Ambulatory Surgery Center. Day hospital - when and for whom What is a day hospital in a hospital

Head of department: Semyon Lvovich Kovarsky, doctor highest category, doctor medical sciences, Professor.

Structure of the Ambulatory Surgery Center

1. Advisory departments

Surgical consultation room

Outpatient orthopedics

Cryotherapy room

Hand surgery room

Office for ostomy children

Specialized Center for Urology and Reproductive Health

Cardiological consultative and diagnostic department for children with birth defects hearts

2. Department of Anesthesiology and Resuscitation

3. Day surgical hospital with 15 beds

The term "one-day surgical hospital" implies hospitalization, surgery, awakening, the next postoperative period and discharge of the patient on the same day. A similar hospital was organized at the Filatov Hospital in January 1985 on the initiative of the Department of Pediatric Surgery of the N.I. Pirogov Russian State Medical University and was the first such children's institution in our country. The work was headed by the assistant of the Department of Pediatric Surgery, Jumber Noevich Gaprindashvili.

Currently, the One-Day Surgical Hospital (HSOD) is a 15-bed department with an operating unit, a post-anesthesia ward, two dressing rooms, four post-operative wards for children and parents, a waiting room, consultation rooms, and auxiliary rooms.

Children with the following diseases are hospitalized at the HSOD:
anterior hernia abdominal wall(inguinal, inguinoscrotal, umbilical, white line of the abdomen)
dropsy and cysts of the testicular membranes and spermatic cord
phimosis
cryptorchidism
soft tissue benign formations small sizes

In medicinal – diagnostic process performed in the HSOD, we distinguish three stages: pre-hospital, hospital and post-hospital.
The most important point at the prehospital stage is a careful selection of patients, which is carried out at a consultative appointment. Appointments are carried out daily by department surgeons. If necessary, an anesthesiologist is invited. A special patient selection algorithm has been developed for surgical treatment in the Children's surgical hospital for one day. The algorithm involves assessing the psycho-emotional status of parents and somatic condition patient. Based on correct selection, about 97% of the children who applied were successfully operated on outpatient setting. The rest were recommended to be treated in the hospital's elective surgery department.

The throughput capacity of the CSOD is currently approximately 1,800 patients per year, about 2,300 surgical interventions are performed, and about 4,000 consultations are carried out. Considering more high level risk of surgical and anesthetic procedures in children in the first months of life, patients are admitted to the same-day surgical hospital after reaching one year of age.

At the hospital stage, basically surgical treatment HSOD is based on the principle of minimally invasive (gentle) effects, which includes the following provisions:
1. Reduce to a minimum surgical wound, and therefore, maximum reduction of the wound surface.
2. Preventing the intersection of muscle and aponeurotic tissues during surgery to avoid damage to nerve trunks in order to preserve innervation zones and reduce pain.
3. Rational use suture material to create the minimum possibility of its rejection.
4. Significant reduction in surgical intervention time and general anesthesia.
5. Achieving maximum cosmetic results.

The department has developed original minimally invasive surgical techniques, thanks to which it was possible to almost completely avoid complications and relapses of diseases in patients operated on at the CSOD. We also note that improved treatment results and a reduction in the number of complications are associated with permanent staff operating surgeons and anesthesiologists with the highest medical category in their specialty, working together for more than 20 years and having extensive experience in pediatric outpatient surgery.

The child’s stay in the CSOD does not exceed 4 hours, during which he receives the full range of therapeutic diagnostic measures, including hospitalization, examination, surgery, postoperative assessment and discharge.
Further monitoring of the patient is carried out at the post-hospital stage. Parents are given necessary recommendations on child care, it is especially emphasized that the child must lead active image life, do not introduce any restrictions into the diet and daily routine, limit only severe physical exercise. If necessary, in the evenings, weekends and holidays, parents can call their doctor at mobile phone and get advice. IN active surveillance The child does not need a surgeon in the postoperative period. On the 7th day after surgery, children are invited for a re-examination. Over the past 18 years, we have completely abandoned such an unpleasant procedure as removing sutures, because... we use an intradermal cosmetic suture with absorbable material from the High Quality. At the re-examination, parents receive recommendations for the future.
Thus, a child undergoing treatment in a one-day surgical hospital receives the entire range of therapeutic and diagnostic measures, starting from establishing correct diagnosis before full recovery, including surgery. It is very important that this entire complex is controlled by one doctor. The validity of this organizational approach to surgical treatment of children is confirmed by positive reviews their parents, an increasing number of whom are inclined to choose a day surgery hospital as a medical facility for their child (see our forums).
The growing popularity of outpatient surgery requires us to constant increase comfort and safety of anesthesia. Individual approach to each child and assessment of his psycho-emotional status is the determining factor in choosing the method of preparation for anesthesia. If a child (usually younger children) age group) is experiencing anxiety or extreme agitation, then the appointment of Midazolam (Dormikum) provides a reliable level of sedation (relief of agitation), is well tolerated by children and does not prolong the time of awakening. For older children, to relieve psycho-emotional stress before anesthesia and surgery, the department has developed a program that allows, through a special conversation and the absence of any aggression, to set the patient up for positive attitude to action medical personnel. It is appropriate to note here that we do not give the child any injections (shots) before surgery. All necessary medications administered only during anesthesia.
It should be noted that to the door operating room child The mother brings it up together with the anesthesiologist, who has already established the necessary contact with the little patient. When entering the operating room, we never undress children completely - the child comes in his pajamas or dressing gown. Next, the anesthesiologist begins anesthesia, holding the child on his lap, which also helps to relieve negative reaction to what is happening.

As for general anesthesia itself, we consider it optimal to transition from the practice of conventional mask anesthesia to the concept of multimodal (combined) anesthesia - the use of various auxiliary drugs for different stages general anesthesia. At the end of 2009, in connection with the commissioning of a new generation of anesthesia machines, we were able to use a new inhalational anesthetic - Sevoflurane (Sevoran), which has several theoretical and practical advantages over older agents.

Drager anesthesia machine (Germany) and Sevoflurane (UK)

At the beginning of anesthesia, when the child is already asleep, we supplement general anesthesia various methods regional (local) anesthesia, which is so effective that it allows the anesthesiologist to administer anesthesia at superficial levels. As a result, the child receives a minimal dose of anesthetic. The use of combined anesthesia almost completely prevents postoperative pain syndrome, which guarantees soft recovery after anesthesia.
Post-anesthesia nausea and vomiting are the most common and significant complication that occurs in the postoperative period. This circumstance acquires particular significance in the conditions of pediatric outpatient surgery, since the postoperative period takes place at home. The previously used antiemetic drug Cerucal (metoclopromide) has weak antiemetic activity.
Postoperative nausea and vomiting varying degrees severity occurred in 40% of our patients. Since 2010 we have been able to use new drug Zofran or its analogues, as a result of which cases of nausea and vomiting in our patients became rare, which is also confirmed by literature data.

The Ambulatory Surgery Center includes the following units:

1. One-day surgical hospital (basic element)
2. Consultative and diagnostic department
3. Department of outpatient orthopedics
4. Department of treatment of benign neoplasms
5. Uroandrological module

DEAR PARENTS!

If you decide to consult, and, if necessary, operate on your child in the conditions of the One-Day Surgical Hospital of the Filatov Hospital, you need to make an initial appointment by calling a multi-line phone number 8-499-766-24-42. If, for some reason, you cannot reach the specified number, you can always call the department directly at 8-499-254-02-38 and contact one of our specialists, whom we will introduce below. It is also possible to sign up and receive an on-line consultation. [email protected].

If at the initial appointment, after establishing the correct diagnosis, we determine indications for surgical treatment for your child, you will need to receive a permit for planned surgery in the conditions of HSOD from the administration of our hospital (we will explain in detail how to do this). The voucher will indicate the date of the operation, recommendations for preparing the child for the operation and a list necessary tests which we present below.

For a successful operation, your child needs:

In the evening, on the eve of the operation, it is good to give the child a bath.
2. In the morning, on the day of surgery, until 07:00 am, children under 3 years old are allowed a light breakfast, and children over 3 years old - 100-150 ml mineral water or sweet tea.
3. On the appointed day, appear at 8:15 in the 2nd building (entrance in the center of the building), 2nd floor, department “Surgical hospital for one day”.
4. You must have with you:
a) two clean sheets (regular),
b) pajamas and slippers (for boys); robe or pajamas and slippers (for girls),
c) replacement shoes for mom (our department provides a robe),
d) a bottle of still mineral water (0.5 l).
5. On the day of the operation, at 13.00 – 13.30 you need to take the child home, always by car.

List of necessary examinations for surgical
operations in a one-day hospital setting:

1. Clinical analysis blood + hemosyndrome (platelets, clotting time and bleeding time) or coagulogram, valid for 14 days.
2. General analysis urine, valid for 14 days.
3. Electrocardiogram (ECG) with interpretation, valid for 2 months.
4. Blood test for HBS antigen and HCV antigen, valid for 2 months.
5. Blood test for HIV, valid for 2 months.
6. The pediatrician’s conclusion about the child’s health status and the absence of contacts with infectious patients, valid for 1-2 days.
7. Photocopy insurance policy.
8. Passport of one of the parents.

NOTE: All tests can be done at the district clinic at your place of residence or at Children's City Clinical Hospital No. 13 named after. N.F. Filatova on a paid basis tel.: 8-499-254-06-51, 8-499-254-87-71.

Operating days for boys: Tuesday, Wednesday, Thursday.
Operating days for girls: Thursday, Friday.

The municipal service includes examination and treatment in a day hospital.
Municipal services are provided free of charge as part of the compulsory health insurance program if you have a compulsory health insurance policy on a scheduled basis.

Emergency medical care is not provided in the day hospital.
Recipients of the service are individuals who applied to the day hospital for medical care within the framework of compulsory health insurance
The purpose of providing municipal services is to provide qualified primary health care in a day hospital setting.
The duration of the service depends on the severity of the disease (diagnosis).

To receive municipal services, the applicant must submit:

1. Identity document (to be presented):
- passport of a citizen of the Russian Federation;
- birth certificate.
2. Compulsory medical insurance policy of the Russian Federation.
3. Referral from the attending physician.

To receive a municipal service, the applicant:
- makes an appointment with the head of the department or the DS doctor for an initial examination;
- provides documents;
- is registered in the DS or receives a reasoned refusal;
- complies with the doctor’s instructions and prescriptions;
- attends prescribed procedures;
- undergoes prescribed clinical diagnostic examinations;
- complies with the DS regime in accordance with the procedure established by the chief physician of the clinic;
- upon completion of treatment, receives a statement from the attending physician with further recommendations.

Waiting time in queue:

For hospitalization in the day hospital of the State Budgetary Healthcare Institution for up to 30 days (depending on availability)
- treatment in a day hospital depending on the diagnosis and course of the disease.

Grounds for refusal of admission:
- lack of a compulsory medical policy;
- lack of an identity document;

Grounds for refusal to provide a service:

Presence of contraindications;
- lack of indications for day hospital;
- the applicant’s refusal to receive treatment;

GENERAL INDICATIONS FOR HOSPITALIZATION IN A DAY HOSPITAL

The following patients can be referred for treatment to the day hospital of the clinic:
- those who are registered at the dispensary for vegetative-vascular dystonia (VSD) and biliary dyskinesia (BDSD), and who do not require round-the-clock monitoring and use due to their health status medicinal products, after use, which should be under medical supervision for a certain time due to possible adverse reactions;
- requiring intravenous drip administration medicines;
- those in need complex treatment using physiotherapy, massage, physical therapy, after which rest is necessary, as well as when administering medications different ways at certain intervals.

GENERAL CONTRAINDICATIONS FOR HOSPITALIZATION IN A DAY HOSPITAL

Staying in a day hospital is contraindicated for patients:
- those in need of round-the-clock medical supervision And medical care, parenteral round-the-clock administration of medications; requiring bed rest;
- having severe concomitant disease, a complication of the underlying disease that developed during treatment in a day hospital;
- with frequent exacerbations at night until the condition stabilizes;
- with sharply disabilities independent movement;
- conditions that require strict adherence to a dietary regimen, and which cannot be fulfilled in a clinic setting;
- health and condition that may worsen when exposed to cold air, heat on the way to the day hospital and home.

INTERNAL RULES OF THE DAY HOSPITAL

The patient is obliged:
- take care of your own health, take timely measures to preserve, strengthen and restore it;
- treat healthcare workers and other patients with respect;
- follow recommendations medical workers necessary to implement the chosen treatment tactics, cooperate with medical professionals in the provision of medical care;
- inform medical workers about the presence of diseases that pose a danger to public health, the human immunodeficiency virus, and also take precautions when contacting other persons;
- inform medical workers about previously identified medical contraindications to the use of medicines, hereditary and previous diseases, about requests for medical help, as well as about changes in health status;
- follow the internal rules of the clinic and treat property with care.

HOSPITALIZATION PROCEDURE IN A DAY HOSPITAL

Hospitalization is carried out as planned.
The patient must have an outpatient card and a referral from a doctor for hospitalization in a day hospital, a change of clothes and shoes.
In case of refusal (from) hospitalization, the doctor of the day hospital makes a record in the register of patient admissions and refusals to hospitalize the reasons for the refusal to hospitalize and measures taken with written information from the patient.
The treatment plan (start date of treatment, duration of treatment, examination methods, time of arrival and duration of stay in a day hospital, etc.) of a patient in a day hospital is determined by a day hospital doctor for each patient individually.
The patient is discharged after 12.00.
Before discharge from the day hospital, a final examination of the patient is carried out by a doctor at the day hospital, and, if necessary, by a specialist doctor at the clinic who referred the patient to the day hospital.
On the day the patient leaves the day hospital outpatient card is transferred to the attending physician through the registry with a completed epicrisis.
The first copy of the epicrisis is pasted into the outpatient medical card patient, the second copy remains in the patient’s day hospital card.
After the patient’s departure from the day hospital, the patient’s card from the day hospital is drawn up within 3 days and stored in the archives of the day hospital.
When conflict situations the patient has the right to contact the administration of the clinic according to the schedule of reception of citizens approved by the chief physician of the clinic.

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Brain Clinic provides inpatient treatment using replacement methods; for this purpose, we have organized intensive therapy on the clinic premises and at home. A “Day Hospital” was organized.

Brain Clinic doctors with extensive experience in treatment various diseases nervous system and dependencies within medical procedures in the conditions of the “Day Hospital”, active therapy is carried out according to special, individually selected therapeutic methods, correctly and safely restoring a person’s neuropsychic activity without any side and negative influences on the body.

Call +7 495 135-44-02

We help in the most severe cases, even if previous treatment did not help. Treatment at the clinic is guaranteed on an anonymous basis.

Day hospital

The main objective of the day hospital at Brain Clinic is intensive outpatient care in an outpatient setting. This usually includes: mandatory examination by a doctor, if necessary medication assistance(drips, injections, issuing tablets to take at home), psychotherapy and physiotherapeutic procedures are carried out if necessary. We understand “day hospital” and offer a highly effective hospital-replacement program in outpatient care settings.

A full-cycle day hospital, which is regulated by the Ministry of Health, involves the patient staying on the clinic premises for 6-12 hours. We, on the basis scientific developments, were able to significantly reduce the length of stay of the patient in a day hospital, while not only not losing quality, but on the contrary, due to a specific approach to the treatment process, improving the quality indicators of the treatment provided.

In cases where conventional outpatient (that is, at home) treatment does not help and therapy is needed in a hospital setting, but the patient does not have the opportunity to be hospitalized (fear of the hospital, no opportunity to leave work, school, no one to leave the children with, etc.) .d.), then a day hospital is a good opportunity not to be left without the necessary help.

The day hospital allows patients to spend active treatment without hospitalization, while maintaining the ability to continue working or studying.

Brain Clinic has the ability to provide intensive and highly effective therapy in a “day hospital” setting (outpatient care).

Treatment provided in a day hospital

Brain Clinic has developed uniquely effective treatment methods neurological diseases, mental disorders, neuroses, depression, insomnia, headaches and other nervous system disorders, which avoid hospitalization in more than 80% of cases. This allows not only to save the patient money on treatment, but also to improve quality indicators medical events. This opportunity was created thanks to a combination of advanced techniques biological treatment(drug and physiotherapy) and active psychotherapeutic assistance. At Brain Clinic, it is possible to provide treatment in a day hospital setting for almost every disease.
Treatment in a day hospital is often used to continue therapy started in a 24-hour hospital, which can significantly reduce the length of hospitalization. After docked acute condition, the basic functions of the body have been stabilized (consciousness has been restored, a critical attitude to one’s condition has been developed, hemodynamic parameters have normalized), the patient can be transferred from a 24-hour hospital to a day hospital. This form of continuation of treatment not only contributes to the socialization of the patient, but also accelerates the recovery process. In order to begin treatment in a day hospital, you need to contact the Brain Clinic for a consultation with a doctor, the doctor will clarify the condition and determine both indications and contraindications for certain inpatient replacement treatment methods. In addition, you can get to the day hospital at the Brain Clinic by referral from any doctor.
The cost of treatment in a day hospital at Brain Clinic is 5,000 rubles per session of outpatient care using inpatient replacement methods, with average price hospital treatment 10,000 rubles per day.

Time spent in day hospital

The length of stay in a day hospital can be from one to several hours, depending on the severity of the disease and the number of necessary procedures. During this time, a doctor or several specialists are consulted to assess the state of the nervous system and physical condition, doctor’s prescriptions are made and carried out (intravenous and/or intramuscular infusions, tablet medications are given to take during the day, physiotherapy, psychotherapy, etc. are provided).

Time of visiting the day hospital

At the Brain Clinic it is possible to visit the day hospital at a time convenient for the patient and his loved ones. In most cases, it is advisable to schedule visits to the day hospital so that the visiting time is at the same time. This may have a more favorable effect on treatment results.
A distinctive feature of the Brain Clinic day hospital is that this form of treatment can be completed regardless of weekends and holidays. At the same time, the cost of a day hospital does not change.

Type of day hospital

Brain Clinic provides active treatment without round-the-clock hospitalization using inpatient replacement methods in various modes: “weekend day hospital” and “daily day hospital”. Which is agreed with the attending physician and, if necessary, in accordance with existing health problems.

Weekend day hospital

For patients who are indicated for active treatment, but who, due to work (study) or distance, are unable to visit the clinic on weekdays, Brain Clinic offers a weekend day hospital. This is outpatient care provided on weekends. For such patients, on weekends active therapy (intravenous infusions, intramuscular injections, physiotherapy), and on weekdays - supportive (for example, taking tablet forms).

Daily day hospital

In this mode, the patient comes to the clinic to receive daily intensive care. This mode is necessary for hospital replacement techniques, when daily monitoring of the patient’s condition is required and the most intensive therapy. The visit can be scheduled at any convenient time. During the day you can go about your business (study, work, etc.). However.

Features of the day hospital at the Brain Clinic

• Wide selection of day care forms
• Patient support by phone
• Free medication for 24 hours
• Constant condition monitoring

All indications and contraindications for treatment in a day hospital, weekend day hospital and daily hospital are determined by the attending physician based on the person’s condition. If you have any questions, please contact us by phone.

What is a day hospital?

Previously, there were only two types of medical care - inpatient and outpatient. Today, another form of it is widespread - day hospital. It is already well known that such medical care can be not only very effective, but also quite economical. The thing is,

That a day hospital can significantly reduce the cost of a person’s stay in the hospital. This form medical care is a person’s stay in a hospital every day, but not for all 24 hours. Naturally, it is not applicable in all cases. Many patients require 24-hour care as their condition can rapidly deteriorate. The same people whose treatment consists of not too frequent administration of certain medicines, can take such a health course.

Advantages

A day hospital has a huge number of advantages. It should be noted that it is attractive to the patients themselves. The fact is that they do not have to constantly be in a medical facility. They can easily go home in the evening and overnight, and return to the hospital only in the morning to continue their treatment. This form of medical care, as noted earlier, is very beneficial for the hospitals themselves. The fact is that organizing meals in a hospital is a rather troublesome and costly process. Also, we should not forget that every hospital is full of pathogenic microbes. They are often resistant to most known antibacterial drugs. So limiting the time of contact with pathogenic microflora is a very rational step that contributes to a significant reduction in in-hospital morbidity of patients.

How does all this happen?

First, the doctor examines the patient and determines whether treatment in a day hospital is possible. If this form of medical care is suitable, the patient is sent to the procedures that were prescribed to him by the specialist. After they are completed, the person can go home. At the same time, he is indicated the time when he must return to medical institution to continue treatment.

Varieties

Today there is enough a large number of various forms such medical care. For example, a day hospital for pregnant women has long been created and is successfully operating. As a result, expectant mothers are able to receive effective medical care and at the same time not carry out medical institutions too much time. Naturally, there are day hospitals for ordinary therapeutic patients. For example, when identifying arterial hypertension(in the absence of crises) the patient needs a detailed examination. At the same time, it is absolutely not necessary for him to constantly be in the hospital. Also for vascular atherosclerosis lower limbs it is necessary to “dig in” every six months. It is best to do this in a day hospital.