Nataliya. Pathological anatomy department List of necessary things

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According to the current regulations, the pathoanatomical department of the hospital is a structural unit of the medical institution. It is organized as part of multidisciplinary hospitals (including children's hospitals), infectious diseases, psychiatric, oncological hospitals and dispensaries, based on the number of autopsies and studies of biopsy and surgical material in each of these hospitals (dispensaries), which must be performed by medical personnel.

If there are several hospitals in the city, by decision of the relevant health authorities, a centralized department can be organized in one of the hospitals. Its staff is established in accordance with the scope of work, which ensures the autopsy of the dead and the study of biopsy material both in the hospital in which the centralized department is organized, and in attached hospitals (dispensaries), as well as the study of biopsy and surgical material from attached polyclinics. In the capitals of the republics, in regional and regional centers, centralized pathological departments, as a rule, are organized as part of republican, regional and regional hospitals.

In the central district hospitals (CRH), pathoanatomical departments are organized taking into account the provision of all autopsies of the dead and the study of all biopsy and surgical material from the attached medical institutions of the district.

To ensure the obligatory presence of attending physicians during the autopsy of deceased patients, these autopsies, if necessary, can be carried out in the morgues of the respective hospitals (dispensaries) by the medical staff of the centralized pathoanatomical department.

The organization of the work of centralized departments should provide for the implementation of urgent biopsy studies in attached hospitals (dispensaries) at their request.

The centralized pathoanatomical department ensures the timely sampling of biopsy material from the attached medical institutions and the delivery of conclusions to them.

To perform appropriate work with attached medical institutions, the centralized pathoanatomical department of the hospital must have an ambulance assigned to it, the use of which is strictly prohibited for other purposes.

The management of the hospital, which has a centralized pathoanatomical department, is fully responsible for ensuring the necessary working conditions for the department, including the staffing of medical personnel, material and technical equipment, economic support, etc.

The management of attached hospitals (dispensaries), in cases of performing autopsies in the hospital, is obliged to provide the necessary conditions for autopsy, as well as urgent studies of biopsy material in the conditions of their hospitals (dispensaries), having for these purposes the appropriate premises, equipment, apparatus, tools, etc.

According to the regulation on the pathoanatomical department of the treatment and prophylactic department, the main tasks of the pathoanatomical department of hospitals (centralized pathoanatomical department) are to improve the life-time diagnosis of diseases using biopsy studies and surgical material and according to autopsy data; ensuring the receipt of reliable data on the causes of death for state mortality statistics.

In recent years, independent pathoanatomical bureaus have been organized and are successfully functioning, serving the city, region (territory), republic.

According to our data [Avtandilov G.G. et al., 1991] the current structure of sectional and biopsy material, which is accounted annually for one pathologist, is characterized by the following results of the analysis of 500 questionnaires (see Table 1).

Despite the great variability of indicators, sectional work prevails in the pathoanatomical departments of hospitals and is small in oncology dispensaries, where it is only 25% of the annual workload of the dissector of a general somatic medical institution. On the contrary, biopsy work prevails in the departments of regional (regional, republican) hospitals and in oncology dispensaries. In terms of the number of biopsies per number of autopsies (1 autopsy is equivalent to the study of 20 biopsies), these data are as follows. Currently, the annual workload of one pathologist in regional (regional, republican) hospitals reaches 253, in city hospitals - 257, in the Central District Hospital - 295 and oncological dispensaries - 170 (at a rate of 200).

Table data. 1 indicate that the main part of the work of the city hospital pathologist is occupied by the study of malignant and benign neoplasms of various localizations (about 30%), diseases of the circulatory system (20%), digestive organs and the genitourinary system (25%).

Analysis of the structure of the sectional material showed similarities in the profile of nosological units, which are the initial cause of death of patients in general somatic hospitals. Autopsies of those who died from myocardial infarction and other forms of coronary heart disease, as well as from cerebral hemorrhages and cerebral infarction (up to 30% of all sectional material) predominated. Cancer patients accounted for 15% of the autopsied deaths.

Table Structure of the generalized annual biopsy and sectional material (in equivalents) of the pathoanatomical department of the city hospital

In oncology dispensaries, as a rule, they autopsy those who died from malignant neoplasms of the stomach, intestines, and lungs (more than 50% of sectional cases).

The structure of the biopsy material examined by the dissector varies significantly both in hospitals and oncology dispensaries. Oncology dispensaries (3386 biopsies per year) and pathological departments of regional, regional, republican hospitals (3272), which provide advisory assistance in the region, are close in terms of the volume of biopsy examinations. In the departments of city hospitals, on average, fewer samples are examined - 2685, in the Central District Hospital - 2117 biopsies and objects of surgical material annually.

In the pathoanatomical departments of hospitals, the number of diagnosed malignant tumors is: in the regional 42%, in the city 40%, in the Central Regional Hospital 32% and in oncology dispensaries 66% of all biopsy material.

The structure of the material received for pathological and histological examination is interesting. These are mainly objects of the female genitourinary system. Among malignant tumors in the material of hospitals, neoplasms of the cervix and body of the uterus, ovary, mammary gland prevail, in oncology dispensaries - tumors of the skin and soft tissues, stomach, rectum, lymph nodes and kidneys.

In the structure of biopsy specimens and surgical material of a non-tumor nature, examined by a pathologist of hospitals, diseases of the uterus (29%), appendix (20%), stomach (8%) are in the first place, and in oncology dispensaries - diseases of the uterus (48%), stomach ( 16%) and lymph nodes (16%).

The presented data make it possible to judge the typical structure of the material examined by the doctor of the pathoanatomical department during the year and, accordingly, reorganize the training and advanced training of a specialist. At the same time, the morphological diagnosis of the most common tumors and diseases is being improved, and the publication of manuals and manuals in these sections is also expanding.

The pathology department has been functioning in the hospital since its foundation. Currently, the staff of the department is thirty people: eleven doctors - three of them are doctors of medical sciences and three candidates of medical sciences, 10 medical laboratory technicians, 9 orderlies.

Head department - Candidate of Medical Sciences Victoria Mikhailovna Pominalnaya.

Employees: pathologist Ivanov A.L., pathologist Trusov A.E., pathologist Dmitriev M.B., pathologist Nechay V.V.

Structure: On the first floor there is a thanatological department. The morphological laboratory occupies the 2nd floor, where histological preparations of postoperative material are made. The laboratory is equipped with modern equipment. The department employs highly qualified specialists with extensive work experience. Thanks to the new equipment, production times are minimal. The department provides the following services:

1 - preparation and viewing of biopsies of various categories of complexity, staining with hematoxylin-eosin (skin, bronchobiopsy, gastro-, colonobiopsy, scrapings, postoperative material, material of gynecological, urological, general and oncological profile);

4 - consultations of glass preparations with additional cutting and painting;

5 - production of an urgent study from raw material;

6 - production of blocks and glasses from raw material (fixation in 10% buffered formalin);

1. This job description defines the job duties, rights and responsibilities of the head of the pathoanatomical department.

2. A person who has a higher professional (medical) education, postgraduate professional education and (or) additional professional education and a certificate of a specialist in the specialty in accordance with the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of health care, approved in the prescribed manner, work experience in the specialty for at least 5 years.

3. The head of the pathoanatomical department must know: the Constitution of the Russian Federation; laws and other regulatory legal acts of the Russian Federation in force in the field of healthcare and sanitary and epidemiological welfare of the population; regulatory and methodological documents in the direction of professional activity; principles of labor organization; basics of planning, economic and financial activities of a medical organization; the procedure for the execution of economic and labor contracts; forms and methods of organizing hygienic education and upbringing of the population; the procedure for maintaining primary accounting and reporting documentation; medical ethics; psychology of professional communication; fundamentals of labor legislation; rules on labor protection and fire safety.

4. The head of the pathoanatomical department is appointed and dismissed by order of the head of the medical organization in accordance with the current legislation of the Russian Federation.

5. The head of the pathoanatomical department is directly subordinate to the head of the medical organization or his deputy.

2. Job responsibilities

Manages the activities of the pathoanatomical department in accordance with the regulation on the department, its functions and tasks (improving the quality of medical care based on clarifying clinical diagnoses using pathoanatomical research methods; conducting pathoanatomical autopsies in accordance with the approved Procedure for conducting pathoanatomical autopsies; conducting histological and other types of laboratory analysis). Participates in pathoanatomical and clinical conferences. Improves the forms and methods of work, planning the activities of the pathoanatomical department, the placement of personnel in the workplace and their use in accordance with qualifications, the formation of a regulatory and methodological base, the base of material and technical means of laboratory and instrumental diagnostics. Coordinates the activities of the pathoanatomical department with other structural units of the medical organization, ensures their relationship in work. Carries out regular monitoring of the work of doctors, middle and junior medical staff of the pathoanatomical department. Ensures compliance with the requirements of labor legislation and labor protection of employees of the pathoanatomical department. Takes measures to ensure that the employees of the pathoanatomical department fulfill their official duties and internal labor regulations, the requirements of standardization and metrological support for research, measurements, and tests. Develops long-term and current work plans for the pathoanatomical department, monitors the implementation of these plans. Analyzes the work of the pathoanatomical department for the quarter, half year, year, submits a report on the work of the pathoanatomical department in the prescribed manner. Controls the quality of medical records. It helps to increase labor motivation and professional qualifications of employees of the pathoanatomical department. Systematically improves his skills.

3. Rights

The head of the pathoanatomical department has the right to:

1. give orders that are obligatory for the employees of the pathoanatomical department;

2. participate in the selection and placement of personnel in the pathology department;

3. make proposals to the management on encouraging and imposing penalties on employees of the pathoanatomical department;

4. make proposals for the development and improvement of the activities of the pathoanatomical department;

5. request from the management, receive and use information materials and legal documents necessary for the performance of their duties;

6. take part in conferences and meetings, which discuss issues related to the work of the pathological department;

7. to improve their qualifications at refresher courses at least once every 5 years;

8. pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;

The head of the pathoanatomical department enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The head of the pathology department is responsible for:

1. timely and high-quality implementation of the duties assigned to him;

2. timely and qualified execution of orders, instructions and instructions of the higher management, regulatory legal acts on their activities;

3. rational and efficient use of material, financial and human resources;

4. compliance with internal regulations, sanitary and anti-epidemic regime, fire safety and labor protection;

5. maintaining the documentation provided for by the current regulatory legal acts;

6. providing, in accordance with the established procedure, statistical and other information on the activities of the pathological department;

7. observance of executive discipline and performance of official duties by employees of the pathoanatomical department;

8. readiness of the pathoanatomical department to work in emergency situations.

For violation of labor discipline, legislative and regulatory legal acts, the head of the pathoanatomical department can be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the misconduct.