В статье обсуждается вопрос маршрутизации беременных женщин на разных сроках гестации с подозрением на острую хирургическую патологию, с целью более быстрой и точной постановки диагноза.
The purpose of the study is to determine the professional competencies that are in demand among emergency medical personnel when they provide medical care in an inpatient department. Materials and research methods. We compared the impersonal reports on the work done by 20 doctors of specialized substations of the emergency medical service in St. Petersburg for 2015–2017 with the information about work in the mode of daily activities in 2017 of 10 doctors in the intensive care unit of the inpatient department of the Emergency Medical Service of the First St. Petersburg State Medical University named after academician I.I. Pavlov, stored in the qMS medical information system of the University. The volume of instrumental examination of patients who sought medical help, received it in the required volume and were discharged in a satisfactory condition within the first day, was assessed. We compared the results of ultrasound diagnostics performed by the emergency doctors in the screening mode using portable equipment with the results of the work of a consultant-specialist. 701 medical records of inpatients from among those admitted to the Medical University were analyzed. By studying 4573 medical records, possibility and effectiveness of independent primary triage of the incoming patients by the nursing staff was determined. In addition, with the help of the FlexSim HealthCare program, which allows to effectively predict and to simulate changes in work processes within medical institutions, computer simulation of the department’s work was carried out in the conditions of autonomous work of an emergency doctor. Statistical comparison was performed using the Mann-Whitney test, Student’s t-test for unrelated values, and analysis of four-field tables using the χ-square test. Research results and their analysis. Analysis of the research results showed: fundamental principles of work of the staff of inpatient department — multidisciplinarity, multitasking, autonomy. An ambulance doctor working in a stationary environment must be able to independently diagnose, to treat patients with various pathologies, and to simultaneously supervise several patients; having the level of practical and theoretical training specified in the professional standard, the emergency doctor can effectively provide resuscitation care in the volume of I – II levels, which is especially important, given the short time spent by patients in the department; professional standard of the emergency doctors requires to master ultrasound diagnostics to identify gross pathological conditions and to perform a number of manipulations; nursing staff working in the inpatient department must be able to work in an autonomous environment. Triage by nurses is effective and allows to identify patients who need an immediate examination by an EMS doctor. The use of a three-level sorting algorithm does not contradict basic principles of medical triage used in world practice.
This article presents the first experience of computer modeling, performed as a result of the construction of the model of the emergency department (ED). A number of experiments were conducted aimed at determining the admissible flow of patients’ arrival per day for a given staffing table, determining the necessary conditions for the department’s readiness for mass one-stage entry, and conducting research in the context of expanding the job responsibilities of the doctor of the ED.
This article presents the experience of the practical application of simulation modeling on the example of a model of an inpatient emergency department in working with a new coronavirus infection.
The article presents main directions for improving the organization of emergency medical services (EMS), specialized medical care and medical evacuation in federal subject of Russia. These directions of development include: the formation of three-tier health system in federal subject of Russia, the integration of ambulance stations and territorial disaster medicine centres, the creation of EMS regional dispatch centres, the development of emergency departments, the modernization of medical information systems for EMS.
Purpose . Conduct an analysis of projects of various inpatient emergency departments and identify optimal planning solutions. Methods . To analyze the projects of various inpatient emergency departments and search for optimal planning solutions, it is possible to use simulation modeling. This approach allows you to create a virtual model of the system and conduct many scenario tests in order to evaluate the efficiency and optimize the work of departments in various conditions. Using simulation modeling, three models of inpatient emergency departments of various sizes (1000, 1200 and 2500 m 2 ) were created. The definition of functioning features was carried out with the same threshold value of the incoming flow of patients — 150 per day. In addition to the structural components of the departments, a “point of primary decision-making” was singled out. After the experiments, a comparison of the obtained statistical data was carried out. Results . As a result of the study, on the model of an inpatient emergency department with an area of 1200 m 2 and 2500 m 2 , there were no queues in the process of work at the “point of primary decision making”. At the same time, on a model with a total area of 1000 m 2 with the same flow of patients, a queue was formed at the established “primary decision point”, waiting for 10 minutes of model time, which was due to the initial small area in the waiting room. Conclusion . Based on the data obtained, it was concluded that the optimal design solution for the creation of an inpatient emergency department is the department area of 1200 m 2 .
В статье обсуждается вопрос влияния информационных технологий на оптимизацию лечебного процесса в СтОСМП, улучшение обмена информацией внутри коллектива, эффективность оказания медицинской помощи.
Introduction. The article presents a comparison of simulation models for financing an inpatient emergency department and a therapeutic department using the example of an emergency therapeutic flow of patients. The objective was to analyze the economic aspects in an inpatient emergency department for the treatment of emergency therapeutic conditions such as hypertension. Methods and materials. Based on a retrospective analysis of the flow of incoming patients for emergency and urgent indications, a simulation model of the load and economic calculations of the work of the inpatient emergency department was developed. Results. According to the results of the study, it was revealed that with a three-fold increase in the flow of patients entering the department, the inpatient emergency department copes with this flow more effectively in comparison with the therapeutic one. Despite this funding, the medical institution receives significantly less. Conclusion. Based on the study, the need to create a special tariff plan for the work of such units as the inpatient emergency department was identified, because the capacity in this department is many times greater.
The article presents the stage results of treatment of patients with out-of-hospital cardiac arrest, who was admitted to ED of the University Clinic. The main obstacle for ECMO-CPR remains a long time of CPR by pre-hospital services. The possibility of using ECMO for conditioning of potential donors by emergency physicians is considered.
