Yerzhan N. Kuspaev, Nurlan E. Dalenov, Timofey F. Kovalenko,

Roman Al. Fursov

Astana medical University, Republic of Kazakhstan, Astana

Optimization of the organization of a emergency department’s work in urgent clinics

This research the comparative analysis of work of a emergency department (ED) on an example of the clinics rendering specialized medical aid by the emergent patient, for the purpose of optimization of their work and to creation of algorithms of rendering of medical aid is carried out.

Indicators of rendering of emergency and urgent medical aid are included in research to adult population of Astana city. Work is based on retrospective and prospective analysis. The retrospective comparative analysis of dynamics of demographic indicators of a city last 10 years, quantities of calls of brigades of first aid and quantity of the treated cases in treatment-and-prophylactic town establishments of Astana from 2004 till 2009 years is carried out.

The acute coronary syndrome (ACS) is characterized by the greatest relative density in structure of calls of brigades of urgent aid. Thus, only in 5,8-8,8 % of cases of calls, patients really require the specialized help. The hospitalization’s percent at the given pathology has made in 2004 - 63,7 %, in 2009 – 64,2 % that testifies to the adjusted work of ambulance’s doctors and weak development of a primary link – ambulatory-out-patient service.

At a acute surgical abdominal pathology majority (from 65,8 % to 73,1 %) patients require survey of the profile practitioner. But, after survey of the surgeon and carrying out of diagnostic inspection, only 50 % (50,4 % in 2004 and 45,1 % in 2009ã.) the delivered patients require a hospitalization, other patient treatment can be spent is out-patient.

Among traumatologic patients from 25,3 to 56,4 % of calls require survey of the traumatologist, and from 78,1 % in 2004 to 53,3 % in 2009 of the delivered patients require treatment in the hospital. Thus, the greatest decrease in percent of hospitalizations is noticed on delivery traumatologic patients that demands carrying out of the further analysis.

Patients with ACS in ED look round the cardiologist, it define the general analysis of blood, haemostasis, time of coagulability of blood and duration of a bleeding, the general analysis of urine, the biochemical analysis of blood (definition of enzymes), remove the electrocardiogram. The patient with a acute surgical abdominal pathology after survey by the surgeon appoint the general analysis of blood, the general analysis of urine, the biochemical analysis of blood (billirubin level, diastase, AsAt, AlAt, creatinine, the general fiber, glucose), haemostasis, definition of time of coagulability of capillary blood, the electrocardiogram, ultrasonic research of abdominal bodies, ultrasonic research of a small basin and survey of the gynecologist at women, if necessary fibrogastroduodenoscopy, survey abdominal X-rays. The traumatologic patients after survey of the doctor was made the general analysis of blood, the general analysis of urine, the biochemical analysis of blood, X-rays research.

Having analyzed the list of diagnostic researches, we have come to conclusion that depending on a profile of diseases there is a certain list of diagnostic researches which should be spent is not dependent from disease’s forms. The given obligatory volume of researches, in our opinion can be spent even before survey of the expert that reduces time necessary for diagnosis statement. Results of the given researches allow the interpretation a clinical picture of disease, to establish the diagnosis, defeat severity level, to deal with a question of necessity of hospitalization and management of the patient.

For carrying out of an estimation of the organization of work of ED we develop indicators (measured sizes). In references of indicators of definition of quality of the rendered medical aid, by us it is not revealed, and ED work is estimated on patients’ satisfaction and development of lethal outcome. For an estimation of work’s quality of ED in work indicators of duration stay of the patient in ED are used; a divergence of preliminary and clinical diagnoses; the repeated reference of patients with the subsequent hospitalization; satisfaction sick of the rendered help. Also indicators of length of stay, frequency of development of complications, frequency of mortality, depending on quality of ED’s work are studied. Object of research in the given section were the Central Railway Hospital, Astana city, the Central Regional Hospital, Astana city, Regional Emergency Hospital, Aktobe city.

Quality of rendering of medical aid in ED does not render influence on indicators: length of stay, development of complications, management of the patient. Thus, long stay of the patient in ED tightens terms of the beginning of rendering of specialised medical aid. And a divergence of diagnoses at receipt and definitive clinical diagnoses considerably above in group with patients who were died. So, during the period from 2005 till 2010 in surgical department of the Central Railway Hospital 7639 patients are treated, from them the divergence of diagnoses took place at receipt and clinical diagnoses at 53 patients that has made 0,7±0,1 %. For the given time interval 165 patients have died, from them divergences of diagnoses met at 9 patients that has made 5,5±1,8 % (ð <0,05).

The time interval from the moment of receipt of the patient in a hospital till the moment of statement of the diagnosis and the beginning of adequate full-scale medical actions should be shown to a minimum. For reduction of time of stay of the patient in ED it is necessary to reconsider organizational approaches of the majority of the hospitals rendering urgent help.

Along with it, for improvement of quality of work of ED it is necessary:

- Constant increase of technical skills on rendering of emergency medical aid by employees of ED;

- Carrying out of specialization in the organization of work of ED, including in near and far abroad;

- Constant studying of the new medical literature and the Internet of the data;

- Introduction of new diagnostic methods;

- To reconsider and add the report of diagnostics and treatment of patients;

- To carry out the internal control over quality of rendering of medical aid;

- To conduct monitoring of satisfaction sick of the rendered medical aid.

Development of the primary medico sanitary help should become one of factors which should lead to improvement of quality of work of a hospital as a whole, and ED in particular. Loading decrease for work of the first help will lead to reduction of loading by 1 doctor of ED, will increase percent of hospitalization of patients and will raise quantity of the satisfied patients who have addressed in ED. On the basis of the above-stated we offer model of the organization of work of ED of the hospital rendering medical aid by the patient with a acute surgical abdominal pathology, a acute coronary pathology and a trauma.