As soon as possible – Newspaper Kommersant No. 154 (7355) dated 08/24/2022
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Moscow Mayor Sergei Sobyanin announced the transition of the capital to a new standard of emergency medical care. Patient streams will be divided into three categories: red (patients requiring resuscitation or surgery), yellow (patients requiring direct observation) and green (relatively stable patients). And new employees will appear in emergency complexes – social coordinators who, in case of emergency hospitalization, will help citizens with documents, pick up their children from school, call relatives, and even place a pet in a shelter. The All-Russian Union of Patients highly appreciated the innovativeness of the approach, but noted that the quality of medical care depending on the region now has significant differences, and this is “an element of inequality for patients.”
Justifying the need to improve the system of emergency medical care, Mayor Sergei Sobyanin noted that about 1.4 million people are hospitalized in the capital’s hospitals every year. Of these, 1 million patients are delivered by ambulances. “The way emergency care is provided – and this happens in the emergency departments of hospitals – largely depends on the health, life of the patient,” declared Mr. Sobyanin on Tuesday at a meeting with chief physicians of the city’s largest multidisciplinary clinics.
The mayor specified that the program to improve the emergency service will be implemented in six city hospitals: Research Institute of Emergency Care named after. N. V. Sklifosovsky, Botkin Hospital, City Clinical Hospital No. 15 named after. O. M. Filatova, GKB im. V. M. Buyanov, GKB im. V. V. Veresaeva and GKB No. 1 named after. N. I. Pirogov.
Modern emergency complexes were built there – full-fledged hospitals with an emergency department, operating rooms, resuscitation and helipads for air ambulance. In total, more than 600 “supermodern” beds will be introduced in 2023-2024, half of which are resuscitation beds. It is planned that patients will spend “from several minutes to a day” in these complexes. “Here they are examined, diagnosed, provided with all the necessary urgent assistance, and if necessary, they will be operated on. And then, depending on the condition, they will either be transferred to a specialized department to continue treatment, or they will be discharged, ”says Sergei Sobyanin’s website.
The new standard of emergency care itself is based on six points: unified medical algorithms; high professionalism and ability to work in a team; unified equipment standard; modern standards of organization of medical care; advanced digital solutions; the focus is on the patient.
It is clarified that doctors, nurses and subject matter experts have developed 87 step-by-step algorithms that cover 96% of all reasons for seeking emergency care.
Each algorithm will be tested “to automaticity” using simulation equipment at the educational site in Sokolniki. The mayor’s office emphasizes that for the first time, an open competitive selection of about 2,000 employees, from administrators to neurosurgeons, is being organized for the staffing of emergency complexes. It is planned to organize about 60 high-tech operating rooms here, some of which have no analogues in Russia.
Routing of patients of emergency complexes will be organized according to the principle of triage – sorting.
Patient streams will be divided into three categories: red (patients requiring resuscitation or surgery), yellow (patients requiring direct observation) and green (relatively stable patients). Patients of the first category will be “instantly” sent to intensive care or emergency surgery. Assistance to patients of the yellow and green categories will be arranged according to the “doctor-to-patient” principle, when, after a quick check-in at the admission department, a person is placed in the diagnostic room and all further examinations and procedures are carried out directly at the patient’s bed.
Emergency complexes will operate in a digital environment. Specialists will have access to electronic patient records even before the arrival of the ambulance team.
For a telemedicine consultation, a doctor who is next to the patient will be able to use a special augmented reality helmet. “They (consultants.— “b”) see the patient as if with their own eyes and can remotely provide assistance to colleagues, ”explain representatives of the mayor’s office.
Embodying the principle of “the focus is on the patient”, the city government promises, in particular, pain relief according to the most modern protocols at all stages of hospital stay.
In addition, a new position is being introduced – social coordinators. Such specialists will take on non-medical functions “that previously fell on the shoulders of doctors and nurses.”
It is expected that consultants will not only provide moral support and help with documents, but also, if necessary, pick up children from school, call next of kin, or arrange temporary placement of a pet. It is emphasized that for the first time in the practice of Moscow healthcare, special conditions will be created for relatives and friends of patients: comfortable waiting rooms, psychological support rooms and cafes will be equipped in emergency complexes.
“Probably, for the first time in Russia, such a modern standard for the provision of emergency medical care appears,” comments Yury Zhulev, co-chairman of the All-Russian Union of Patients, “It is important that attention will be paid to competent routing, the state in which the patient arrives, and other details that allow the provision of medical assistance as soon as possible and in full. Mr. Zhulev notes that the gradation of response depending on the patient’s condition is already present in the ambulance system, but mainly affects the ranking of the departure of teams. At the same time, the expert notes, the quality of medical care depending on the region now has significant differences, and in this, in his opinion, “an element of inequality for patients.”
The chairman of the Feldsher.ru trade union, Dmitry Belyakov, believes that, nevertheless, the main problem, the shortage of personnel, has not been resolved.
He speaks of a “giant staff turnover” despite high salaries in Moscow’s ambulance service. On average, about 20% of the teams, according to Mr. Belyakov, “go to work one at a time” (according to order No. 88 of the Ministry of Health, an ambulance team should consist of two doctors).
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