The hospital at home is a new step in the system of providing qualified non-medical care to the population. It is organized as part of the city polyclinic, intended for patients with acute and chronic diseases, mainly therapeutic and neurological profiles (who do not need round-the-clock medical supervision and treatment). Patients with complications requiring round-the-clock monitoring and surgical intervention are not left in the hospital at home. The hospital at home uses all the consultative and treatment and diagnostic services available in the clinic. Medicines are purchased in pharmacies by the doctor's prescription by the patients themselves. Its work is managed by the head of the department. The need to treat a patient in a hospital at home is decided by the local therapist after agreement with the head of the department. This takes into account:

one . The diagnosis is clear and for its statement, confirmation does not require laboratory and instrumental examination in a hospital setting.

The patient's condition allows for diagnostic and therapeutic measures at home.

The condition and course of the disease in the patient is not threatening and is not accompanied by the development of complications requiring complex interventions (resuscitation, surgery).

Living conditions are good, relatives agree and can take care of.

Responsibilities of the doctor in the organization of medical care "hospital at home":

1. Regular examinations of patients.

2. Organization, if necessary, consultations of specialists.

3. Determining the volume of laboratory and instrumental studies at home.

4. Development of treatment tactics.

5. Constant careful monitoring of the implementation and appointment.

Day hospital.

This is a new form of medical care for the population, which allows for examinations, treatment, and rehabilitation of patients during the daytime. The day hospital does not provide beds for a round-the-clock stay, therefore, only those patients who do not need round-the-clock supervision of medical workers are hospitalized.

The main goals of day hospitals:

1. Timely provision of medical care in full.

2. Reducing the period of temporary disability in these patients due to faster examination and the use of intensive care methods

3. . Release and rational use of hospital beds for patients who can receive medical care only in a hospital, hospitals.

A day hospital is organized for the hospitalization of patients with acute and chronic diseases of various profiles (therapeutic, cardiological, surgical, etc.) whose condition does not require round-the-clock monitoring and treatment, but who are indicated for treatment and diagnostic care in the daytime. Examination and treatment in it should be mainly patients of working age, suffering from cardiovascular diseases, bronchopulmonary, gastrointestinal tract, etc. A day hospital can be multidisciplinary and specific - neurological, therapeutic, surgical. The most appropriate multidisciplinary hospitals. Special states are allocated for it. Its mode of operation is determined in different ways, preferably in 3 shifts. The length of stay for each patient is 3-4 hours. It is desirable that the day hospital be on the same floor as the rehabilitation departments, which allows the wider use of physiotherapy, exercise therapy, balneotherapy, etc. For full-fledged work, the day hospital, in addition to highly qualified personnel, technical equipment, must have:

1. Chambers for 3-4 people (male and female).

2.Procedural room.

3. Office of the head of the department and the doctor.

2.1. The hospital at home provides medical care at home.

2.2. The hospital at home is organized on the basis of a medical institution:

Outpatient clinic;

Women's consultation;

Specialized dispensary and is its structural subdivision.

2.3. Observation and treatment of patients in a hospital at home is carried out by a local therapist, a specialist doctor, a district medical doctor. clinic nurse.

2.4. Medical institutions, the structural subdivision of which is a hospital at home, provides the doctor with transport.

2.5. The management of a hospital at home can be carried out by one of the heads of the therapeutic department (polyclinic, hospital institution), who visits the patient at home 1-2 times during the treatment period in order to monitor the quality of diagnosis and correct treatment.

2.6. The selection of patients for treatment in a hospital at home is carried out by the attending physician of the hospital or outpatient clinic in agreement with the head of the department.

2.7. Treatment in a hospital at home is subject to:

patients discharged from the hospital to complete the course of therapy in a home bed under the supervision of a physician;

patients of moderate severity and severe in the absence of indications for hospitalization in a round-the-clock hospital, such as:

Threat to the life of the patient: acute cardiovascular failure, acute respiratory failure, acute liver failure, acute renal failure, acute cerebrovascular accident, shock of various etiologies, acute poisoning, coma of various etiologies, acute myocardial infarction;

The threat of the above violations in the first day;

The need for constant medical supervision;

The impossibility of carrying out diagnostic and therapeutic measures in an outpatient setting;

The need for round-the-clock medical procedures;

Isolation according to epidemiological indications;

Threat to the life and health of others.

patients who need rehabilitation treatment if it is impossible to carry it out on an outpatient basis;

Patients with chronic diseases for planned treatment.

2.8. The hospital at home uses in its work all the advisory and treatment and diagnostic services available in the medical institution.

2.9. The mode of operation of a hospital at home is established by the head of the institution in accordance with the needs of the population in this type of assistance and local conditions.

2.10. To adjust the treatment and extend the temporary disability certificate, the clinical expert commission is held at home within the time limits established by the legislation for the examination of temporary disability.

2.11. The report on the activities of hospitals at home is submitted in the prescribed manner and within the established time limits.

2.12. The duration of the working week of a doctor and a nurse of a hospital at home is 38.5 hours.

2.13. On weekends and holidays, appointments in a hospital at home are performed by nurses on duty at an outpatient clinic; seriously ill patients are examined by the doctor on duty at the health facility.

2.14. If the patient's condition worsens, life-threatening conditions occur in him or the need for round-the-clock medical supervision, the patient is transferred to a round-the-clock hospital.

2.15. The length of stay of a patient in a hospital at home is determined by the patient's condition, averages 12 days, for gerontological patients - 14 days.

2.16. Payment for the treatment of patients is made at the expense of the Compulsory Medical Insurance Fund upon presentation of invoices for the medical services provided according to the profile of treated patients or at the expense of the budget.

Purpose and functions

1.1. The purpose of the day hospital is to improve the quality of medical care in outpatient and inpatient settings, as well as to increase the economic efficiency of medical institutions through the introduction and widespread implementation of modern resource-saving medical technologies for prevention, diagnosis, treatment and rehabilitation.

1.2. In accordance with this goal, the day hospital performs the following functions:

1.2.1 Selection of adequate therapy for patients with a newly diagnosed disease or chronic patients with an exacerbation of the process, a change in the severity of the disease.

1.2.2 Conducting a comprehensive course of treatment using modern medical technologies for patients who do not require round-the-clock medical supervision.

1.2.3. Implementation of rehabilitation and health-improving complex course treatment of sick and disabled people, pregnant women.

1.2.4. Decrease in the level of morbidity with temporary disability.

1.2.5. Carrying out an examination of the state of health, the degree of disability of citizens and resolving the issue of referral to a medical and social examination.

1.2.6. Carrying out complex preventive and health-improving measures for persons at risk of increased morbidity, including occupational, as well as for long-term and frequently ill people.

Station at home.

2.1 The purpose of the work of the hospital at home is to improve the quality of the provision of qualified and specialized care to patients in the conditions of staying at home, the development and improvement of new methods of treatment aimed at the development of out-of-hospital care and resource-saving technologies.

2.2. In accordance with this goal, the hospital at home performs the following functions:

2.2.1. Diagnosis and treatment of diseases in accordance with indications for hospitals at home.

2.2.2. Post-treatment of patients after the stage of intensive treatment using modern tools and methods of out-of-hospital medical care.

2.2.3 Relationship and continuity with various medical and preventive social welfare institutions.

Structure and states

Day hospital on the basis of an outpatient clinic and a hospital

3.1. The structure of a day hospital may include:

wards equipped with the necessary equipment and inventory;

treatment room;

a surgical room with a small operating room;

a room for the stay of medical personnel;

room for meals for patients (at hospitals);

· other rooms by decision of the management of the medical institution.

Requirements for the premises of day hospitals are specified in SanPiN 2.1.3.1375-03 Appendix 3, 4.

For the implementation of the functions of a day hospital, diagnostic, therapeutic, rehabilitation and other units of the medical institution, in the structure of which it was created, can be used.

3.2. The staffing and load norms of medical personnel of medical institutions are established taking into account the presence of a day hospital in this institution.

The indicator of the volume of medical care provided in a day hospital under the State Guarantee program is expressed in the number of patient days and is 577 per 1000 attached population.

3.3. The position of the head of the department is introduced instead of the position of a doctor, if the department has less than 60 beds. If the number of beds is more than 60, the position of the head is introduced additionally.

The position of a day hospital doctor is established at the rate of 1 position for 25 beds.

The position of the head nurse is introduced according to the position of the head of the department.

In day hospitals, the position of a ward nurse is introduced at the rate of: 1 position for 15 beds.

The positions of ward nurses are established according to the positions of nurses.

Station at home.

The structure of a home hospital may include:

Premises for medical personnel;

A room for storing mobile equipment, equipment, medicines, patient care items.

The position of the head is established instead of the position of a doctor, if the number of beds is less than 60, if more, the position of the head is introduced additionally.

Staff positions are approved at the rate of 1 doctor position for 10 patients, 1 nurse position for 15 patients.

It is one of the ways to provide qualified drug treatment at home population and has become quite a popular phenomenon in the treatment of patients with narcological profile. Home hospital - This is a convenient service for both the patient and his relatives. Indeed, in some cases, the hospitalization of a patient in a long-term state of binge can cause a number of certain difficulties. In addition, the patient is provided with professional narcological assistance and at the same time he is in a comfortable home environment and is surrounded by the attention of his family, relatives and medical personnel.

Service " Hospital at home» organized as part of our medical center for patients:

• with a duration of drunkenness for more than 5 days,
• categorical refusal of the patient from hospitalization in a hospital and in those cases when
• observation of the patient by relatives is difficult for one reason or another, but the patient does not need round-the-clock medical supervision and care.

• Delirium tremens (delirium)
• Various types of hallucinosis
• Heart rhythm disturbances (arrhythmias) causing circulatory failure
• Stomach and esophageal bleeding
• Complications of diabetes mellitus (hyper- and hypoglycemia)
• Heart failure manifesting itself as a pronounced edematous syndrome.
• Severe liver failure (jaundice of the sclera and integument of the body)
• And other life-threatening complications.

But, nevertheless, the decision to organize a day hospital lies with the narcologist and is agreed with the chief physician of our medical center.
Despite the fact that withdrawal from hard drinking in a home hospital is carried out at home, the entire range of medical and psychotherapeutic procedures fully coincides with the volume of medical care provided to the clinic.

So: How does it happen?

• You use the services of our emergency drug treatment and call a narcologist at home.
• The doctor evaluates the objective condition of the patient, his medical history, comorbidities and the degree of complications.
• In agreement with the head physician of our center and the patient's relatives, a decision is made to provide drug treatment in a home hospital.

What is included in the home care service?
The narcologist is near the patient for 10-12 hours a day, performing all the necessary manipulations to bring the patient out of hard drinking. This:

• Tablet therapy
• Infusion therapy (Dropper for carrying out)
• A course of intramuscular and subcutaneous injections.
• Symptomatic therapy.
• Monitoring the patient's condition in conditions of medical sleep.

dropper the patient is given twice during these 10-12 hours with a time gap of 5-6 hours. The volume of the dropper is selected by the doctor individually, depending on the severity of the patient's condition. Cm. . This procedure is performed 3 days in a row, i.e. 30-36 hours the patient is under the close supervision of a professional narcologist. It means a lot! After all, the doctor can foresee the development of possible complications and prevent them from developing!

And as our practice shows, these 3 days are absolutely enough to “put a person on their feet” after a long and heavy drinking bout!

In addition, in cases of positive motivation of the patient to refuse alcohol and his unwillingness or impossibility for various reasons to undergo treatment in a narcological hospital, we can offer effective methods of prohibitive anti-alcohol therapy. Such as drug and drug-free coding and psycho-correction, and constant communication with a specialist allows the doctor to convince the patient of the need to continue and form this motivation.

Service cost A: A hospital at home in our center is 20,000 rubles for 3 days. With further free coding.

Experienced doctors of the Narcological Center "Narcodetox" will always provide you with assistance with a guaranteed positive result at a convenient time for you. We are always happy to help you in a difficult situation. And if it occurs, do not delay and contact our specialists!

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FEDERAL AGENCY FOR HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

SEI HPE "Northern State Medical University (Arkhangelsk)"

TEST

Subject: "Family Medicine"

Topic: "hospital at home: options, documentation, indications and contraindications for home treatment"

Arkhangelsk-2013

Introduction.

Conclusion

Bibliography

Introduction

Family medicine is relatively young and as a clinical discipline does not yet have a generally accepted definition. Traditionally, the basis for the division of clinical medicine into specialties is anatomy, age, or technology used by medical professionals. From these positions, it is logical to assume that family medicine is the science of the most common health problems of the family and the patient, regardless of gender and age; the family is considered as a unit of observation.

According to the definition of the Ministry of Health of the Russian Federation, a family doctor is a specialist with a higher medical education who provides primary medical care to the population, regardless of gender and age.

There is no doubt that family life has a profound effect on a person's health and the course of any disease. Translated from Greek, "doctor" means "teacher." Education of the patient and his family members is the most important element of the doctor's activity. The art of managing a patient and his family is the quintessence of clinical practice, a unique field of knowledge for a family doctor. The obligatory assistant of the family doctor in this work is the family nurse.

Thus, family medicine is an integrative specialty that considers the health and illness of a person, taking into account his biopsychosocial status.

Family medicine, due to its high social significance, is closely related to such concepts as sufficiency, expediency and profitability. In all countries, an increase in health care spending is projected due to 3 trends: an increase in the number of elderly patients; development of medical and technical progress; increasing demand for medical services. The purpose of the work is to consider the organization of the work of hospitals at home.

1. Hospital at home - one of the types of outpatient care

1.1 Importance of home hospitals

hospital patient medical doctor

Along with the day hospital of the polyclinic, another organizational form of hospital-replacing care is the so-called home hospital for patients with joint diseases, the consequences of injuries, for patients with cerebral circulation disorders, although this organizational form is not new and was actively used in the sixties for patients with other pathology.

The organization of hospitals at home makes it possible to reduce the number of planned hospitalizations in a hospital, reduce the percentage of unjustified hospitalizations, reduce the number of beds without compromising the availability of medical and preventive measures, while expanding the volume of outpatient care. One of the possible forms of rehabilitation of patients is an exit form of rehabilitation treatment at home for chronic patients and disabled people with severe functional impairments, due to which they are sometimes completely immobilized and cannot move independently.

A home hospital is organized as a department of outpatient clinics (subdivisions of municipal health care institutions) to provide medical care at home in cases where the patient has lost the ability to visit the clinic or the patient needs temporary compliance with the home regimen, therapeutic measures are shown, daily medical supervision employees, but there is no need for its round-the-clock supervision and round-the-clock performance of medical procedures.

The conditions for organizing a hospital at home are the availability of satisfactory living conditions and the possibility of caring for the patient by family members.

At home, massage, physiotherapy, acupuncture, acupressure, some types of hardware physiotherapy - electrophoresis of drugs, ozocerite-paraffin applications, electrosleep, UHF, etc. are used. Some authors express doubts about the rationality of organizing rehabilitation treatment at home due to the high cost of funds and the alleged inefficient use of qualified medical personnel.

At the same time, a WHO expert committee (1983) concludes that, given the high cost of rehabilitation in medical institutions, the transition from rehabilitation in a hospital to rehabilitation organized on a communal basis, provided that relatives take care of their disabled family members, can be fully provided for at a much lower cost to society as a whole.

1.2 Options for organizing the work of doctors and nurses in hospitals at home

In the conditions of restructuring of medical and preventive care, such an organizational form of medical care as hospitals at home at outpatient clinics is being further developed.

A home hospital is usually a structural subdivision of the emergency department of a polyclinic. Hospitals at home can also be created on the basis of medical units, polyclinic departments of hospitals, dispensaries, antenatal clinics and even hospitals.

The organization of a hospital at home ensures the provision of qualified medical care to patients in need of treatment in a hospital, if the patient's condition and home conditions (social, material, moral) allow organizing the necessary care for the patient at home.

Patients are referred for this treatment by local internists, medical specialists and emergency physicians, as well as general practitioners and family doctors.

In practice, there are 2 methods of organizing the work of doctors and nurses in hospitals at home:

ѕ Centralized, when a general practitioner and 1-2 nurses are specially assigned to work in a hospital at home. With this form in a hospital at home, 12-14 patients are served per day.

* Decentralized - The most appropriate method of organizing the work of the hospital is carried out at home by a general practitioner or district physician and a nurse.

In most cases, elderly people with chronic pathology are observed in hospitals at home. At the same time, there is experience in organizing a hospital at home for people of working age. The practice of organizing hospitals at home has also justified itself in pediatrics, obstetrics and gynecology (up to childbirth at home).

Speaking about the prospects for the development of hospitals at home, one can foresee their transformation with the transfer of functions to a general practitioner. Such an organizational form can already be implemented in rural areas and in cities where general medical (family) practice has been introduced.

In another option, home hospitals can develop into outpatient care centers that will provide not only specialized, but also social care.

1.3 Aims and main activities of the home hospital

The purpose of the work of the hospital at home is to improve the quality of medical care for patients in the conditions of staying at home, the development and improvement of new methods of treatment aimed at the development of hospital replacement care and resource-saving technologies.

The following main activities are carried out in the hospital at home:

* Diagnosis and treatment of diseases in accordance with the indications for hospitals at home.

* Post-treatment of patients after the stage of intensive treatment using modern tools and methods of out-of-hospital medical care.

ѕ Relationship and succession of health care institutions with social protection authorities.

2. Organization of the work of home hospitals

2.1 Hospital management at home. Accounting and reporting medical documentation

The management of the hospital at home is carried out by one of the heads of the therapeutic departments or the head of the polyclinic.

The mode of operation of the hospital at home and staff positions are established by the head of the institution in accordance with the needs of the population in this type of assistance and local conditions.

The terms of treatment of patients in a hospital at home are determined by the orders of the Health Committee.

The report on the activities of hospitals at home is submitted in the prescribed manner and within the established time limits.

Medical and drug assistance to the population in a hospital at home is provided within the framework of the Territorial programs of state guarantees for the provision of free medical care.

Payment for the treatment of patients is made at the expense of compulsory medical insurance upon presentation of invoices for medical services rendered according to the profile of treated patients, as well as at the expense of the local budget.

Treatment and monitoring of patients in a hospital at home is carried out by the attending physician (district internist, district pediatrician, general practitioner, specialist doctor), paramedic, district nurse of the polyclinic or nurse of the GP.

The organization of a hospital at home involves daily monitoring of the patient by medical workers, laboratory diagnostic examinations, ECG, drug therapy (intravenous, intramuscular injections), and various procedures. If necessary, the complex of treatment of patients also includes physiotherapy, massage, exercise therapy, etc.

The selection of patients for treatment in a hospital at home is carried out by a local doctor, a general practitioner, a specialist doctor or the attending physician of the hospital in agreement with the head of the department or the head of the polyclinic.

To organize the work of the hospital at home, all advisory and treatment and diagnostic services available in the medical institution are used. Complicated diagnostic examinations (echocardiogram, X-ray examinations, etc.) are performed in the presence of clinical indications in the clinic, where patients are delivered by ambulance.

When organizing a hospital at home, the time spent by the doctor and nurse on the road is taken into account. However, they should not exceed 20 minutes one way. A medical institution, whose structural subdivision is a hospital at home, provides medical personnel with transport.

On weekends and holidays, appointments in a hospital at home are performed by nurses on duty at an outpatient clinic.

If the patient's condition worsens, life-threatening conditions occur, or the need for round-the-clock medical supervision, the patient is transferred to a round-the-clock hospital.

In a hospital at home, the established accounting and reporting medical documentation is maintained:

ѕ a card of a sick hospital at home (form 003-2/y-88);

¾ register of admission of patients and denials of hospitalization (form 001-y);

ѕ book of issuance of certificates of incapacity for work (form 036-y);

* an extract from the medical record of an outpatient (inpatient) patient (form 027/y);

¾ register of procedures (form 029-y);

* registration sheet for the transfusion of transfusion media (form 005-y);

* register of transfusion of transfusion media (form 009-y);

¾ journal of records of surgical interventions (form 008-y);

* statistical card of the person who left the hospital (form 066/y-02);

* a sheet of records of the movement of patients and hospital beds (form 007ds / y-02).

For each patient in a hospital at home, F. No. 003-2 / y-88 "Card of a patient in a day hospital of a polyclinic (hospital at home), a day hospital in a hospital" is maintained.

In the card, the attending physician writes down appointments, diagnostic tests, procedures, medical and recreational activities. The attending physician, medical specialists who consult the patient, paramedical workers who carry out the appointments of doctors put the date of the examination (execution of appointments) and their signature.

The card is issued to the patient in his hands for the duration of his stay in the hospital at home.

Accounting for the work of a doctor working in a hospital at home is kept on a general basis according to F. No. 039 / y-02 "Record of medical visits in outpatient clinics, at home."

Daily registration of patients who are in a hospital at home is carried out according to F. No. 007ds / u-02 "Sheet of daily registration of the movement of patients and bed fund of a day hospital at an outpatient institution, a hospital at home."

When a patient is discharged from the department, F. No. 066 / y-02 "Statistical card of a person who left a round-the-clock stay hospital, a day hospital at a hospital institution, a day hospital at an outpatient institution, a hospital at home" is filled in.

A patient who has completed treatment is issued F. No. 027 / y "Extract from the medical card of an outpatient, inpatient" about the treatment.

A sick person may be issued a certificate of temporary disability on a general basis.

According to the results of the work of the hospital at home for the year, the reporting form 14-DS "Information on the activities of the day hospital" is filled out.

A hospital at home is provided by vehicles for examining a patient by a doctor, performing treatment and diagnostic procedures at home, and if necessary, transporting a patient for diagnostic procedures to the APU.

The hospital is managed at home by a doctor - the head of the hospital, who reports to the chief doctor and deputy for medical work, or on a functional basis, the head of the therapeutic department, the district doctor. Staff positions are established within the staffing table in accordance with the load on the position.

The primary selection of patients in a hospital at home is carried out by district doctors, general practitioners, medical specialists with recommendations for the proposed treatment in agreement with the head of the structural unit and the head of the hospital at home.

Sources of funding for a home hospital are:

Mandatory medical insurance funds for the provision of medical care to the population within the framework of the territorial CHI program, including the cost of wages, payroll charges, the purchase of medicines, dressings, medical instruments, reagents and chemicals, glass, chemical dishes and other material supplies, payment expenses the cost of laboratory and instrumental studies carried out in other institutions (in the absence of their own laboratory and diagnostic equipment);

Budget funds for all items for the provision of medical care, financed according to the cost estimate for the maintenance of the institution;

Funds of citizens for the provision of paid medical services;

Funds under contracts of voluntary medical insurance programs;

Other means not prohibited by the legislation of the Russian Federation.

The organization of a hospital at home provides for a daily visit to the patient by a doctor, laboratory diagnostic examinations, drug therapy in accordance with the standards of its provision. If necessary, the complex of treatment of patients includes physiotherapy, massage, exercise therapy, etc.

The procedure for providing medical care on weekends and holidays is determined by the chief physician of the medical institution.

2.2 Indications for inpatient treatment at home

Completion of the course of treatment at home after discharge from the hospital if there are indications for the continuation of therapeutic measures, regular medical supervision and the absence of the opportunity to visit the clinic.

Patients of moderate severity and severe in the absence of indications or the possibility of hospitalization in a round-the-clock hospital.

Patients who need outpatient treatment, but for health reasons who are not able to visit the clinic.

Treatment at home for children.

Provision of palliative care.

Patients referred to the hospital for treatment at home:

ѕ with acute diseases and exacerbations of chronic diseases of various profiles (therapeutic, pediatric, neurological, surgical, traumatological, oncological, obstetric-gynecological, otolaryngological, ophthalmological, dermatological, narcological, psychiatric, phthisiatric), the course of which does not require round-the-clock monitoring of the patient;

¾ needing follow-up treatment and rehabilitation after the stage of treatment in a round-the-clock hospital with an updated diagnosis;

¾ in need of controlled treatment and observation;

ѕ in need of comprehensive rehabilitation measures;

ѕ requiring complex expert questions with the use of additional laboratory and functional studies

Approximate list of diseases to be treated in a hospital at home

I. Hospital at home of a therapeutic profile:

* Hypertension, hypertensive crisis.

* Diseases of the cardiovascular system with circulatory disorders stage II-III.

* Mild pneumonia (under normal living conditions and the possibility of organizing patient care).

* Chronic bronchitis in the acute stage, DN II st.

* Oncological diseases of the IV stage (course treatment in the stage of decompensation).

II. Hospital at home of a cardiological profile:

IHD - acute myocardial infarction - only in the case of a categorical refusal of the patient from inpatient treatment.

IHD - unstable angina (only in the case of a categorical refusal of the patient from inpatient treatment).

IHD is an arrhythmic variant.

III. Hospital at home neurological profile:

* Acute violation of cerebral circulation (acute period, early recovery period).

* Osteochondrosis of the spine with severe pain syndrome.

The volume of research conducted in a hospital at home

Required:

* complete blood count - 1 time in 10 days;

* General analysis of urine - 1 time in 10 days;

* blood on RW;

According to indications:

* Biochemical blood tests;

* General sputum analysis.

* Sputum culture for flora and sensitivity to antibiotics.

* Determination of the prothrombin index.

* Fluorography or X-ray of the chest.

* Other studies.

Blood sampling for clinical studies, as well as material (urine, sputum) for biochemical studies, is carried out by a nurse at a hospital at home. For carrying out fluorographic, radiographic and other diagnostic studies, the patient is delivered to the clinic by a hospital machine at home. An ECG is performed at home by a nurse.

2.3 Contraindications for home hospital treatment

The presence of life-threatening conditions: acute cardiovascular failure, acute respiratory failure, acute liver failure, acute renal failure, acute cerebrovascular accident, shock of various etiologies, acute poisoning, coma of various etiologies, acute myocardial infarction.

* The presence of a threat of the above violations on the first day.

* The need for round-the-clock medical supervision.

* The impossibility of carrying out diagnostic and therapeutic measures in an outpatient setting.

* Necessity of round-the-clock performance of medical procedures.

* The need to isolate the patient for epidemiological reasons.

* The presence of a threat to the life and health of others during treatment at home.

Conclusion

Medical care in a hospital at home is provided to people with disabilities - patients who, for various reasons, cannot visit the clinic themselves and do not need a round-the-clock stay in the hospital. In addition, for such patients, if necessary, consultations with a specialist doctor are organized, some diagnostic studies are carried out (for example, an ECG recording), as well as blood sampling for research.

Medicines and medical products are used by the polyclinic according to the list established by the regional program of state guarantees for the provision of free medical care at the expense of compulsory medical insurance, that is, free of charge for the patient.

The course of treatment in a hospital at home is designed for 10 days. Patients are visited daily by the district doctor (general practitioner) or the district nurse (general practice nurse). Also, all the necessary manipulations are carried out for patients: droppers, injections, dressings, and so on.

Thanks to this, medical care has become more convenient and affordable.

Bibliography

1. Order of the Ministry of Health of the Russian Federation of December 9, 1999 No. 438 "On the organization of the activities of day hospitals in medical institutions"

2. Outpatient medicine: B.L. Movshovich - St. Petersburg, Medical Information Agency, 2010 - 1064 p.

3. Selected lectures on family medicine: Edited by O. Yu. Kuznetsova - Moscow, ELBI-SPb, 2008 - 728 p.

4. General medical practice (family medicine): A practical guide / I.N. Denisov, B.L. Movshovich. - M ..: GOU VUNMTS, 2005. - 1000 p.

5. General medical practice according to John Nobel // Ed. J. Nobel with the participation

6. G. Grina et al.; Translation from English. Ed. E.R. Timofeeva, N.A. Fedorova. - M., Practice, 2005. - 1760 p.

7. Postmenopausal therapy: E.M. Vikhlyaeva - St. Petersburg, MEDpress-inform, 2008 - 448 p.

8. Directory of the family nurse. In 2 volumes. Volume 2: - St. Petersburg, AST, Stalker, 2005 - 640 p.

9. Legal bases of activity of the doctor. Medical law: Textbook in schemes and definitions. / Ed. Yu.D. Sergeeva. - M.: GEOTAR-Media, 2006. - 248 p.

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Acquaintance with the history of the development of hospital-replacing technologies. Determination of the intended purpose of day hospitals in the hospital and at outpatient clinics; revealing their medical, social and economic effects.

abstract, added 04/18/2011


Legal status of citizens and certain groups of the population in the field of health protection. Provision of emergency medical care. The system of inpatient medical care to the population. Medical and social assistance to citizens suffering from socially significant diseases.

term paper, added 11/03/2013


Medical measures to protect the population and the provision of medical care to the population during the liquidation of an emergency. The essence of the staged treatment system. Features of the methodology of valeology. What is socionics. informational metabolism.

abstract, added 10/31/2008


The essence and significance of outpatient care. Types of compulsory medical measures and their application. Sanatorium-and-spa treatment is a type of medical and preventive care provided in specialized inpatient institutions.