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In the context of health care reform and the transition to health insurance for citizens, the task of developing and introducing into practice new medical technologies, including diagnostic systems and complexes that make it possible to increase the efficiency of the diagnostic and treatment process and reduce economic and labor losses, becomes extremely urgent.
In this regard, the role and importance of functional research methods are increasing, which are widely used for the purpose of early detection of pathology, differential diagnosis of various diseases and monitoring the effectiveness of therapeutic measures.
In 1993, there were 10.7 thousand functional diagnostic departments in medical institutions of the republic, in which about 60 million studies are carried out annually.
The range of studies is constantly expanding, mainly due to highly informative methods of functional diagnostics. Their share in the total volume of instrumental studies in diagnostic centers alone reaches 25-30 percent.
At the same time, in many medical institutions, especially at the prehospital stage, there is a serious lag in the development of functional diagnostics services.
As of 01/01/93 in the Russian Federation, out of 19.6 thousand outpatient clinics and inpatient institutions, only about half of the institutions had departments (offices) of functional diagnostics.
In the last three years, the growth in the volume of functional research, especially in clinics serving the adult population, has practically ceased.
There has been a steady downward trend in the rate of provision of the population with these types of research from 5.6 in 1990 to 5.0 in 1992 per 100 visits.
Compared to 1991, the number of remote diagnostic rooms decreased from 354 to 286 and the number of ECG studies performed in them decreased from 887.7 to 857.1 thousand.
The capabilities of functional diagnostics are unjustifiably reduced due to insufficiently clear organization of the work of its structural units, irrational use of technical means, the slow introduction into practice of new forms of management and labor organization of medical personnel, highly effective diagnostic programs and algorithms.
The effectiveness of using the information received in medical institutions is insufficient due to the poor preparedness of specialists in functional diagnostics and attending physicians, and the lack of proper continuity in their work.
To a certain extent, difficulties in organizing a functional diagnostics service are associated with the lack of the necessary regulatory framework, recommendations for optimizing the structure, staffing and nomenclature of research in departments and functional diagnostics rooms of health care facilities of various capacities. The principles of phasing with differentiation of levels and strict unification of the methods and techniques used at each stage, as well as accounting and reporting, which allow analyzing the activities of the service to the required extent, have not been worked out.
The development of domestic diagnostic equipment necessary for the technical equipment of healthcare institutions at all levels has not received systematic development. In medical institutions, metrological support of measuring instruments is carried out at an extremely low level.
It is necessary to take effective measures to strengthen the interaction of functional diagnostics with other diagnostic services and the introduction of diagnostic algorithms.
In order to improve the organization of the functional diagnostics service and improve the quality of its work, the rapid introduction of new diagnostic methods, as well as improving personnel training and technical re-equipment of departments with modern equipment.
I affirm:
1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and the republics within the Russian Federation, regional (territorial), city departments, health departments (Appendix 1).
2. (Appendix 2).
3. Regulations on the head of the department, division, functional diagnostics room (Appendix 3).
4. Regulations on the doctor of the department, department, functional diagnostics office (Appendix 4).
5. Regulations on the head nurse of the department, department of functional diagnostics (Appendix 5).
6. Regulations on the nurse of the department, functional diagnostics room (Appendix 6).
7. The estimated workload for a doctor and nurse in the department (office) of functional diagnostics for a 6.5-hour working day is 33 conventional units.
8. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical institutions (Appendix 7).
9. Instructions for the use of estimated time standards for functional studies (Appendix 8).
10. Instructions for the development of estimated time standards when introducing new equipment or new types of research (Appendix 9).
11. Qualification requirements for a doctor-specialist in functional diagnostics (Appendix 10).
12. Qualification requirements for a functional diagnostic nurse (Appendix 11).
15. Journal of registration of studies performed in the department (office) of functional diagnostics - form No. 157/u-93 (Appendix 14).
16. Instructions for filling out a log of studies performed in the department (office) of functional diagnostics (Appendix 15).
17. Addition to the list of forms of primary medical documentation (Appendix 16).
I order:
1. To the health ministers of the republics within the Russian Federation, heads of government bodies and health care institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.1. Organize the work of departments, departments, functional diagnostic rooms in accordance with this order.
1.2. During 1993-1994. organize departments of functional diagnostics on the basis of treatment and preventive institutions and clinics of medical and research institutes, including rooms for instrumental studies of the functions of blood circulation, respiration, digestion, nervous and endocrine systems, as well as other types of functional diagnostics, taking into account the profile of institutions and local conditions; organize their work in accordance with the Regulations on the department, unit, functional diagnostics room and its personnel (Appendices 2-6).
1.3. Approve the position of the chief freelance specialist of the health authority in functional diagnostics, organize its activities in accordance with the Regulations on the chief freelance specialist in functional diagnostics (Appendix 1).
1.4. Provide regular training to medical doctors on current issues of functional diagnostics.
1.5. Together with territorial VET "Medtechnika" to ensure the organization of high-quality and timely service of diagnostic equipment and metrological support of measuring instruments.
2. The Department of Medical Assistance to the Population of the Ministry of Health of Russia (Tsaregorodtsev A.D.) together with other interested departments:
2.1. Ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.
2.2. Carry out in 1994-1995. seminars for specialists in various areas of functional diagnostics.
3. The Department of Educational Institutions (N.N. Volodin) should supplement the training programs for specialists in functional diagnostics in medical and pharmaceutical universities, as well as in medical faculties of universities, taking into account the introduction of modern equipment and new research methods into practical work.
4. Heads of healthcare institutions:
4.1. It is recommended to establish the number of personnel in departments, divisions, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).
4.2. To develop standardized and unified schemes for the diagnostic examination of patients for various diseases, taking into account the phasing and continuity of the examination carried out in medical institutions of various levels.
5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of specialists and doctors of various profiles on functional diagnostics in accordance with the approved standard programs.
6. The State Central Scientific Medical Library of the Ministry of Health of Russia (Loginov B.R.) to create reference information and methodological centers to provide specialist doctors and cadets with the necessary information about modern effective methods of functional diagnostics.
7. Directorate of Scientific Research of the Ministry of Health of Russia (Samko N.N.):
7.1. To develop and approve in the prescribed manner a promising program related to the creation of various types of devices for functional research that meet modern technical and medical requirements for equipping medical institutions at various levels.
7.2. Ensure regular distribution to health authorities with the right to replicate in the required number of orders of the Ministry of Health of the Russian Federation on permission to use new devices and equipment and on the exclusion of obsolete equipment from the range.
8. All-Russian Research and Testing Institute of Medical Equipment (Leonov B.I.):
8.1. Together with the chief metrologists of administrative-territorial health authorities, organize work on certification of measurement methods and functional diagnostics.
8.2. To provide, on a self-supporting basis, at the request of health authorities and institutions, information on the consumer characteristics of mass-produced domestic medical equipment, addresses and details of organizations and manufacturing companies.
8.3. Organize permanent and traveling exhibitions of medical equipment for functional diagnostics.
9. Heads and chief metrologists of territorial health authorities and heads of health care institutions should ensure timely maintenance of medical equipment products and verification of measuring instruments.
10. Consider the order of the USSR Ministry of Health dated August 12, 1988 No. 642 “On the estimated time standards for functional research”, the production of medical equipment and consumables coming from enterprises and organizations with various forms of ownership, to be considered invalid for institutions of the Russian Ministry of Health system.
3.8. Participate in the certification of doctors and paramedical workers involved in functional diagnostics, in the work on certification of the activities of medical personnel, licensing of medical institutions, development of medical and economic standards and price tariffs.
4.
HELL. Tsaregorodtsev
DI. Zelinskaya
Annex 1
REGULATIONS ABOUT THE DEPARTMENT, DIVISION, OFFICE OF FUNCTIONAL DIAGNOSTICS
2. The management of the department, department of functional diagnostics is carried out by the head, appointed and dismissed in the prescribed manner by the head of the healthcare institution.
Rational and efficient use of expensive medical equipment.
5. In accordance with the specified tasks, the department, division, functional diagnostics office carries out:
production of medical equipment and consumables coming from enterprises and organizations with various forms of ownership.
3.8. Participate in the certification of doctors and paramedical workers involved in functional diagnostics, in the work on certification of the activities of medical personnel, licensing of medical institutions, development of medical and economic standards and price tariffs.
3.9. Participate in the development of long-term plans to improve the qualifications of doctors and nursing staff.
3.10. Interact with the specialized association of specialists on current issues of improving the service.
4. The chief freelance specialist has the right:
4.1. Request and receive all the necessary information to study the work of medical institutions in the specialty.
4.2. Coordinate the activities of chief specialists of subordinate health authorities.
5. The chief freelance specialist, in order to improve the quality of medical care to the population in his specialty, in the prescribed manner organizes meetings of specialists from subordinate bodies and healthcare institutions with the involvement of the scientific and medical community to discuss scientific, organizational and methodological issues.
Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
DI. Zelinskaya
Appendix 2
to the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
REGULATIONS ABOUT THE DEPARTMENT, DIVISION, OFFICE OF FUNCTIONAL DIAGNOSTICS
1. The department, department, office of functional diagnostics is a structural unit of a medical institution.
2. The management of the department, department of functional diagnostics is carried out by the head, appointed and dismissed in the prescribed manner by the head of the healthcare institution.
3. The activities of the department, department, functional diagnostics room are regulated by the relevant regulatory documents and these regulations.
4. The main tasks of the department, department, functional diagnostics room are:
Carrying out research using special biophysical methods and means for the purpose of physiological assessment of the state of organs, systems and the body as a whole of healthy and sick people;
The most complete satisfaction of the population's needs in all main types of functional research provided for by specialization and the list of methods and techniques recommended for medical institutions at various levels;
Use in practice of new, modern, most informative diagnostic methods, rational expansion of the list of research methods;
Rational and efficient use of expensive medical equipment.
5. In accordance with the specified tasks, the department, division, functional diagnostics office carries out:
Mastering and introducing into the practice of their work methods of functional diagnostics that correspond to the profile and level of the medical institution, new instruments and devices, progressive research technology;
Conducting functional studies and issuing medical reports based on their results.
6. The department, division, functional diagnostics room is located in specially equipped premises that fully meet the requirements of the rules for design, operation and safety.
7. The equipment of the department, department, functional diagnostics room is carried out in accordance with the level and profile of the medical institution.
8. The staffing of medical and technical personnel is established in accordance with the recommended staffing standards, the amount of work being performed or planned, depending on local conditions, based on the estimated time standards for functional studies.
9. The workload of specialists is determined by the tasks of the department, department, functional diagnostics room, the regulations on their functional responsibilities, as well as the estimated time standards for conducting various studies.
10. In the department, department, functional diagnostics room, all necessary accounting and reporting documentation is maintained in accordance with approved forms, an archive of recorded films and other documents in compliance with the storage periods established by regulatory documents.
Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
DI. Zelinskaya
Appendix 3
REGULATIONS ON THE HEAD OF DEPARTMENT, DIVISION, OFFICE OF FUNCTIONAL DIAGNOSTICS
1. A qualified functional diagnostics doctor with at least 3 years of experience in the specialty and organizational skills is appointed to the position of head of the department.
2. The appointment and dismissal of the head of the department is carried out (hereinafter referred to as “head of the department”) by the chief physician of the medical institution in the prescribed manner.
3. The head of the department reports directly to the chief physician of the institution or his deputy for medical issues.
4. In his work, the head of the department is guided by the regulations on the medical institution, department, unit, functional diagnostics room, this regulation, job descriptions, orders and other current regulatory documents.
5. In accordance with the tasks of the department, division, functional diagnostics office, the head carries out:
Organization of the activities of the unit, management and control over the work of its personnel;
Advisory assistance to doctors of functional diagnostics;
Analysis of complex cases and diagnostic errors;
Development and implementation of new modern methods of functional diagnostics and technical means;
Measures for coordination and continuity of work between departments of a medical institution;
Promoting systematic staff training;
Control over the maintenance of medical records and archives;
Registration and submission in the prescribed manner of applications for the purchase of new equipment, consumables (paper, film, etc.)
Development of measures to ensure the accuracy and reliability of measurements and research, including timely and competent maintenance of medical equipment and regular metrological control of measuring instruments;
Systematic analysis of qualitative and quantitative performance indicators, preparation and submission of work reports in a timely manner and development on their basis of measures to improve the activities of the unit.
6. The head of the department is obliged to:
Ensure accurate and timely performance by staff of official duties and internal regulations;
Timely communicate to employees orders and directives from the administration, as well as instructions, methodological and other documents;
Monitor compliance with safety regulations and fire safety regulations;
7. The head of the department has the right:
Take direct part in the selection of personnel for the department;
Conduct staff placement in the department and distribute responsibilities between employees;
Give orders and instructions to employees in accordance with the level of their competence, qualifications and the nature of the functions assigned to them;
Participate in meetings and conferences where issues related to the work of the department are discussed;
Represent employees subordinate to him for promotion or punishment;
Make proposals to the administration of the institution on issues of improving the work of the unit, conditions and remuneration.
8. The manager’s orders are binding on all department personnel.
9. The head of a department (department, office) of functional diagnostics bears full responsibility for the level of organization and quality of work of the department.
10. The appointment and dismissal of the head of the department is carried out by the chief physician of the medical institution in the prescribed manner.
Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
DI. Zelinskaya
Appendix 4
to the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
REGULATIONS ON THE DOCTOR OF FUNCTIONAL DIAGNOSTICS OF THE DEPARTMENT, OFFICE, OFFICE OF FUNCTIONAL DIAGNOSTICS
1. A specialist with a higher medical education who has completed a training program in functional diagnostics in accordance with the qualification requirements and has received a certificate is appointed to the position of a functional diagnostics doctor.
2. The training of a functional diagnostics doctor is carried out on the basis of institutes and faculties for advanced training of doctors from among medical specialists and pediatricians.
3. In his work, the doctor of functional diagnostics is guided by the regulations on the medical institution, department, unit, functional diagnostics office, this regulation, job descriptions, orders and other current regulatory documents.
4. The functional diagnostics doctor is directly subordinate to the head of the unit, and in his absence, to the head of the medical institution.
5. The orders of the functional diagnostics doctor are mandatory for middle and junior medical personnel of the functional diagnostics unit.
6. In accordance with the tasks of the department, division, functional diagnostics office, the doctor carries out:
Carrying out research and issuing conclusions based on their results;
Participation in the analysis of complex cases and errors in diagnosis, identification and analysis of the reasons for the discrepancy between conclusions on functional diagnostic methods and the results of other diagnostic methods;
Development and implementation of diagnostic methods and equipment;
High-quality maintenance of medical records and records, archives, analysis of qualitative and quantitative performance indicators;
Monitoring the work of nursing and junior medical personnel within their competence;
Monitoring the safety and rational use of equipment and equipment, their technically competent operation;
Participation in advanced training of nursing and junior medical personnel.
7. The functional diagnostics doctor is obliged to:
Ensure accurate and timely fulfillment of their official duties and internal labor regulations;
Monitor compliance by nursing and junior medical staff with safety and labor protection rules, sanitary, economic, technical and fire safety conditions of the unit;
Submit work reports to the head of the functional diagnostics department, and in his absence, to the chief physician;
Improve your qualifications in the prescribed manner.
8. A functional diagnostics doctor has the right:
Make proposals to the administration on issues of improving the activities of the unit, organization and working conditions;
Participate in meetings and conferences that discuss issues related to the work of the functional diagnostics department.
9. The appointment and dismissal of a functional diagnostics doctor is carried out by the chief physician of the institution in the prescribed manner.
Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
DI. Zelinskaya
Appendix 5
to the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
REGULATIONS ON THE SENIOR NURSE OF THE DEPARTMENT, FUNCTIONAL DIAGNOSTICS DEPARTMENT
1. A qualified nurse who has undergone special training in functional diagnostics and has organizational skills is appointed to the position of senior nurse of the department, department of functional diagnostics.
2. In her work, the senior nurse of a department or department is guided by the regulations on the medical institution, department, department of functional diagnostics, these regulations, job descriptions, orders and instructions of the head of the department or department.
3. The senior nurse is directly subordinate to the head of the department, department of functional diagnostics.
4. The senior nurse is subordinate to the middle and junior medical staff of the department or department.
5. The main tasks of the head nurse of the department, department of functional diagnostics are:
Rational placement and organization of work of nursing and junior medical personnel;
Monitoring the work of paramedical and junior medical personnel of the department, department, compliance with labor protection and safety rules, internal labor regulations, sanitary and anti-epidemic regime, condition and safety of equipment and equipment;
Timely execution of requests for medicines, consumables, equipment repairs, etc.;
Maintaining the necessary accounting and reporting documentation of the department, department;
Implementation of activities to improve the qualifications of nursing staff of the department, department;
Conducting briefings for nursing and junior medical personnel of the department and department on compliance with occupational health and safety requirements.
6. The senior nurse of the department, department of functional diagnostics is obliged to:
Improve your qualifications in the prescribed manner;
Inform the head of the department, department about the state of affairs in the department, department and the work of nursing and junior medical personnel.
7. The senior nurse of the department, department of functional diagnostics has the right:
Give orders and instructions to middle and junior medical personnel of the department, department within the limits of their job duties and monitor their implementation;
Make proposals to the head of the department or department to improve the organization and working conditions of mid-level and junior medical personnel of the department or department;
Take part in meetings held in the department or department when considering issues within its competence.
8. The orders of the head nurse are mandatory for execution by the middle and junior medical staff of the department or department.
9. The senior nurse of the department, department of functional diagnostics is responsible for the timely and high-quality implementation of the tasks and responsibilities provided for by these regulations.
10. The appointment and dismissal of a senior nurse of a department or department is carried out by the chief physician of the institution in the prescribed manner.
Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
DI. Zelinskaya
Application
6 to the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
REGULATIONS ON THE NURSE OF THE DEPARTMENT, UNIT, OFFICE OF FUNCTIONAL DIAGNOSTICS
1. A medical worker who has a secondary medical education and has undergone special training in functional diagnostics is appointed to the position of nurse.
2. In her work, the nurse is guided by the regulations on the department, department, functional diagnostics room, these regulations and job descriptions.
3. The nurse works under the direct supervision of the functional diagnostics doctor and the head nurse of the department.
4. The nurse carries out (hereinafter referred to as “nurse”):
Calling patients for examination, preparing them and participating in the study within the framework of performing the assigned technological operations (see Appendix No. 9 of the order of the Ministry of Health of the Russian Federation dated ___________ No. ___)
Registration of patients and studies in accounting documentation in the prescribed form;
Regulating the flow of visitors, the order of research and pre-registration for research;
General preparatory work to ensure the functioning of diagnostic and auxiliary equipment, ongoing monitoring of its operation, timely registration of faults, creation of the necessary working conditions in diagnostic rooms and at your workplace;
Control over the safety, consumption of necessary materials (medicines, dressings, registration paper, instruments, etc.) and their timely replenishment;
Daily activities to maintain the proper sanitary condition of the premises of the department, department, office and your workplace, as well as to comply with hygiene requirements and the sanitary and anti-epidemic regime;
High-quality maintenance of medical records and research archives.
5. The nurse is obliged to:
Improve your qualifications;
Comply with safety regulations and internal labor regulations.
6. The nurse has the right:
Make proposals to the head nurse or doctor of the department or office on how to improve the organization of the department’s work and their working conditions;
Take part in meetings held in the department on issues within its competence.
7. The nurse is responsible for the timely and high-quality performance of his tasks and responsibilities provided for by these regulations and internal labor regulations.
8. The appointment and dismissal of a nurse is made by the chief physician of the institution in the prescribed manner.
Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
In case No. 2-
Accepted Khorolsky District Court (Primorsky Territory)
Estimated time standards for functional studies are determined taking into account the necessary relationship between the optimal labor productivity of medical staff and the high quality and completeness of functional diagnostic studies.
This instruction is intended for heads of departments and doctors of departments of functional diagnostics to use it for the purpose of rational application of calculated time standards approved by Order of the Ministry of Health of the Russian Federation dated November 30, 1993 No. 283 (Appendix 7).
The main purpose of the calculated time standards for functional studies is to use them when:
Resolving issues of improving the organization of activities of functional diagnostics rooms (departments);
Planning and organizing the work of medical personnel of these units;
Analysis of labor costs of medical staff;
Formation of staffing standards for medical staff of relevant medical institutions.
1. Use of estimated time standards for functional studies for planning and organizing the work of medical personnel in functional diagnostics offices (departments).
The share of medical staff's work on direct functional research (main and auxiliary activities, work with documentation) for doctors and nurses is 84.0% of working time. This time is included in the estimated time standards. Time for other necessary work and personal necessary time is not taken into account in the standards.
For doctors, this is a joint planned discussion with their attending physicians of clinical and instrumental data, participation in medical conferences, reviews, and rounds; supervising the work of nurses, mastering techniques, equipment, monitoring their work, working with archives and documentation, administrative and economic work.
For nurses, preparatory work at the beginning of the working day (preparing the workplace, group calling patients from departments, etc.), issuing reports, putting the workplace in order at the end of the shift, obtaining the necessary materials (medicines, special paper, tools) , equipment care.
When determining the estimated workload standards for doctors and nursing staff, it is recommended to be guided by the methodology for rationing the work of medical personnel (M., 1987, approved by the USSR Ministry of Health). In this case, the ratio of the above-mentioned working time costs is taken as a basis.
To take into account the work of staff in functional diagnostics rooms (departments), the possibility of comparing their workload, etc., the calculated time standards and the determined workload standards for doctors and nursing staff are reduced to a common unit of measurement - conventional units. 1 conventional unit is 10 minutes of working time. Thus, the shift load rate is 33 conventional units.
In accordance with the clarifications of the Ministry of Labor of the Russian Federation dated December 29, 1992 No. 5, approved by Decree No. 65 dated December 29, 1992, the transfer of days off coinciding with holidays is carried out at enterprises, institutions and organizations that apply different work and rest regimes, with which work is not carried out on holidays.
The standard working time for certain periods of time is calculated according to the estimated schedule of a five-day work week with two days off, Saturday and Sunday, based on the following "duration of daily work (shift):
With a 40-hour work week - 8 hours, on holidays - 7 hours;
If the duration of the working week is less than 40 hours - the number of hours obtained by dividing the established duration of the working week by five days, on the eve of holidays, in this case, no reduction in working hours is made (Article 47 of the Labor Code of the Russian Federation). For example, in 1993, with a five-day work week with two days off, taking into account additional days of rest on January 4, May 3, 4 and 10, June 14 and November 8 due to the coincidence of holidays on January 2, May 1, 2 and 9, 12 June and November 7 with Saturdays and Sundays off - 252 working days and 113 days off, incl. 4 pre-holiday days (January 6, April 30, June 11 and December 31).
Based on this, the annual workload of the doctor and nurse in the office (department) of functional diagnostics will be 8316 conventional units in 1993. units or on average - 8300 conventional units. units (252 days x 33 conventional units = 8316 conventional units).
When planning the activities of a functional diagnostics unit, it is important to distribute the workload between medical and paramedical personnel, taking into account the different time costs for performing the same types of studies. For example, it is incorrect to combine within a single team or one schedule a doctor analyzing electrocardiograms and a nurse recording an ECG on a multi-channel device in the office (department), because it takes a doctor more time to decipher 1 ECG than it takes a nurse to record an ECG and prepare data for its analysis. Depending on local conditions, the need for various types of electrocardiographic studies, the number of doctors and nurses, it is necessary to select a variant of their work schedule in which the sum of the products (according to the relevant research methods and techniques) of the number of planned studies per work shift by the estimated time standard established for this study, would be approximately the same. Failure to comply with this condition will result in the fact that part of the research performed by the nurse will not be completed that day by the doctor's analysis.
You can, for example, entrust a nurse with recording part of the ECG at home (in an outpatient setting) or in the ward (in an inpatient setting), to equalize the shift costs of working time for a doctor and a nurse.
The same approach should be used when scheduling physicians and nurses when scheduling other studies, including those that do not require same-day conclusions. These conditions must also be observed when developing weekly and monthly schedules.
Thus, the work schedules of employees and the schedule for performing various types of research must take into account the benchmark indicators of the unit’s activities, the needs of the medical institution in the structure and number of functional research methods, the different throughput during the work of medical and nursing staff, depending on the type of diagnostic techniques.
^ 2. Use of estimated time standards for functional studies to account for and analyze the activities of the functional diagnostics office (department).
The actual or planned annual volume of activity for conducting functional research, expressed in conventional units, is determined by the formula:
T = t 1 x n 1 +t 2 x n 2 + t i x n i, (1)
where T is the actual or planned annual volume of activity for conducting functional research, expressed in conventional units;
T 1 , t 2 , t i - time in conventional units in accordance with the approved estimated time standards for research (main and additional);
N 1, n 2, n i - the actual or planned number of studies during the year using individual diagnostic methods.
A comparison of the actual annual volume of activity with the planned one allows for an integral assessment of the unit’s activities, to get an idea of the labor productivity of its personnel and the efficiency of the unit as a whole.
Carrying out research on a larger scale throughout the year can be achieved by intensifying the work of medical staff, or by increasing the amount of time used for core activities by significantly reducing the share of other necessary types of labor. If this is not the result of the use of automation tools for research and calculation of physiological parameters, methods for more rational organization of the work of doctors and nurses, then such intensification of work inevitably leads to a decrease in the quality, information content and reliability of conclusions. Failure to fulfill the plan for the volume of activity may be the result of improper planning, a consequence of defects in the organization of work and in the management of the department. Therefore, both failure to fulfill the plan and its excessive overfulfillment should be equally carefully analyzed by both the head of the office (department) and the management of the medical institution in order to identify their causes and take appropriate measures. Deviations of the actual volume of activity from the annual planned volume within +20% ... -10% can be considered acceptable.
Along with the general indicators of the work performed, the structure of the studies conducted and the number of studies on individual diagnostic methods are traditionally analyzed to assess the balance and adequacy of the structure, the sufficiency of the number of studies, and the actual need for them.
The average time spent on one study is determined by:
C = Ф/n, cu, (2)
where C is the average time spent on one study;
F - total actual time spent (on basic and additional diagnostic procedures) in total for all studies performed using a certain diagnostic technique (in arbitrary units);
N is the number of studies performed using the same diagnostic technique.
The correspondence of the average time spent on research to the calculated time standards (in%) for a certain method is determined by the formula:
K = (C/t)x100. (3)
It is acceptable, along with the above, to use other traditional and non-traditional methods of analysis with the calculation and use of other indicators.
Heads of institutions and chief specialists also need to monitor the rational use of medical personnel and, when determining staffing levels, be guided by the results of an annual or multi-year analysis of the actual or planned volume of activity of the department.
^ Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
DI. Zelinskaya
Appendix 9
To the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
^ INSTRUCTIONS FOR DEVELOPING ESTIMATED TIME STANDARDS WHEN IMPLEMENTING NEW EQUIPMENT OR NEW TYPES OF RESEARCH
When introducing new diagnostic methods and technical means for their implementation, which are based on different research methodology and technology, new content of medical personnel’s work, the absence of estimated time standards approved by the Ministry of Health of Russia, they can be developed on the spot and agreed upon with the trade union committee in those institutions where they are being introduced new techniques.
The development of new calculation standards includes taking time measurements of the actual time spent on individual elements of labor, processing this data (according to the methodology outlined below), and calculating the time spent on the study as a whole.
Before timing, a list of technological operations (main and additional) for each method is compiled. For these purposes, it is recommended to use the methodology applied in compiling a universal list of labor elements for technological operations. In this case, it is possible to use the “List..” itself, adapting each technological operation to the technology of a specific new diagnostic method.
^ A universal list of labor elements for technological operations, recommended when developing estimated time standards.
№№ | Name of technological operations and labor elements | Who performs |
|
Functional diagnostics doctor | Nurse |
||
1 | 2 | 3 | 4 |
1 | Calling the subject into the office | - | + |
2 | Registration of the subject | - | + |
3 | Studying the medical history (outpatient card) | + | , |
4 | Undressing the subject | - | + |
5 | Measuring and recording anthropometric data | + |
|
6 | Measuring and recording meteorological data | . | + |
7 | Blood pressure measurement and recording | - | + |
8 | Additional, clarifying survey of the subject | + | |
9 | Examination and auscultation | + | - |
10 | Preparation of the subject | - | + |
11 | Turning on, calibrating and setting up the device(s) | + |
|
12 | Application of electrodes | - | + |
13 | Measuring and recording the dimensions of individual areas of the body and the distances between electrodes (sensors) | + |
|
14 | Overlay, installation of sensors | - | + |
15 | Final adjustment and configuration of devices | + |
|
16 | Recording information curve | - | + |
17 | Application (installation) of electrodes or sensors at non-standard points | + |
|
18 | Recording information curves from non-standard points and leads | + | |
19 | Evaluating curves (data) and deciding whether to expand the scope of the study | + | |
20 | Performing a functional test | + | + |
21 | Recording the information curve at the peak of the functional test | + | + |
22 | Recording an information curve upon returning the studied parameters to their original state | + | + |
23 | Elimination of the causes of forced research stops (forced technological break) | + | + |
24 | Removing the Electrodes | - | + |
25 | Turning off the device(s) | - | + |
26 | Dressing the subject | - | + |
27 | Special film processing | - | + |
28 | Preparing film (curves) for analysis | - | + |
29 | | ^ | + |
30 | Curve analysis and medical opinion | + | |
31 | Communication with your doctor | + | - |
32 | Consulting complex cases with a consultant | + | |
33 | Referring to specialized literature and reference books | + |
Note: If a labor operation is to be performed by a doctor and a nurse, then it is carried out simultaneously.
Timing is carried out using sheets of timing measurements, which consistently set out the names of technological operations and the time of their implementation.
Processing the results of timing measurements includes calculating the average time spent, determining the actual and expert repeatability coefficient for each technological operation and the estimated time to complete the study under study.
The average time spent on an individual technological operation is determined as the arithmetic average of all measurements.
The actual repeatability factor of technological operations in each study is calculated using the formula:
K = n/N, (4)
where K is the actual repeatability coefficient of the technological operation;
N is the number of timed studies using a specific research method in which a given technological operation took place;
N is the total number of the same timed studies.
The expert coefficient of repeatability of a technological operation is determined by the most qualified functional diagnostics doctor who knows this technique, based on the existing experience in using the method and professional understanding of the proper repeatability of the technological operation.
The estimated time for each technological operation is determined by multiplying the average actual time spent on a given timing operation by the export coefficient of its repeatability.
The estimated time to complete the study as a whole is determined separately for the doctor and the nurse as the sum of the estimated time to complete all technological operations using this method. It, after approval by the order of the head of the medical institution, is the estimated time limit for performing this type of research in this institution.
To ensure the reliability of local time standards and their correspondence to the true time spent, not dependent on random causes, the number of studies subjected to time measurements should be as large as possible, but not less than 20-25.
It is possible to develop local time standards only when the staff of the office (department) have mastered the methods sufficiently well, when they have developed a certain automatism and professional stereotypes in performing diagnostic and analytical manipulations. Before this, research is carried out in the order of mastering new methods, within the time spent on other types of activities.
^ An example of determining the estimated time limit for conducting an initial ECG for a nurse (when recording on a manual 5-channel electrocardiograph).
№№ | Name of technological operation | Average time spent (in sec.) | Process repeatability factor | Estimated time for carrying out a technological operation |
||
Fact. | Expert | Fact. | Taking into account the data of F. 5 |
|||
1 | 2 | 3 | 4 | 5 | 6 | 7 |
1 | Calling the subject into the office | 55,0 | 1,0 | 1,0 | 55,0 | 55,0 |
2 | Registration of the subject | 123,7 | 1,0 | 1,0 | 123,7 | 123,7 |
3 | Preparation of the subject | 93,0 | 0,29 | 0,02 | 27,0 | 1,9 |
4 | Turning on, setting up, adjusting and calibrating the device | 141,0 | 1,0 | 0,1 | 141,0 | 14,1 |
5 | Application of electrodes | 88,8 | 1,0 | 1,0 | 88,8 | 88,8 |
6 | Recording an electrocardiogram | 124,2 | 1,0 | 1,0 | 124,2 | 124,2 |
7 | Removing the electrodes, turning off the device and cleaning the workplace | 64,2 | 1,0 | 1,0 | 64,2 | 64,2 |
8 | Preparing curves for medical analysis | 105,2 | 1,0 | 1,0 | 105,2 | 105,2 |
9 | Search the archive of previous research data | 149,0 | 0,48 | 0,6 | 71,7 | 89,6 |
10 | Rewriting a medical report in form No. 157/u-93 | 132,6 | 1,0 | 1,0 | 132,6 | 132,6 |
11 | Rewriting a medical report into a medical history (outpatient card) | 156,3 | 1,0 | 1,0 | 156,3 | 0,0 |
Total: sec. | 1089,7 | 799,3 |
||||
min. | 18,2 | 13,3 |
||||
conventional units | 1,8 | 1,3 |
Appendix 10
To the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
^ QUALIFICATION REQUIREMENTS FOR A SPECIALIST IN FUNCTIONAL DIAGNOSTICS
In accordance with the requirements of the specialty, a functional diagnostics doctor must know and be able to:
1. General knowledge:
Fundamentals of healthcare legislation and policy documents defining the activities of healthcare bodies and institutions;
General issues of organizing therapeutic, cardiological, pulmonological, neurological services in the Russian Federation, organizing a functional diagnostic service in medical institutions;
Classification and metrological characteristics of equipment for functional studies, nomenclature of the main instruments used in functional diagnostics, the use of electronic computer technology in functional diagnostic studies;
Clinical physiology of blood circulation and respiration and, depending on the profile of the institution, other sections of clinical physiology;
Etiology, pathogenesis and clinic of major diseases in the relevant field of functional diagnostic research (cardiology, angiology, pulmonology, neurology and other areas depending on the profile of the institution).
2. General skills:
Identify general and specific signs of the disease;
Determine what functional methods of examining the patient are necessary to clarify the diagnosis;
Determine indications for additional consultations with specialists or for hospitalization, as well as indications and contraindications for the choice of treatment method and tactics;
Prepare medical documentation approved in accordance with the established procedure.
3. Special knowledge and skills:
A functional diagnostics doctor must know the principles of the equipment on which he works, the rules of its operation, the method of recording curves and functional diagnostic parameters using this equipment, and write a conclusion on them;
Depending on the qualification category, a functional diagnostics doctor must be proficient in all of the specified research methods for one of the following systems:
^ Second qualification category
of cardio-vascular system:
Electrocardiography (ECG), including examination in additional leads and functional tests;
Phonocardiography (PCG);
Rheovasography (RVG);
Determination of central hemodynamic parameters.
respiratory systems:
Electronic pneumotachometry with registration of the flow-volume loop;
Spirography in a closed system (for the study of residual lung volume and lateral position test).
nervous system:
- Echoencephalography;
Rheoencephalography;
Routine electroencephalography with functional tests;
Determination of SRV by motor and sensory fibers of peripheral vessels.
^ First qualification category
of cardio-vascular system:
- Electrocardiography (ECG), including studies in additional leads and functional tests;
Phonocardiography (PCG);
Rheovasography (RVG);
Determination of central hemodynamic parameters;
Sphygmography (SFG);
Bicycle ergometry (VEM);
Holter monitoring.
respiratory systems:
- Electronic pneumotachometry with registration of the flow-volume loop;
Spirography in a closed system (to conduct a study of residual lung volume and a lateral position test);
Study of the structure of the total lung capacity;
Indirect photooximetry;
Lung rheography;
Study of exhaled air gases (O 2 CO 2 N 2,).
nervous system:
- Echoencephalography;
Rheoencephalography;
Routine electrocephalography with functional tests;
Neuromuscular transmission testing;
Determination of SRV by motor and sensory fibers of peripheral vessels;
Standard needle electromyography;
Thermal imaging;
Doppler vasography of the brain.
In the context of health care reform and the transition to health insurance for citizens, the development and implementation of new medical technologies, including diagnostic systems and complexes that make it possible to increase the efficiency of the treatment and diagnostic process and reduce economic and labor losses, becomes extremely urgent.
In this regard, the role and importance of functional research methods are increasing, which are widely used for the purpose of early detection of pathology, differential diagnosis of various diseases and monitoring the effectiveness of therapeutic measures.
In 1993, in medical and preventive institutions of the republic there were 10.7 thousand departments of functional diagnostics, in which about 60 million studies are carried out annually.
The development of domestic diagnostic equipment necessary for the technical equipment of healthcare institutions at all levels has not received systematic development. In medical and preventive institutions, metrological support of measuring instruments is carried out at an extremely low level.
It is necessary to take effective measures to strengthen the interaction of functional diagnostics with other diagnostic services and the introduction of diagnostic algorithms.
In order to improve the organization of the functional diagnostics service and improve the quality of its work, the rapid introduction of new diagnostic methods, as well as improving personnel training and technical re-equipment of departments with modern equipment
I affirm:
1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and the republics within the Russian Federation, regional (territorial), city departments, health departments (Appendix 1).
2. Regulations on the department, unit, functional diagnostics room (Appendix 2).
3. Regulations on the head of the department, division, functional diagnostics room (Appendix 3).
4. Regulations on the doctor of the department, department, functional diagnostics office (Appendix 4).
5. Regulations on the head nurse of the department, department of functional diagnostics (Appendix 5).
6. Regulations on the nurse of the department, functional diagnostics room (Appendix 6).
7. The estimated workload for a doctor and nurse in the department (office) of functional diagnostics for a 6.5-hour working day is 33 conventional units.
8. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical and preventive institutions (Appendix 7).
9. Instructions for the use of estimated time standards for functional studies (Appendix 8).
10. Instructions for the development of estimated time standards when introducing new equipment or new types of research (Appendix 9).
11. Qualification requirements for a doctor - specialist in functional diagnostics (Appendix 10).
12. Qualification requirements for a functional diagnostic nurse (Appendix 11).
15. Journal of registration of studies performed in the department (office) of functional diagnostics - form N 157/u-93 (Appendix 14).
16. Instructions for filling out a log of studies performed in the department (office) of functional diagnostics (Appendix 15).
17. Addition to the list of forms of primary medical documentation (Appendix 16).
I order:
1. To the ministers of health of the republics within the Russian Federation, heads of government bodies and health care institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.1. Organize the work of departments, departments, functional diagnostic rooms in accordance with this order.
1.2. During 1993-1994. organize departments of functional diagnostics on the basis of treatment and preventive institutions and clinics of medical and research institutes, including rooms for instrumental studies of the function of blood circulation, respiration, digestion, nervous and endocrine systems, as well as other types of functional diagnostics, taking into account the profile of institutions and local conditions; organize their work in accordance with the Regulations on the department, unit, functional diagnostics room and its personnel (Appendices 2 - 6).
1.3. Approve the position of the chief freelance specialist of the health authority in functional diagnostics, organize its activities in accordance with the Regulations on the chief freelance specialist in functional diagnostics (Appendix 1).
1.4. Provide regular training to medical doctors on current issues of functional diagnostics.
1.5. Together with territorial VET "Medtechnika" to ensure the organization of high-quality and timely service of diagnostic equipment and metrological support of measuring instruments.
2. The Department of Medical Assistance to the Population of the Ministry of Health of Russia (Tsaregorodtsev A.D.) together with other interested departments:
2.1. Ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.
2.2. Carry out in 1994-1995. seminars for specialists in various areas of functional diagnostics.
3. The Department of Educational Institutions (N.N. Volodin) should supplement the training programs for specialists in functional diagnostics in medical and pharmaceutical universities, as well as in medical faculties of universities, taking into account the introduction of modern equipment and new research methods into practical work.
4. Heads of healthcare institutions:
4.1. It is recommended to establish the number of personnel in departments, divisions, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).
4.2. To develop standardized and unified schemes for the diagnostic examination of patients for various diseases, taking into account the phasing and continuity in the examination carried out in medical and preventive institutions of various levels.
5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of specialists and doctors of various profiles on functional diagnostics in accordance with the approved standard programs.
6. The State Central Scientific Medical Library of the Ministry of Health of Russia (Loginov B.R.) to create reference information and methodological centers to provide specialist doctors and cadets with the necessary information about modern effective methods of functional diagnostics.
7. Directorate of Scientific Research of the Ministry of Health of Russia (Samko N.N.):
7.1. To develop and approve in the prescribed manner a long-term program related to the creation of various types of devices for functional research that meet modern technical and medical requirements for equipping medical and preventive institutions at various levels.
7.2. Ensure regular distribution to health authorities with the right to replicate in the required number of orders of the Ministry of Health of the Russian Federation on permission to use new devices and equipment and on the exclusion of obsolete equipment from the range.
8. All-Russian Scientific Research and Testing Institute of Medical Technology (Leonov B.I.).
To case No. 2-983/14
SOLUTION
In the name of the Russian Federation
Seversky District Court of the Krasnodar Territory composed of:
Presiding Judge – Judge V.G. Maslaka,
Under secretary Chikova I.A.,
With the participation of: plaintiff Yu.I. Vasiliev, representative of the defendant E.V. Orlova,
Having considered in open court a civil case on the claim of Vasiliev Yuri Ivanovich against the Municipal Budgetary Institution of the Moscow Region Severskaya Central District Hospital about the obligation to restore the length of the working day, about changing the terms of payment, about collecting underpaid amounts of wages, about payment for damage caused to health, and about compensation for moral damage,
U S T A N O V I L:
Plaintiff Vasiliev Yu.I. appealed to the court with a statement to the Municipal Budgetary Institution of the Moscow Region "Severskaya Central District Hospital" about the obligation to restore the length of the working day, to change the terms of payment, to collect unpaid amounts of wages, to pay for damage caused to health, and to compensate for moral damage.
In support of the stated claims, the plaintiff stated the following in his application:
He has been working at the Seversk Central District Hospital since 1984, and since 2002 he has been working as a doctor in the functional diagnostics room.
In 2003, the administration of the Seversk Central District Hospital increased the duration of his work shift by 1 position, by 1 hour 12 minutes.
In December 2013, he received a letter from the Ministry of Labor of the Russian Federation dated December 12, 2013 and the full text of the order of the Ministry of Health No. 283 dated November 30, 1993, which states that the working day of a doctor in a functional diagnostics office (department) with a five-day work week is 6 hours 30 minutes. Of these, 84% (5 hours 30 minutes) of working time is spent on functional studies (ECG interpretation). All other types of work are allocated 16% (60 minutes) of working time. The total work shift is 6 hours 30 minutes.
For 11 years, the plaintiff worked 1 hour and 12 minutes every day and received underpayment for ECGs interpreted by 1 rate above the norm.
In 2013, the salary for 1 rate, work shift is exactly 6085 rubles, 21 days = 289 rubles 76 kopecks. Cost of 1 ECG: 289.76:19.4 = 14.93 rubles. It turns out that for each deciphered ECG he should receive 14 rubles 93 kopecks, and not 10 rubles 91 kopecks, as the chief doctor of the Central District Hospital claims. Since 2003, he has received less than 480,000 rubles in salary.
Every year, the plaintiff was at the workplace for more than 266 hours beyond working hours by illegal order of the administration of the Seversk Central District Hospital, and since he overworked on the initiative of the defendant, he must be paid for these hours at double the rate, that is, 532 hours. Over 11 years of operation, the processing amounted to 5852 hours. The cost of 1 hour of work is more than 44 rubles, therefore, he should receive compensation in the amount of 257,488 rubles.
These overwork resulted in him losing sight in one eye and suffering from retinal detachment. He estimates the damage caused to his health by the illegal increase in working hours at 2,000,000 rubles.
In connection with the above, the plaintiff asks the court to restore the length of the working day in accordance with Order of the Ministry of Health No. 283 of November 30, 1993, with a five-day working week of up to 6 hours 30 minutes, of which 5 hours 30 minutes for decoding the ECG, 60 minutes for other work; pay for labor in accordance with Order No. 283, based on the shift load of 19.4 ECGs per shift; pay the money underpaid to him for deciphering the ECG in excess of the rate for 11 years - 480,000 rubles; pay for 5852 hours of overtime in the amount of 257,488 rubles; pay him for the damage caused to his health in the amount of 2,000,000 rubles; pay him moral damages in the amount of 2,000,000 rubles, and a total of 4,737,488 rubles (case sheet 1-6).
At the court hearing, the plaintiff insists on the claims set out in the statement of claim and asks them to be satisfied in full.
Representative of the defendant Orlova E.V. At the court hearing, she did not recognize the plaintiff’s claims; she presented to the court an objection to Yu.V. Vasiliev’s statement of claim. The defendant's representative considers the plaintiff's demands to be unfounded, far-fetched and cannot be satisfied for the following reasons:
Vasiliev Yuri Ivanovich,<...>year of birth, has been working at the Severskaya Central District Hospital since 10/08/1984, as a functional diagnostics doctor since 06/28/2000 at one rate under the terms of employment contract No. 470 dated 10/02/2006.
DECIDED:
In the claim of Vasilyev Yuri Ivanovich against the Municipal Budgetary Institution of Healthcare of the Moscow Region "Severskaya Central District Hospital" about the obligation to restore the working hours, about changing the terms of remuneration, about collecting underpaid amounts of wages in the amount of 737,488 rubles, about payment of damage caused to health in the amount of 2,000,000 rubles and to refuse compensation for moral damage in the amount of 2,000,000 rubles.
The decision can be appealed to the Krasnodar Regional Court through the Seversky District Court within a month from the date the court decision was made in final form.
Judge Maslak V.G.