What do they do in a day hospital at a polyclinic. Day hospital. Full amount of necessary funds for course treatment without hospitalization

In this article I want to answer a question that interests many. It concerns the terms of treatment in a neurological hospital around the clock and day stay. There are several various aspects, affecting the duration of treatment, including the diagnosis, what type of hospitalization was carried out and much more. I'll tell you more about everything. So, how many are in the hospital?

IN Russian Federation There are two types of the concept of hospitalization. The first is emergency hospitalization. In this case, the patient or people nearby call an ambulance team, indications for inpatient treatment and the person is taken away. Sometimes there is a suspicion of a stroke, then initially the patient goes to the vascular center, where the diagnosis is clarified. If the diagnosis is negative, the patient is usually transferred to an emergency neurological hospital on duty that day in the city/district/region. If there is no doubt about the diagnosis, or it is not possible to exclude or confirm the diagnosis, the person is hospitalized in the vascular center.

The terms of treatment in the vascular center, as, indeed, in any other neurological department, depend on the severity of the patient. It is clear that if the threat to a person's life persists, he will not be discharged. However, if the patient is not in danger, the state of health has become better, even if not all functions have been restored, then the patient is discharged, on average this happens 21 days after the start of treatment. His further fate ambulatory treatment and rehabilitation in conditions specialized centers, as well as in sanatorium-resort conditions.

Treatment of an emergency patient in the absence of a stroke is carried out in a specialized neurological hospital that accepts emergency patients and has the appropriate conditions (availability of personnel, equipment, equipment with specific drugs, the presence of an intensive care unit, etc.).

The patient also has the right to apply for an initial malaise for planned inpatient treatment in the following situations:

• A person has a chronic disease that requires regular monitoring (for example, drug-resistant form).
• Available neurodegenerative disease(For example, ).
• There is a deterioration in other chronic process(, consequences of a stroke, etc.).
• There is an exacerbation of the chronic vertebrogenic process (, etc.).

Planned inpatient treatment is provided to people who have a referral for hospitalization, clinical minimum analyzes and research. At the same time, the word planned itself implies a queue. If the situation is urgent, an ambulance should be called.

Treatment in the planned neurological department is divided into a day hospital and a round-the-clock hospital. The duration of treatment in a day bed is 9-10 days, while the day is considered both the day of admission and the day of discharge. The bed in a round-the-clock hospital is longer, the course of treatment takes from 11 to 14 days. Exceeding the terms of a round-the-clock stay (due to the severity of the condition, insufficient examination for technical problems that have already been resolved, other serious reasons) is possible, but only after passing the meeting procedure medical commission headed by the Deputy Chief Physician for Medical Work. And, of course, relying only on the patient’s desire (I want to lie down longer, I need to “dig” more, I want to be examined from head to toe, even if I don’t have any evidence, but suddenly there is something there, etc. .), the commission will issue a negative verdict.

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Summing up all of the above. Average duration in a hospital will depend on the severity of the patient's condition, his disease, the effectiveness of treatment. The list will look something like this:

• Stroke in the vascular center. The duration of stay is on average 21 days, after which it is sent to a spa or rehabilitation treatment. The duration may increase due to staying in the intensive care unit of the vascular center in severe cases.
• Acute neurological pathology of a different nature (first-time diagnosed epilepsy of a generalized plan, etc.) from 9 to 16 days on average. Often ends with a transfer to other specialized hospitals (infectious for meningitis, neurosurgical for hematomas, etc.).
• Planned day hospital 8-10 days. The terms are strict and cannot be increased, since the day hospital implies mild and moderate pathology.
• Planned round-the-clock hospital 11-14 days. The duration of treatment may be increased if necessary by decision of the medical commission.

In conclusion, I would like to add: in domestic medicine, there has been, as I call it, the European path. Bed-day is reduced. In the end, we will probably reach such a level that in 3-4 days the patient will undergo an examination, stop the acute situation, and then be transferred to outpatient treatment.

Day hospital - what are the features of this unit medical institution? From the very name "day hospital" it becomes clear that this type of medical care is a cross between inpatient treatment (in a hospital) and outpatient treatment (treatment at home with control visits to a doctor in a polyclinic).

Who can become a day hospital patient?

Any person in need of medical care that does not require round-the-clock assistance can become a day hospital patient. medical supervision. A person from the street cannot come to the day hospital and ask for treatment, he is sent by a specialist doctor of the polyclinic.

How long is the patient in the day hospital?

As a rule, the time of stay in the day hospital does not exceed 4 hours. During this time, the patient can take tests, conduct any instrumental research and medical procedures, and evaluate their effectiveness. During their stay in the day hospital, patients undergo examination and treatment in comfortable wards under the supervision of medical personnel. It also monitors the main vital signs of the body ( blood pressure, often-you and correctness heart rate and others), since some diagnostic studies and therapeutic manipulations require medical supervision of the patient's condition within 2-4 hours after their implementation. Doctors of the appropriate profile, qualified nurses work with patients under treatment. Medical staff day hospitals practically fully equipped.

No meals are provided for patients in day hospital conditions, however, conditions for eating homemade food are provided.

Currently, the system of day hospitals is developing dynamically. This is also convenient for the patients themselves - after all, they stay in the day hospital for only a few hours a day, and the rest of the time they are surrounded by family and familiar home environment. At the same time, all the necessary diagnostic and therapeutic procedures, manipulations, and operations are carried out here. In addition, world practice shows that the use of hospital-replacing technologies has a significant economic effect.

How many day hospitals are there in Zelenograd today?

Until 2013, only two day hospitals operated in Zelenograd - an oncological profile at the former 152nd polyclinic (now branch No. 1 of GBUZ GP No. 201, which was opened back in the 1990s) and a urological one - on the basis of GBUZ GP No. 201 (building 911). This year, Zelenograd health care has been replenished with three more day hospitals - neurological, surgical (including vascular) and cardio-rheumatological, opened on the basis of the new building of GBUZ GP No. 201 in the 20th microdistrict.

Today, there are five day hospitals in Zelenograd polyclinics:

• urological for 4 beds - in bldg. 911;
• oncology for 6 beds - in branch No. 1 of GBUZ GP No. 201 in the 2nd microdistrict; neurological for 10 beds,
• surgical for 12 beds,
• cardio-rheumatological for 5 beds - located in GBUZ GP No. 201 (building 2042).

Day hospitals work in two shifts - from 8 to 20 hours.

Only a specialist doctor (cardiologist, oncologist, urologist, neurologist, etc.) can refer to a day hospital, and only for medical reasons.

Information provided by the organizational and methodological department of GBUZ GP No. 201.

Along with outpatient and inpatient treatments, medical care is also widely provided in so-called day hospitals. This is a kind of intermediate option between the outpatient clinic and inpatient treatment.

Each area of ​​medicine has a list of indications that are the basis for referring a patient to a day hospital. Patient reviews, as well as statistics, testify to the convenience and effectiveness of such

What is a day hospital

A day hospital is one of the structural units intended for the stay of patients who do not need round-the-clock monitoring of their condition and supervision medical staff.

Being a full-fledged department of a medical institution, a day hospital has full access to all the possibilities of medical, diagnostic, consultative, and rehabilitation units at its disposal.

The most common day hospitals have the following profile:

• Therapeutic.
• Surgical.
• Obstetrics and gynecology.
• Neurological.
• Dermatological.

Organization

The number of beds in a day hospital (the so-called bed capacity indicator) is determined by the head of the medical institution, based on the total bed capacity of the institution, the actual need of the population for medical care and the estimated load of the day hospital. The number of beds is consistent with authorized body healthcare.

Regular positions of medical personnel are determined by the head doctor of the institution, based on the bed capacity, medical profile and mode of operation. In the absence of narrow specialists in the staff of the day hospital, patients are provided with advisory assistance doctors of relevant specialties, who are on the staff of a medical institution and work in the relevant specialized departments.

If a day hospital is part of a round-the-clock hospital, then its patients should be provided with two meals a day in accordance with the current regime adopted in this medical institution.

Medical provision of the day hospital is carried out in whole or in part at the expense of the medical institution, on the basis of which the day hospital operates.

Day hospitals created on the basis of hospitals differ from similar units of the outpatient service in the possibility of conducting more a wide range diagnostic procedures, as well as more opportunities in the organization rehabilitation measures. On the basis of such a department, it is possible to carry out more complex, compared to a polyclinic institution, diagnostic and therapeutic manipulations.

Areas of work of the day hospital

The day hospital provides medical care population in the following areas:

• Preventive measures, in particular, prevention of exacerbations of long-term chronic diseases(in accordance with the recommendations of the specialist observing the patient).
• Treatment of patients requiring observation during the procedure therapeutic procedures, but not requiring round-the-clock condition monitoring.
• Rehabilitation activities in the volumes available to the rehabilitation services of this medical institution.

The volume of medical care provided in the day hospital

1. Intramuscular, subcutaneous and intravenous injections.
2. Intravenous infusion of medicinal solutions.
3. Follow-up and treatment of patients who completed inpatient treatment and were discharged in early dates from the hospital and received recommendations on the completion of therapy and rehabilitation in an active mode.
4. Medical supervision of patients undergoing uncomplicated surgical interventions V stationary conditions, after which they do not need round-the-clock medical supervision ( we are talking O postoperative period after interventions such as surgery benign neoplasms, intervention for an ingrown nail, uncomplicated phlegmon, panaritium).

Indications for treatment in a day hospital

• The implementation of therapeutic procedures recommended to the patient when he completed inpatient treatment, and not requiring constant, round-the-clock monitoring of the patient's condition.
• Carrying out diagnostic procedures that do not imply round-the-clock monitoring of the patient's condition.
• Treatment of diseases with acute or chronic course that does not require 24/7 surveillance.

Implementation of a set of measures for the rehabilitation of the patient in cases where he does not require a round-the-clock stay in a hospital.

• The inability to hospitalize the patient in a round-the-clock hospital for reasons dependent on the patient.
• Patients undergoing outpatient treatment requiring medical supervision during medical procedure(vasoactive drugs, hyposensitizing and desensitizing therapy, intra-articular injections).
• The need for intravenous drip of drugs: in this case, dynamic monitoring is necessary. For example, cardiac glycosides, glucocorticosteroids, antiarrhythmic drugs.
• The need to monitor the patient during minor interventions or diagnostic procedures (eg, endoscopy).
• The need for diagnostic measures requiring prolonged preparation (intravenous pyelography, bronchoscopy, biopsy of the mucous membrane of the gastrointestinal tract).
• Occurrence in a patient during a stay in the clinic emergency conditions(such as hypertensive crisis, collapse, angina attack); - until the condition stabilizes and the ambulance arrives.

Contraindications for referral to a day hospital

• The need to monitor the patient's condition around the clock during treatment. The work of the day hospital is carried out in daytime Therefore, such patients should be hospitalized in a 24-hour hospital.
• The patient's condition requiring
• Limited opportunities patient to move.
• Patients suffering from diseases cannot pass characteristic feature which is an exacerbation or worsening of the condition at night.
• heavy concomitant pathology capable of provoking a complication of the underlying disease.

Disability

Treatment in a day hospital does not imply a permanent stay in medical institution, however, this implies that the patient has a serious illness, as well as the need long time be on treatment. Therefore, it is advisable for the patient to issue a certificate of incapacity for work during the stay in a day hospital. During the day, the patient will spend several hours in a medical institution, so he will not be able to be at the workplace for most of the working day.

Day hospital in pediatrics

Children's day hospital has a number of features:

• On their basis, there should be close cooperation medical service and education; long-term students in treatment should be able to master the curriculum on an equal basis with their peers.
• The possibility of the child staying together with one of the parents (relevant for cases when a child of an early age is sent to a children's day hospital).

Day hospital during pregnancy

State future mother requires great attention from the side medical workers. Due to the peculiarities of the course of diseases during pregnancy, many of them are included in the list of indications for a pregnant woman to stay in a day hospital:

• Sustained and severe arterial hypotension.
• Arterial hypertension, manifested in any of the trimesters of pregnancy.
• Anemia.
• early toxicosis.
• A day hospital during pregnancy is indicated for the threat of premature termination of pregnancy in the first or second trimesters. An important condition is the safety of the cervix and the absence of miscarriages in history.
• The need for invasive diagnostic procedures (such as chorionic biopsy or amniocentesis).
• Examination associated with Rh-conflict in a pregnant woman.
• In the case of isthmic-cervical insufficiency: dynamic observation after suturing the cervix.
• The recovery period after a long inpatient treatment, if the patient continues to need long-term medical supervision.

Any occurring during pregnancy should be analyzed in terms of the safety of the baby. In case of danger to the fetus, a woman should be hospitalized in a round-the-clock hospital.

Once we were terribly proud that, in terms of the number of beds in hospitals Soviet Union no equal in the world. Today, this indicator does not cause much joy. It is very expensive to maintain those beds. Patients also do not particularly favor hospitals. By different reasons. Someone cannot go to a round-the-clock hospital, because there is no one to look after the children, someone because of the fear of losing their job. Someone is hungry in the hospital, for someone it is unbearable because of the snoring and groans of a neighbor in a bed ... Therefore, many fall into this bed in a neglected state when they need emergency help.

Today, one of the promising areas in the reform of inpatient care is the organization of day hospitals. Their existence is beneficial both from an economic point of view and from the point of view of the maximum approximation to the population of medical services of the very general profile. Day hospitals put the interests of the patient first and take a minimum of time for treatment. In addition to medical services, the state does not have to provide “hotel” services: accommodation, food, sanitation, etc. Of course, we are talking about patients whose condition does not require round-the-clock medical supervision and complex medical manipulations, as well as isolation.

Often you just need to perform the necessary amount of medical care in the form of prescribed treatments and procedures. With a well-thought-out day hospital schedule, able-bodied patients, as a rule, do not need sick leave, which additionally saves money for both the state and the patient himself.

IN last years and day hospitals began to appear in Russia. One of them is located on the outskirts of Krasnoyarsk - at the city polyclinic No. 6. It opened in 2002.

The profile of the day hospital, working in two shifts, is therapeutic and neurological. Patients with broncho-pulmonary, gastrointestinal, cardiovascular, neurological diseases are treated here. And the treatment is free.

I came here for the first time and am very satisfied. A day hospital is a hundred times better than a round-the-clock one, where I regularly have to lie, - says Vera Grinko, a patient of the hospital. - A variety of procedures are prescribed here. All treatment is free. And it takes a little time - by lunchtime you are already returning home. I am not worried that someone will flood the apartment or rob it. It seems to me that the day hospital is the medicine of the future. That is how it should be treated.

Treatment of patients in a day hospital is not limited to prescribing tablets, injections and droppers. Depending on the indications, patients can be prescribed manual, reflexology, massage - treatment methods that are common in medicine today. But they also provide exclusive services in the day hospital. For example, nebulizer therapy is used to treat respiratory diseases. This is the method in which medicinal product penetrates deep into the bronchi due to the inhaler, which breaks the medicinal substance into tiny particles.

Using various traditional views physiotherapy, day hospital specialists prescribe and little known in our country, but effective method treatment - a dry carbonic bath, which is indicated for cardiovascular diseases, thrombophlebitis, atherosclerosis, osteochondrosis, neurasthenia, etc.

Last year, about 450 people were treated in the day hospital of the city polyclinic No. 6. All of them were released from the need to seek help in a round-the-clock hospital and received quality treatment, which did not cost them money, and the state cost less than if the patient was in the hospital.

Both for the state and for patients, the benefits of day hospitals are obvious. Why, then, do they develop slowly, according to at least, in Krasnoyarsk? We asked people whose work is related to medicine and who are invested with power to answer this question.

Vladimir FOKIN, deputy of the City Council, chief physician Hospital No. 20:

In fact, it is necessary to develop hospital-replacing technologies today. For example, there are chronic patients who have to undergo planned treatment once or twice a year. And it is not at all necessary that they stay in the hospital around the clock. They can come to a day hospital: undergo diagnostics, receive treatment, and then return home. This is especially true for the elderly. We are already doing this work. A few years ago, a cardiological dispensary was opened, where people who have had severe cardiovascular diseases undergo corrective, preventive treatment, and rehabilitation. The department works successfully, patients respond positively about it.

There are plans to open a gastroenterological day hospital, a dispensary for pediatric services. Opening day hospitals, it is possible and necessary to reduce round-the-clock beds. However, an individual approach is required here: there are departments where the number of round-the-clock beds does not decrease when using hospital-replacing technologies. Thus, the possibilities for treating patients using the resource base of the hospital are only expanding. But there are also departments where we can safely reduce beds, thereby increasing the area in the department, increasing the comfort of keeping patients, saving budget money.

Unfortunately, there is no incentive for hospitals to make these changes. For example, in some district hospitals, the number of beds was reduced after the opening of day hospitals. Thus, the chief physicians have achieved cost savings. But they weren't rewarded for it. It turns out that they simply lost part of their budget. If the saved funds at least partially remained in the medical institution, they could be used to develop the material and technical base, carry out repairs, purchase medicines, etc.

Natalya PAVLOVA, Deputy of the City Council, Chief Physician of City Polyclinic No. 6:

One of the main reasons for the slow development of hospital-replacing technologies in the region and the city is that it is not economically profitable for hospitals to reduce the number of round-the-clock beds. This cuts down on funding. And, in my opinion, the solution of this problem should be undertaken by the authorities, considering the efficiency of beds in each hospital, but from the standpoint of the needs of the region or city in certain medical services. Some beds should be left around the clock, others should be transferred to a day hospital, and others, perhaps, should be made social.

The chief physicians of polyclinics are not interested in the development of hospital-replacing technologies either. Because the declaration remains the point in the general tariff agreement that polyclinics introducing hospital-replacing technologies should be encouraged and receive additional funding. There was also talk about opening risk funds, thanks to which day hospitals would receive funds for development. But this is not the case either.

By the way, there are regions in Russia where the transformation of the healthcare system, the transition to insurance began with polyclinics - technical medical institutions that are as close as possible to the population. And today, polyclinics there are firmly on their feet, respectively, it is possible to successfully develop hospital-replacing technologies on their basis. In the edge of the system health insurance began to introduce from hospitals. And as before, 80 percent of the funds of the Compulsory Medical Insurance Fund are directed there. Financing of polyclinics is carried out according to the residual principle, hence the problems with equipment and medicines. In such conditions, it is very difficult to develop day hospitals in polyclinics.

Viktor SHEVCHENKO, head of the city health department:

Unfortunately, day hospitals in the city practically do not develop, although they are needed. Just existing in healthcare financial model does not contribute to this. There are criteria for the continuity of medical care: the powers of outpatient treatment, having exhausted themselves, are transferred to a day hospital, then to a general profile and, finally, a specialized hospital. But they often do not work, because they are not strung on a single economic core. Today, the patient can come to the clinic, ask for a referral to the hospital where his friend works. And he will receive a referral, although perhaps it would be enough to prescribe outpatient treatment or refer him to another, less “expensive” hospital. Because the salary of a doctor is not affected in any way by working on a technology that makes it possible to provide medical care not only with high quality, but also at the lowest cost.

Meanwhile, in some regions of Russia, such chains have been built. That is why, directing to health care much less funds than in our region, they achieve indicators comparable to ours, provide quality assistance.

It is necessary to build a health care system so that the patient does not reach such a state when he needs treatment in a round-the-clock hospital. If we achieve this, it will be possible to reduce expensive hospital beds and develop day hospitals. But today such conditions are not created. A small touch: there are no cars in polyclinics today to serve patients at home. Here lies old man in his apartment, his condition is deteriorating due to the lack of assistance, and as a result serious condition he is taken to the hospital by ambulance. And if there was a car, the district nurse would come if necessary, do the necessary manipulations. And the patient would not end up in the hospital.

Of course, the development of health care largely depends on federal government. But at the regional level, it is possible to carry out qualitative changes that other territories show us. The main thing is desire and will, which, apparently, is not enough. There are only declarations of intent.

prepared by Tatyana Popova

Day hospital is a phrase familiar to many. And about what he does, many have also heard about it. However, not everyone can fully imagine who can apply there for treatment, what documents are required upon admission and how long treatment can take. About the benefits of a day hospital and what functions it takes on, AiF.ru told Pavel Pletner, Head of the Day Hospital, Central Clinical Hospital, Russian Academy of Sciences.

Mobility and convenience

AiF.ru: Pavel Dmitrievich, why do we need a day hospital at all and what is its advantage?

Pavel Pletner: The day hospital differs from the usual departments of the hospital in its mobility. Here, everything is organizationally arranged in such a way that it is possible to arrange all the studies and procedures in a short time. Patients who come to the day hospital do not require round-the-clock supervision. For the hospital it additional view activities, allowing to attract the most active part of society, which does not have the opportunity to stay in the hospital for a long time.

— Who is interested in this treatment option?

— Life in the metropolis is very fleeting, and it is difficult for people to free up a lot of time in their work schedules, even for treatment. Plus, it’s very difficult now with work, and many patients are afraid of losing it, choosing time off or sick leave. We are often approached by those people who have repeatedly contacted us and have undergone research. It is convenient for them to receive a compiled version of surveys, by calling the branch no queues, no hassle.

- What types of services can be obtained in a day hospital? And how long does it take to heal?

- The decision where to undergo treatment for the patient is made by his attending physician. If a person's condition requires round-the-clock monitoring, then better therapy take place in the inpatient department. In our department, patients can receive the entire multidisciplinary range of studies in as soon as possible. Sometimes a set of services performed in one day, they could take 2-3 weeks in the clinic, and it takes us 1-2 days. All studies and their sequence are selected by our attending physicians in agreement with related services.

- What diseases can be treated by coming to the hospital only during the day? How effective is this therapy?

— The effectiveness of therapy given to patients in a day hospital is no worse than treatment in a round-the-clock hospital. In addition, a person admitted for treatment does not experience psychological and physical inconvenience, since in the evening he returns to his habitual life. On present stage medicine has reached a certain level and continues to raise it, introducing more and more minimally invasive methods interventions, so we use and apply a large number of risk-reducing operations postoperative pain and other complications that allow the patient to go home on the day of treatment.

Documenting

— What documents are required for registration in a day hospital? Is it necessary to undergo preliminary training, such as the one that takes place before admission to a regular hospital?

- If we are talking about an operation, then the entire list of laboratory and instrumental research required during normal hospitalization. This clinical analysis blood, biochemical research blood, determination of the blood group and Rh factor, tests for HIV, syphilis and hepatitis, general analysis urine, etc. Often, as, for example, it is organized in our country, all these studies are carried out in coordination with related departments more quickly. Therefore, one hour after the patient's admission to the hospital, the results of all necessary research is already in the patient's record and allows you to proceed to the next stage - surgical treatment.

“Our department starts working at eight in the morning, and this is the busiest time, since it is necessary to plan a route list for all newly arriving patients and build a working day for specialists. Upon admission, the patient needs a passport and a referral for hospitalization in a day hospital. The end of the working day does not always coincide with the established regime, since a person is an unpredictable creature, and if one patient can be released 3 hours after admission, then another may require observation until 5-6 pm.

Prevention and weekend work

- Whether they are carried out in a day hospital preventive actions?

— All types of treatment and ongoing research are aimed at prevention and detection hidden diseases. Therefore, situations are not uncommon when, during examinations, various diseases requiring hospitalization in a round-the-clock hospital in the future due to the severity of further research and their risks. It also happens that the patient's condition may worsen during some manipulations, which will require an emergency transfer to a round-the-clock hospital.

- Weekend day hospital - what is it?

- Weekends are no different from weekdays, so everything that can be spent on common days- Can also be done on weekends. The effectiveness of these studies is no worse. But for busy patients, this treatment option is better, as it allows you to take care of your health without interrupting work.