medical worker, unit, etc.

It is advisable to calculate the coefficients on a quarterly basis. They can be calculated in the context of departments, institutions as a whole, individual specialists and nosological forms of interest.

An analysis of the activities of a city hospital based on an assessment of the relevant indicators makes it possible to identify shortcomings in the organization of the treatment and diagnostic process, determine the efficiency of the use and reserves of the bed fund, and develop specific measures to improve the quality of medical care for the population.