Central district hospital, its structure, tasks and role in the medical care of the rural population. Central District Hospital (CRH): tasks, structures, personnel, organizational and methodological work Structure, organization of work and main tasks of

The second stage of medical care for the rural population.

The main institution of the second stage of medical care for the rural population is the central district hospital (CRH). It provides the rural population with qualified medical and preventive care, both inpatient and outpatient.

Main CRH tasks:

providing highly qualified, specialized inpatient and outpatient care to the population of the district and the district center;

operational and organizational and methodological guidance and control over the activities of all health care institutions;

planning, financing and organization of material and technical supply of health care institutions of the district;

development and implementation of measures aimed at improving the quality of medical care for the population of the region, reducing morbidity, disability, hospital mortality, child and general mortality and improving the health of adolescents;

timely introduction of modern methods and means of prevention, diagnosis and treatment into the practice of health care facilities;

implementation of measures for the placement, rational use and professional development of personnel;

carrying out activities aimed at the effective use of funds and forces, strengthening the material and technical base of the district, improving the systems of organizational, methodological and operational management, managing all health facilities in the district, using modern scientific achievements;

provision of first aid and urgent care in the region.

The CRH, regardless of the bed capacity, population and service radius, has a hospital, a polyclinic, a pharmacy, a dissecting office, paraclinical and administrative services, an organizational and methodological office (OMK), an ambulance and emergency department.

In the CRH hospital, at least 5 departments in specialties should be organized; therapy, surgery, pediatrics, obstetrics and gynecology, infectious diseases. In addition to the necessary minimum, departments in other specialties (neurology, otorhinolaryngology, ophthalmology, traumatology, etc.) can be organized in large CRHs.

In the polyclinic department of the Central District Hospital, specialized care is provided in 1015 specialties, and such departments often function as inter-district specialized centers.

Patients living in the area assigned to the district hospital are served directly by the hospital. Patients living on the territory of other districts are admitted to the district hospital in the direction of the doctors of district hospitals. District doctors refer patients to the district hospital in cases where the necessary specialized assistance cannot be provided on the spot, when patients need consultation, clarification of the diagnosis, and X-ray or laboratory clinical diagnostic examination. The participation of specialists from district hospitals during medical examinations is widely used.

Rural residents turn to the district hospital in the direction of medical institutions of the rural area if they need specialized medical care, functional examination, consultations with specialist doctors.

A large place in the work of the Central District Hospital is occupied by mobile assistance. Mobile medical teams are formed by the chief physician and receive patients in 5-7 specialties. The composition of the medical specialists of the brigade is determined depending on the development of the network of outpatient clinics in the given territory, its staffing with doctors and the population's need for appropriate types of medical care. It may include doctors: general practitioners, pediatricians, surgeons, obstetricians-gynecologists, ophthalmologists, neuropathologists, etc. The field team is provided with vehicles, including special ones, equipped with the necessary equipment (mostly portable) and equipment for examining and treating patients . The management of the mobile medical team is entrusted to one of the qualified doctors of the team, who has experience in medical and organizational work. X-ray and dental offices, clinical diagnostic and bacteriological laboratories regularly visit the village.

Ambulance and emergency care is provided by the relevant department, which is part of the Central District Hospital, which is responsible for providing this type of assistance to the population of the district center and the settlements assigned to it.

One of the most important structural subdivisions of the CRH is the organizational and methodological cabinet (OMC), headed by the deputy chief physician of the CRH for medical care of the population of the district. OMK is the main assistant to the chief physician in matters of management, organization and coordination of all organizational and methodological work of the Central District Hospital and other medical and preventive institutions of the district.

The main tasks of OMK include:

analysis and generalization of data on the state of health of the population and the activities of the health care facilities of the district;

calculation of estimated indicators and analysis of the activities of the Central District Hospital as a whole and for individual specialized services;

drawing up a summary report on the network, personnel and activities of the health care facilities of the district; identification of shortcomings in the work of health facilities and the development of measures to eliminate them; development of an action plan for medical care for the entire population of the district, control over its implementation;

implementation of measures to improve the quality of medical and preventive work,

advanced training of specialists,

study and dissemination of new modern forms of work in medical care,

long-term planning for the development of health care in the district,

organization of work on extrabudgetary commercial activities and medical insurance.

The OMK work plan is actually a plan for the organizational and methodological work of the entire CRH. Its mandatory sections are:

analysis of demographic indicators and reporting materials on the network, personnel and activities of health facilities in the district and on the state of public health;

organization and implementation of measures to provide medical advisory and organizational and methodological assistance to medical institutions of the region;

carrying out activities to improve the skills of medical workers; strengthening the material and technical base of the health care facilities of the district.

assessment of the activities and efficiency of the work of medical institutions of the district and departments of the Central District Hospital;

measures to improve the quality of medical care, ambulance and emergency care;

introduction of new types of diagnostics and treatment;

improvement of ethical and deontological aspects in the team of medical institutions.

On the basis of a systematic analysis of the state of health of the population of the region, the plans of regional institutions, the cabinet draws up a comprehensive plan of measures to improve medical care and strengthen the health of the population of the region.

Ensuring the methodological guidance of accounting and statistical work and control over it in all institutions of the district is the most important function of the organizational and methodological office. The duties of the cabinets include receiving annual reports. Based on the data of the reporting forms and a special analysis, the organizational methodological office compiles an overview of the health status of various population groups and evaluates health indicators. The organizational method rooms should contain information about district conferences and classes with doctors and paramedical personnel, about seminars with the participation of district specialists, specialization and advanced training of medical workers.

The main (district) specialists of the district work in close contact with OMK CRH, who are also heads of specialized departments of the CRH. At present, practically in all districts there are district specialists in therapy, pediatrics, surgery, obstetrics and gynecology, and phthisiology. They are appointed by the chief physician of the district in agreement with the chief regional specialists and report directly to the chief physician of the CRH or his deputy.

The main functions of regional specialists are:

organizational and methodological management of the work of the relevant specialized service;

regular departures in accordance with the schedule to district hospitals, outpatient clinics and FAPs;

improvement of methods of diagnostics, treatment, prevention of profile diseases;

observation and control of the dispensary contingent, especially those of leading agricultural professions;

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The second stage of providing medical care to the rural population is the healthcare institutions of the municipal district, and among them the central district hospital (CRH) occupies a leading position. The CRH provides the main types of specialized medical care and at the same time performs the functions of a health management body on the territory of the municipal district.

The capacity of the Central Regional Hospital, the profile of specialized departments in its composition depend on the population size, structure and level of morbidity, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, CRHs have a capacity of 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatrics, infectious diseases and obstetrics and gynecology (if there is no maternity hospital in the area).

The chief physician of the central district hospital is the head of health care of the municipal district, appointed and dismissed by the administration of the municipal district.

An approximate organizational structure of the central district hospital is shown in fig. 12.2.

Rice. 12.2. Approximate organizational structure of the central district hospital

In order to bring specialized medical care closer to the rural population, inter-district medical centers can be created. The functions of such centers are performed by large CRHs (with a capacity of 500-700 beds), capable of providing the population of a given municipal district with the missing types of specialized inpatient and outpatient medical care.

The structure of the Central District Hospital has a polyclinic that provides primary health care to the rural population in the direction of paramedics FAPs, outpatient doctors, general medical (family) practice centers.

The provision of out-of-hospital and inpatient medical and preventive care to children in a municipal district is entrusted to children's consultations (polyclinics) and children's departments of central district hospitals. The preventive and curative work of children's polyclinics and children's departments of district hospitals is carried out on the same principles as in urban children's polyclinics.

The provision of obstetric and gynecological care to women in a municipal district is entrusted to antenatal clinics, maternity and gynecological departments of central district hospitals.

The functional responsibilities of medical personnel, accounting and reporting documentation, the calculation of statistical indicators of the activity of the Central District Hospital do not fundamentally differ from those in city hospitals and APUs.

O.P. Shchepin, V.A. Medic

The main institution of the second stage of medical care for the rural population is the central district hospital (CRH). It provides the rural population with qualified medical and preventive care, both inpatient and outpatient.

Rural residents apply to the district hospital in the direction of medical institutions of the rural area if they need specialized medical care, functional examination, consultations with specialist doctors, as well as residents of assigned plots and the district center itself.

The categories of district hospitals are determined by the population of the district and the number of beds (including rural district hospitals). In total, 6 categories of CRH are distinguished: from 100 (VI category) to 400 (I category) beds. The staffing of district hospitals makes it possible to have doctors of most specialties (in some densely populated areas, especially those with inter-district specialized centers, up to 30). The district link is the main link in the health care of the rural administrative territory, which provides specialized qualified medical care for its main types. In addition, specialists from the central district hospital (CRH) provide organizational and methodological guidance to all medical institutions in the district.

In addition to the CRH, located in the vast majority of cases in the district center, there may be other district hospitals on the territory of the district, the so-called “numbered” hospitals, which often function as a branch of the CRH or may specialize in certain types of medical care.

In order to better provide specialized medical care, inter-district specialized centers (departments) equipped with modern equipment are being created. Inter-district specialized centers provide medical and advisory assistance, carry out organizational and methodological work, improve the skills of medical personnel of district and district hospitals and polyclinics, analyze health indicators and risk factors that determine morbidity in a particular specialty.

Tasks of the CRH:

1. providing the population of the district and the district center with highly qualified, specialized inpatient and outpatient medical care;

2. operational and organizational-methodical management and control over the activities of all health care institutions of the district;

3. planning, financing and organization of material and technical supply of medical institutions of the district;

4. development and implementation of measures aimed at improving the quality of medical care for the rural population;

5. introduction of modern methods and means of prevention, diagnosis and treatment into the practice of the work of the health care facility of the district;

6. carrying out activities for the placement, rational use and professional development of personnel.

The structure of the CRH.

At least 5 departments in such specialties as therapy, surgery, pediatrics, obstetrics and gynecology, and infectious diseases should be organized in the CRH hospital. In addition to the required minimum, large CRHs may have departments in other specialties (neurology, otorhinolaryngology, ophthalmology, traumatology, etc.).

The CRH has the following structural divisions: a hospital with main specialized departments, a polyclinic with consultative appointments of specialist doctors and relevant medical and diagnostic departments, an organizational and methodological office, an emergency medical department and other structural divisions (mortuary, catering department, pharmacy, etc. .). District specialists travel for consultations, conduct demonstrative operations, examine and treat patients, send teams of medical specialists to medical institutions in a rural area, hear reports from district hospital doctors, heads of feldsher-obstetric stations, analyze work plans, statistical reports, hold scientific conferences, seminars , professional development in the workplace, etc.

An important structural subdivision of the central district hospital is organizational and methodological office, whose work is aimed at providing methodological guidance: analysis of the activities of medical institutions, implementation of measures to improve the quality of medical and preventive work, advanced training of specialists, organization of work on medical statistics and assessment of public health, study and dissemination of new modern forms of work on medical care, promising planning the development of health care in the district, organizing work on extrabudgetary commercial activities and medical insurance. The organizational method room should be staffed by the most experienced medical specialists. For the correct organization of work and the implementation of organizational and methodological guidance, the offices must have data on the economy and sanitary condition of the region, on the network and staffing of medical institutions, on the provision of the population with various types of medical and social security.

On the basis of a systematic analysis of the state of health of the population of the region, plans of regional institutions, the organizational and methodological office draws up a comprehensive plan of measures to improve medical care and strengthen the health of the population of the region.

Ensuring the methodological guidance of accounting and statistical work and control over it of all institutions of the district is the most important function of the organizational and methodological office. The duties of the cabinets include receiving annual reports. On the basis of these reporting forms and a special analysis, the organizational methodological office compiles an overview of the health status of various population groups and evaluates health indicators. The organizational method rooms should contain information about district conferences and classes with doctors and paramedical personnel, about seminars with the participation of district specialists, specialization and advanced training of medical workers (which in rural areas should be held once every 5 years). Every month, quarterly, the office calculates the main indicators of the work of each medical institution. An analysis of the qualitative indicators of activity in the Central District Hospital and in the district is carried out with the development of measures to improve them.

The CRH may include mobile medical teams (permanent functional units). In addition, in order to bring specialized care closer to the population of the region, mobile types of medical care are important: medical outpatient clinics, fluorography rooms, clinical diagnostic laboratories, dental and denture rooms.

The role of dispensaries is also important in the system of specialized care. At the district level, as a rule, there are anti-tuberculosis and dermatovenerological dispensaries (if there are no other dispensaries, then the corresponding specialists work in the polyclinic of the Central District Hospital).

CRH states.

Chief Physician of the CRH

He is also the chief doctor of the district. He relies in his work on his deputies (there are three of them):

For medical care of the population of the district (head of the organizational and methodological office),

Childhood and obstetrics

On the medical side.

The chief physician organizes and provides:

Analysis of health indicators;

Studying the causes of morbidity;

Priority medical support for machine operators, livestock breeders, field team workers, adolescents engaged in agricultural work and studying in vocational institutions;

Qualified and accessible medical care to the population;

Providing medical advisory and organizational and methodological assistance to doctors of district hospitals and FAP workers;

Organization of dispensary observation of certain contingents of patients;

Study and dissemination of best practices.

A medical council under the chief physician is created for the operational management of health care. It includes responsible employees and specialists: deputy chief physician, chief physician of the district sanitary and epidemiological station, head of the polyclinic of the Central District Hospital, head of the central district pharmacy, leading specialists of the district (therapist, surgeon, pediatrician, obstetrician-gynecologist, etc.).

Organizational and methodological work.

The analysis of the activities of the hospital and polyclinic of the Central District Hospital is evaluated by the same indicators as in the city hospital and polyclinic.

Question 64.

Central district hospital - in the area, a polyclinic with it (surgeons, therapists, ophthalmologists, ENT doctors, pediatricians, obstetricians-gynecologists), a hospital with it (almost all departments).

Problems: reduction of beds.

CRH is a center for the provision of specialized and qualified medical services. assistance to the rural population in the region.

Structure:

1) hospital,

2) clinic,

3) treatment and diagnostic rooms and laboratories

4) emergency departments,

5) pathoanatomical department,

6) organizational and methodological office,

7) auxiliary (pharmacies, kitchen, etc.)

1) providing the population of the district with specialized inpatient and outpatient care,

2) organization of emergency and emergency care,

3) organization of advisory and practical assistance to doctors of rural district hospitals on the issues of LP activities,

4) planning, financing and organization of material and technical supply of health care institutions of the district,

5) control over the activities of all medical institutions of the district.

6) Decrease in morbidity, disability among the inhabitants of the region.

The chief physician of the CRH (chief physician of the district) is subordinate to the district (city).

60. Rules for the issuance and extension of disability certificates for diseases. 2.1. In case of illnesses and injuries, the attending physician issues the LN single-handedly and at a time for up to 10 calendar days and extends it single-handedly for up to 30 calendar days,

2.2. An average medical worker who has the right to issue LN, up to 5 days and extends up to 10 days, in exceptional cases, after consultations with the doctor of the nearest medical institution, for a period of up to 30 days.

2.3. With periods of temporary disability for more than 30 days, the decision on the issue of further treatment and extension of the sick leave is carried out by the CEC, appointed by the head of the medical institution.

By decision of the clinical expert commission, LN can be extended until full recovery of working capacity, but for a period not exceeding 10 months, in some cases (injuries, conditions after reconstructive operations, tuberculosis) - no more than 12 months, with a frequency of extension by the commission at least, than 30 days later.

2.4. In case of diseases (injuries), a certificate of incapacity for work is issued on the day the incapacity for work is established, including holidays and weekends. It is not allowed to issue it for the past days when the patient was not examined by a doctor.

In exceptional cases, a certificate of incapacity for work may be issued for the past period by decision of the clinical expert commission.

2.5. Citizens who applied for medical assistance at the end of the working day, a certificate of incapacity for work, with their consent, is issued from the next calendar day.

2.6. Citizens sent by the health center to a medical institution and recognized as disabled are issued a certificate of incapacity for work from the moment they apply to the health center.

2.7. Citizens who need treatment in specialized medical institutions are issued by the attending physicians with a certificate of incapacity for work, followed by referral to institutions of the appropriate profile to continue treatment.

2.10. In cases where the disease or injury that caused temporary disability was the result of alcohol, narcotic, non-drug intoxication, a disability certificate is issued with a corresponding note on the fact of intoxication in the medical history (outpatient card) and in the disability certificate.

2.12. Citizens who are referred by a court decision for a forensic medical or forensic psychiatric examination and are recognized as incapable of work are issued a certificate of incapacity for work from the day they enter the examination.