How many hours does an uzist work on? New rules for conducting ultrasound diagnostic studies. Equipment standard for a functional diagnostics room

Privacy Policy

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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.

Court:

Judges of the case:

"On approval of the Rules for conducting functional research"

Revision dated December 26, 2016 — Valid from July 1, 2017

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER
dated December 26, 2016 N 997н

ON APPROVAL OF THE RULES FOR CONDUCTING FUNCTIONAL STUDIES

1. Approve the Rules for conducting functional studies in accordance with the appendix.

Minister
IN AND. SKVORTSOVA

2. Functional studies are carried out for the purpose of: diagnostics;

timely detection of socially significant and most common diseases of internal organs;

identifying hidden forms of diseases.

3. Functional studies are carried out if there are medical indications when providing:

primary health care;

specialized, including high-tech, medical care;

emergency, including specialized emergency medical care;

palliative care;

medical assistance during sanatorium-resort treatment.

4. Functional studies are carried out when providing medical care under the following conditions:

outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);

in a day hospital (in conditions that provide medical supervision and treatment during the day, but do not require round-the-clock medical supervision and treatment);

inpatient (in conditions that provide round-the-clock medical supervision and treatment).

5. Functional studies are carried out during the provision of medical care in emergency, urgent and planned forms.

6. Functional studies in the provision of emergency, including specialized emergency medical care are carried out in accordance with the Procedure for the provision of emergency, including specialized emergency medical care<1>.

<1>dated June 20, 2013 N 388n “On approval of the Procedure for the provision of emergency, including emergency specialized medical care” (registered by the Ministry of Justice of the Russian Federation on August 16, 2013, registration N 29422) as amended by orders of the Ministry of Health of the Russian Federation dated January 22, 2016 N 33n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016, registration N 41353) and dated May 5, 2016 N 283n (registered by the Ministry of Justice of the Russian Federation on May 26, 2016, registration N 42283).

7. The organization of the activities of medical organizations conducting functional research as part of the provision of primary pre-medical health care is carried out in accordance with Appendices N - to the Regulations on the organization of primary health care for the adult population<1>.

<1>Order of the Ministry of Health and Social Development of the Russian Federation dated May 15, 2012 N 543n “On approval of the Regulations on the organization of provision of primary health care to the adult population” (registered by the Ministry of Justice of the Russian Federation on June 27, 2012, registration N 24726) as amended, introduced by orders of the Ministry of Health of the Russian Federation dated June 23, 2015 N 361n (registered by the Ministry of Justice of the Russian Federation on July 7, 2015, registration N 37921) and dated September 30, 2015 N 683n (registered by the Ministry of Justice of the Russian Federation on November 24, 2015 , registration N 39822).

The organization of the activities of medical organizations conducting functional research within the framework of primary specialized health care, specialized medical care, palliative care and medical care in sanatorium and resort treatment is carried out in accordance with Appendices No. 1 - 15 to these Rules.

8. Functional studies are carried out at the direction of the attending physician or paramedic, midwife if they are assigned certain functions of the attending physician<1>taking into account the patient’s right to choose a medical organization<2>.

<1>Order of the Ministry of Health and Social Development of the Russian Federation dated March 23, 2012 N 252n “On approval of the Procedure for assigning to a paramedic, midwife by the head of a medical organization when organizing the provision of primary health care and emergency medical care certain functions of the attending physician for the direct provision of medical care to the patient during the period of observation and treatment of him, including on the prescription and use of medications, including narcotic drugs and psychotropic drugs" (registered by the Ministry of Justice of the Russian Federation on April 28, 2012, registration No. 23971).

9. Functional studies carried out as part of the provision of primary pre-medical health care are carried out by a paramedic or nurse.

The analysis of the results of these functional studies is carried out by a paramedic.

If the results of functional studies carried out as part of the provision of primary pre-medical health care are insufficient to achieve the goals specified in paragraph 2 of these Rules, the paramedic or midwife refers patients to medical organizations to provide primary specialized health care or specialized medical care in cases provided for by the procedures for providing medical care according to profiles<1>.

In the absence of a functional diagnostics doctor, the analysis of the results of functional studies is carried out by the attending physician, about which a corresponding entry is made in the patient’s medical documentation.

11. To conduct functional studies as part of the provision of primary specialized health care, specialized medical care, palliative care and medical care in sanatorium-resort treatment:

when providing medical care in a day hospital, inpatient conditions, the attending physician (paramedic, midwife) makes an entry in the list of prescriptions and their implementation contained in the medical record of the inpatient (hereinafter referred to as the prescription sheet), about the type of functional research required or, in the case of referral to another medical organization, draws up a Referral;

when providing medical care during sanatorium-resort treatment, the attending physician makes an entry in the prescription sheet contained in the patient’s medical record about the type of functional research required or, in the case of referral to another medical organization, draws up a Referral.

12. For patients who receive medical care in an inpatient setting and in a day hospital, and whose movement is limited for medical reasons, including due to the prescribed treatment regimen, functional studies can be carried out directly in the structural unit of the medical organization in which they are staying, with using portable diagnostic equipment.

13. The direction for conducting a functional study in the medical organization in which it was issued contains:

the name of the medical organization in accordance with the charter of the medical organization referring the patient for a functional study, the address of its location;

last name, first name, patronymic (if any) of the patient, date of birth; medical record number of a patient receiving medical care on an outpatient basis<1>, or a medical record of an inpatient;

<1>Order of the Ministry of Health of the Russian Federation of December 15, 2014 N 834n “On approval of unified forms of medical documentation used in medical organizations providing medical care on an outpatient basis, and procedures for filling them out” (registered by the Ministry of Justice of the Russian Federation on February 20, 2015 , registration N 36160).

diagnosis of the underlying disease, diagnosis code in accordance with the International Statistical Classification of Diseases and Related Health Problems, 10th revision (hereinafter referred to as ICD-10);

additional clinical information (main symptoms, results of laboratory, instrumental and other types of studies, description of medical interventions (manipulations, operations) (if necessary);

type of functional study required;

last name, first name, patronymic (if available) and position of the attending physician (paramedic, midwife).

14. Referral to another medical organization, in addition to the information specified in paragraph 13 of this Procedure, contains:

name of the medical organization to which the patient is sent for functional testing;

contact phone number (if available), email address (if available) of the attending physician (paramedic, midwife).

15. A functional study is carried out in a medical organization on the basis of an entry in the appointment sheet or a Referral submitted by the patient.

16. Based on the results of the functional study, on the day of its conduct, a functional study protocol (hereinafter referred to as the Protocol) is drawn up, which is filled out legibly by hand or in printed form, certified by the personal signature of the medical worker who conducted the functional study, and the functional diagnostics doctor or paramedic who analyzed the results functional research.

17. The protocol based on the results of a functional study, which was carried out in a medical organization that sent for a functional study, contains:

the name of the medical organization in accordance with the charter of the medical organization in which the functional study was carried out, the address of its location;

date and time of functional study;

last name, first name, patronymic (if any) of the patient, date of birth;

technological characteristics of the performed functional study;

a detailed description of the results of the functional study;

calculated indicators of functional impairment;

conclusion based on the results of a functional study;

last name, first name, patronymic (if available) of the medical worker who performed the functional study, and the functional diagnostics doctor or paramedic who analyzed the results of the functional study, contact phone number (if available), email address (if available).

18. The protocol based on the results of a functional study that was carried out in a medical organization following a Referral from another medical organization, in addition to the information specified in paragraph 17 of this Procedure, contains the name of the medical organization that issued the Referral.

19. The Protocol is accompanied by functional diagnostic curves, graphs or images obtained during a functional study.

20. When conducting a functional study as part of the provision of emergency medical care, the Protocol is drawn up immediately after the functional study and is immediately transferred to the attending physician (paramedic, midwife).

21. In diagnostically complex cases when conducting functional studies as part of the provision of primary specialized health care, specialized medical care, palliative care and medical care during sanatorium-resort treatment, a functional diagnostics doctor may engage in consultation for the purpose of making a conclusion based on the results of a functional study other medical specialists from the medical organization conducting the functional study, or medical specialists who referred the patient, as well as doctors from other medical organizations, including using telemedicine.

In this case, the Protocol is also signed by the specialist doctor who provided the consultation.

22. The protocol is entered into the patient’s medical documentation, drawn up in the medical organization that conducted the functional study.

23. If a referral for a functional study is issued to conduct a functional study in another medical organization, then the Protocol is drawn up in two copies, one of which is sent to the medical organization that referred the patient for a functional study, and the second remains in the medical organization that conducted the functional study study.

24. A copy of the Protocol, upon an oral request from the patient or his legal representative, is issued to the specified person by the medical organization that conducted the functional study.

3. Functional studies are carried out in the Office in accordance with the technological capabilities of the installed equipment.

requirements

requirements

7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 2 to the Rules for Conducting Functional Research, approved by this order.

8. The office is equipped with equipment in accordance with Appendix No. 3 to the Rules for Conducting Functional Research, approved by this order.

Conducting functional studies;

development and implementation of modern methods of functional diagnostics into clinical practice in order to improve the quality of diagnostic and treatment work of a medical organization;

ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies;

identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies with the results of other diagnostic studies, clinical and pathological-anatomical diagnoses;

<1> <2>.

Appendix No. 2
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

RECOMMENDED STANDARDS FOR THE FUNCTIONAL DIAGNOSTICS OFFICE

Appendix No. 3
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

STANDARD OF EQUIPMENT FOR A FUNCTIONAL DIAGNOSTICS OFFICE

Appendix No. 4
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

RULES FOR ORGANIZING THE ACTIVITY OF THE OFFICE OF FUNCTIONAL DIAGNOSTICS OF THE CARDIOVASCULAR SYSTEM

1. These Rules determine the procedure for organizing the activities of the office for functional diagnostics of the cardiovascular system (hereinafter referred to as the Office).

2. The office is created as a structural unit of a medical organization or other organization carrying out medical activities (hereinafter referred to as a medical organization), or as a structural unit of the functional diagnostics department of a medical organization.

3. In the Cabinet, functional studies of the cardiovascular system are performed in accordance with the technological capabilities of the installed equipment.

4. The management of the activities of the Cabinet is carried out by a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure he was created.

5. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by order of the Ministry of Health of the Russian Federation dated October 8, 2015 N 707n (registered by the Ministry) is appointed to the position of a doctor of functional diagnostics of the Cabinet. Justice of the Russian Federation October 23, 2015, registration N 39438), specializing in “functional diagnostics”.

6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016) is appointed to the position of a nurse in the Cabinet. ., registration N 41337), specializing in “functional diagnostics”.

7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 5 to the Rules for Conducting Functional Research, approved by this order.

8. The office is equipped with equipment in accordance with Appendix No. 6 to the Rules for Conducting Functional Research, approved by this order.

9. The main functions of the Cabinet are:

conducting functional studies of the cardiovascular system, including ultrasound studies;

development and introduction into clinical practice of modern methods of functional diagnostics of the cardiovascular system in order to improve the quality of diagnostic and treatment work of a medical organization;

ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies of the cardiovascular system;

methodological work with doctors of diagnostic and treatment units of a medical organization on the correctness and validity of issuing referrals for functional studies;

identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies of the cardiovascular system with the results of other diagnostic studies, clinical and pathological diagnoses;

submission of reports in accordance with the established procedure<1>, provision of primary data on medical activities for health information systems<2>.

Appendix No. 5
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

RECOMMENDED STAFF STANDARDS FOR THE FUNCTIONAL DIAGNOSTICS OFFICE OF THE CARDIOVASCULAR SYSTEM

Appendix No. 6
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

STANDARD OF EQUIPMENT FOR THE FUNCTIONAL DIAGNOSTICS OFFICE OF THE CARDIOVASCULAR SYSTEM

Appendix No. 7
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

RULES FOR ORGANIZING THE ACTIVITY OF THE OFFICE OF FUNCTIONAL DIAGNOSTICS OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM

1. These Rules determine the procedure for organizing the activities of the office for functional diagnostics of the central and peripheral nervous system (hereinafter referred to as the Office).

2. The office is created as a structural unit of a medical organization or other organization carrying out medical activities (hereinafter referred to as a medical organization), or as a structural unit of the functional diagnostics department of a medical organization.

3. In the Office, functional studies of the central and peripheral nervous system are performed in accordance with the technological capabilities of the installed equipment.

4. The management of the activities of the Cabinet is carried out by a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure he was created.

5. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by order of the Ministry of Health of the Russian Federation dated October 8, 2015 N 707n (registered by the Ministry) is appointed to the position of a doctor of functional diagnostics of the Cabinet. Justice of the Russian Federation October 23, 2015, registration N 39438), specializing in “functional diagnostics”.

6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016) is appointed to the position of a nurse in the Cabinet. ., registration N 41337), specializing in “functional diagnostics”.

7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 8 to the Rules for Conducting Functional Research, approved by this order.

8. The office is equipped with equipment in accordance with Appendix No. 9 to the Rules for Conducting Functional Research, approved by this order.

9. The main functions of the Cabinet are:

conducting functional studies of the central and peripheral nervous system, including ultrasound studies;

development and introduction into clinical practice of modern methods of functional diagnostics of the central and peripheral nervous system in order to improve the quality of diagnostic and treatment work of a medical organization;

ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies of the central and peripheral nervous system;

methodological work with doctors of diagnostic and treatment units of a medical organization on the correctness and validity of issuing referrals for functional studies;

identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies of the central and peripheral nervous system with the results of other diagnostic studies, clinical and pathological-anatomical diagnoses;

submission of reports in accordance with the established procedure<1>, provision of primary data on medical activities for health information systems<2>.

Appendix No. 9
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

STANDARD OF EQUIPMENT OF THE OFFICE FOR FUNCTIONAL DIAGNOSTICS OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM

Appendix No. 10
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

RULES FOR ORGANIZING THE ACTIVITY OF THE OFFICE OF FUNCTIONAL DIAGNOSTICS OF THE RESPIRATORY SYSTEM

1. These Rules determine the procedure for organizing the activities of the office for functional diagnostics of the respiratory system (hereinafter referred to as the Office).

2. The office is created as a structural unit of a medical organization or other organization carrying out medical activities (hereinafter referred to as a medical organization), or as a structural unit of the functional diagnostics department of a medical organization.

3. In the Office, functional studies of the respiratory system are performed in accordance with the technological capabilities of the installed equipment.

4. The management of the activities of the Cabinet is carried out by a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure he was created.

5. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by order of the Ministry of Health of the Russian Federation dated October 8, 2015 N 707n (registered by the Ministry) is appointed to the position of a doctor of functional diagnostics of the Cabinet. Justice of the Russian Federation October 23, 2015, registration N 39438), specializing in “functional diagnostics”.

6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016) is appointed to the position of a nurse in the Cabinet. ., registration N 41337), specializing in “functional diagnostics”.

7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 11 to the Rules for Conducting Functional Research, approved by this order.

8. The office is equipped with equipment in accordance with Appendix No. 12 to the Rules for Conducting Functional Research, approved by this order.

9. The main functions of the Cabinet are:

conducting functional studies of the respiratory system; development and introduction into clinical practice of modern methods of functional diagnostics of the respiratory system in order to improve the quality of diagnostic and treatment work of a medical organization;

ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies of the respiratory system;

methodological work with doctors of diagnostic and treatment units of a medical organization on the correctness and validity of issuing referrals for functional studies;

identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies of the respiratory system with the results of other diagnostic studies, clinical and pathological-anatomical diagnoses;

submission of reports in accordance with the established procedure<1>, provision of primary data on medical activities for health information systems<2>.

Appendix No. 11
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н

RECOMMENDED STAFF STANDARDS FOR THE FUNCTIONAL DIAGNOSTICS OFFICE OF THE RESPIRATORY SYSTEM

3. The Department may create an office for functional diagnostics of the cardiovascular system, an office for functional diagnostics of the central and peripheral nervous system, and an office for functional diagnostics of the respiratory system.

4. The Department carries out functional studies in accordance with the technological capabilities of the installed equipment.

5. Management of the activities of the Department is carried out by the head of the department - a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure it was created.

6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by Order of the Ministry of Health of the Russian Federation dated October 8, 2015 N 707n ( registered by the Ministry of Justice of the Russian Federation on October 23, 2015, registration N 39438) (hereinafter referred to as Qualification Requirements), in the specialty "functional diagnostics".

7. A medical worker who meets the Qualification requirements for the specialty “functional diagnostics” is appointed to the position of functional diagnostics doctor of the Department.

8. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016) is appointed to the position of nurse of the Department ., registration N 41337), specializing in “functional diagnostics”.

9. The staffing level of the Department is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 14 to the Rules for Conducting Functional Research, approved by this order.

10. The department is equipped with equipment in accordance with Appendix No. 15 to the Rules for Conducting Functional Research, approved by this order.

11. The main functions of the Department are: conducting functional research;

comprehensive use and integration of various types of functional studies, implementation of diagnostic algorithms in order to obtain complete and reliable diagnostic information in the shortest possible time;

development and implementation into practice of economically sound, clinically effective methods of functional research, new organizational forms of work;

providing advisory assistance to specialists from clinical departments of a medical organization on functional diagnostics of diseases and conditions;

implementation of measures to ensure the quality of functional studies and the correct functioning of diagnostic equipment;

submission of reports in accordance with the established procedure<1>, provision of primary data on medical activities for health information systems<2>.

<2>Part 1 of Article 91 of the Federal Law of November 21, 2011 N 323-FZ (Collection of Legislation of the Russian Federation, 2011, N 48, Art. 6724).

Appendix No. 14
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation

In accordance with the Decree of the Ministry of Health dated December 3, 2012 No. 185 “On approval of approximate staffing standards for medical and other workers of polyclinics and children's clinics (outpatient departments) and the recognition as invalid of some resolutions of the Ministry of Health of the Republic of Belarus” (as amended by the resolution of the Ministry of Health dated January 20, 2018 No. 10) positions of ultrasound diagnostic doctors are established based on the volume of work and estimated time standards at the rate of 1 position per 10,400 conventional units of ultrasound examinations and therapeutic and diagnostic procedures under ultrasound control per year with a 38.5-hour working week.

For a medical specialist, including the head of a structural unit engaged in ultrasound diagnostics and working in nursing homes for the elderly and disabled, in nursing hospitals, in institutions, departments, wards for palliative care in special clinics for hopelessly ill people (hospice), in departments and wards for patients with acute cerebrovascular accident, damage to the spinal cord and spine (spinal patients), as well as their early medical rehabilitation, a 35-hour work week is established (see resolution of the Ministry of Labor and Social Protection dated July 7, 2014 No. 57 “ On some issues of providing compensation for working conditions in the form of reduced working hours”, Chapter 34).

What regulatory legal act regulates the annual load on the ultrasound machine at 20,800 conventional units of ultrasound examinations and therapeutic and diagnostic procedures under ultrasound control?

The indicator of the annual load on the ultrasound machine was not introduced by the regulatory legal acts of the Ministry of Health. However, to ensure the availability of medical care and avoid downtime of expensive equipment, which includes ultrasound scanners, it is advisable to organize the work of ultrasound rooms in outpatient health care organizations based on the staffing of two ultrasound doctor positions.

Thus, the annual volume of work of an ultrasound room, in which one ultrasound scanner is installed and the staffing table implies the presence of two doctors, is determined based on the calculation of 1 position per 10,400 conventional units of ultrasound examinations and therapeutic and diagnostic procedures under ultrasound control per year at 38 ,5-hour work week, which amounts to 20,800 conventional units of ultrasound examinations and therapeutic and diagnostic procedures under ultrasound control per year.

How is an ultrasound doctor paid for providing paid medical services?

Remuneration for workers providing paid medical services, including ultrasound diagnostics, is carried out:

• when an employee is enrolled in a staff position for extra-budgetary activities - for the time actually worked under the conditions established for budgetary organizations by Resolution of the Ministry of Labor dated January 21, 2000 No. 6 “On measures to improve the conditions of remuneration for employees of budgetary organizations and other organizations receiving subsidies, employees whose wages are equal to employees of budgetary organizations";
• when performing paid medical services during regular working hours, the employee is given additional incentive payments (bonuses), and financial assistance is provided in accordance with the provisions on material incentives, which are developed in each health care institution and are an integral part of the collective agreement.

What regulatory legal act defines the concept of research in ultrasound diagnostics?

The definition of the term “research in ultrasound diagnostics” is given in the resolution of the Ministry of Health dated November 28, 2007 No. 129 “On approval of uniform norms and standards of material and labor costs (time, consumption of basic and auxiliary materials) for paid medical services for instrumental diagnostics provided by legal entities of all forms of ownership and individual entrepreneurs in the prescribed manner.” The specified term is used as a unit of measurement, taking into account, among other things, the time standards for conducting research. For example, an ultrasound of the abdominal organs, in accordance with the above-mentioned resolution, is counted as one study.

All subjects of the identified issues are considered in the most detailed way during the educational process at retraining courses in ultrasonic diagnostics and advanced training courses for ultrasound doctors with an analysis of regulatory legal acts regulating the activities of the ultrasound diagnostic service and analysis of specific examples.

Elena Krutova, Deputy Head of the Department of Economic Analysis and Health Development of the Ministry of Health,

Elena Latushkina, chief specialist of the Department of Medical Care Organization of the Ministry of Health,

Alexey Chukanov, Chief freelance specialist in ultrasound diagnostics of the Ministry of Health.

MAIN SANITARY AND EPIDEMIOLOGICAL DEPARTMENT

1. Purpose and scope.

1.1 The recommendations were developed to develop the current “Sanitary norms and rules when working with equipment that creates ultrasound transmitted by contact to the hands of workers” No. 2282-80 in order to optimize and improve the working conditions of medical workers in ultrasound rooms.

2. Hygienic requirements for equipment in ultrasound rooms

2.1 A set of premises intended for equipping ultrasound rooms,
should include:

A room for conducting diagnostic studies of at least 20 m2 per installation;

A room for undressing and dressing the patient with an area of ​​at least 7m2;

Room for waiting for an appointment at the rate of 1.2 m 2 per patient, not less than 10 m 2.

2.2 It is prohibited to place ultrasound rooms in basements, semi-basements and basements.

2.3 The room for performing ultrasound must have:
- natural and artificial lighting;
- sink with cold and hot water supply;

A general exchange ventilation system with an exchange ratio of 1:3, the presence of BK-1500 air conditioners is allowed.

2.4 The walls in the ultrasound room should be painted with light-colored oil paint. Wall cladding with ceramic tiles is prohibited.

2.5 Noise levels in workplaces are no more than 40 dB.

In order to reduce noise in rooms, it is recommended to line ceilings and walls with sound-absorbing materials (for example, Akmigran).

2.7 The couch / with adjustable height / should be installed in the center of the room or at some distance from the wall.

2.8 When conducting research, general lighting should be turned off, only a table lamp should be left, and windows in offices should be darkened with curtains.

2.9 Electrical devices that cause interference with the operation of ultrasound equipment should not be placed in or near the ultrasound room.

3. Hygienic requirements for organizing and conducting ultrasound.

Persons at least 18 years of age who have completed the appropriate training course and safety instructions are allowed to work with ultrasonic equipment.

Considering that the duration of a diagnostic study varies widely, the number of patients examined by one health worker should not exceed 10-11 people.

For carrying out a set of gymnastic exercises, physiotherapeutic procedures, etc. It is recommended that medical personnel working on ultrasound machines take two 10-minute breaks during their work shift.

To protect the hands of personnel from the effects of contact ultrasound, two pairs of gloves should be used: lower ones are cotton and upper ones are rubber.

Contact of unprotected hands with the scanning surface of a working ultrasonic sensor is not allowed.

When applying contact lubricant to the area of ​​interest, care should be taken not to allow it to come into contact with the health care worker's hands.

4. Therapeutic and preventive measures to prevent the adverse effects of high-frequency ultrasound and related factors.

4.1 The treatment and prophylactic complex of measures includes:
- medical examinations, clinical examination;
- physiotherapeutic procedures;

Special industrial gymnastics complex;

Eye exercises;

Psychological relief.

4.2 Order of the Ministry of Health N 700 (dated June 19, 1984).

DOCUMENTATION OF THE ULTRASOUND ROOM

The working documentation of the ultrasound diagnostic room is:

1. Pre-registration journal for the study. The purpose of the journal is to plan the volume of office work. In this case, patients are distributed among doctors according to their work schedule and by area of ​​study (abdominal cavity, kidneys, thyroid gland, mammary glands, etc.). Instead of this journal, separate sheets can be used, which are submitted to the registry in advance.

2. Journal of registration of research results. This journal should contain:

Date of the study;

Serial number of the study;

Patient’s passport data (full name, year of birth);

Medical institution, department or name of the doctor who referred the patient for the study;

Preliminary clinical diagnosis (the basis for the diagnostic procedure);

Number of studies conducted (codes, ciphers, etc.);

Conclusion of ultrasound examination (research results).

The last column briefly records the conclusion of the doctor who conducted the study, and a copy of the protocol with a detailed description of the ultrasound picture and the images taken should be stored in the archives of the department, so that they can be easily found if necessary.

3. Journal of analysis of identified pathology. It is most advisable to keep a journal according to the organ-nosological principle (organ - disease - number of identified cases per month, quarter, half-year, year). The most interesting cases can be recorded separately (indicating the medical history, ultrasound results, surgery, section).

4. Archive (card index). The archive organization system can be different and depends on the profile of the medical institution and the volume of research conducted. In small departments (offices) of ultrasound diagnostics, second copies of protocols can be filed, stored in folders or pasted into notebooks according to the dates of examination.

It is also possible to create a card index in alphabetical order by year of operation.

In large departments where multidisciplinary research is carried out, it is advisable to maintain an archive not only in chronological order, but also thematically (i.e. by organs and diseases).

You should keep a copy of the ultrasound protocol and images of the adult patient. 5 years (if pathology is detected) and 1 year (if there are no pathological changes) counting from the date of the last examination. The results of ultrasound examinations of children are stored in the archive for at least 5 years, regardless of the nature of the identified changes.

5. Ultrasound examination protocol. If a special form is not used for the protocol, the name and address of the medical institution, the date of the study and the name of the doctor who conducted the study must be indicated. The conclusion is a medical document only if it has the seal of a medical institution or the personal seal of a doctor.

Order of the USSR Ministry of Health N 581 of June 21, 1988.

STAFF REGULATIONS FOR MEDICAL STAFF OF ULTRASOUND DIAGNOSTICS DEPARTMENTS (OFFICES) OF TREATMENT AND PREVENTIONAL INSTITUTIONS (Appendix 7).

1. Medical personnel. The positions of ultrasound diagnostic doctors are established depending on the volume of work and the current estimated time standards for ultrasound examinations. These positions are established within the labor plan and salary allocations. The position of the head of the department is established if there are at least 3 positions of ultrasound diagnostic doctors on the staff instead of 0.5 doctor positions.

2.Nurse medical personnel. The position of a nurse is established in accordance with the positions of ultrasound diagnostic doctors, including the position of head of the department. The position of the head nurse is established according to the position of the head of the department instead of 0.5 of the position of the nurse.

3. Junior medical staff. The positions of nurses are established at the rate of 0.5 positions per 1 position of ultrasound diagnostic doctor, including the position of head of the department, but not less than 1 position.

Note: engineering support for the functioning of ultrasound diagnostics departments (rooms) is carried out by personnel whose positions are introduced in accordance with the standard staff of managers, specialists, employees and workers of healthcare institutions.

MINISTRY OF HEALTH OF THE RSFSR ORDER No. 132, 02.08.91. ON IMPROVING THE RADIATION DIAGNOSTICS SERVICE (excerpt) I ORDER: ... resolve the issue of organizing medical and
research institutes of departments (departments) of radiation diagnostics, including X-ray and radiological,
X-ray diagnostic departments (offices), radionuclide, ultrasound, computer departments,
magnetic resonance and other types of diagnostics, taking into account local conditions, organize their work in accordance
with the “Regulations on the department (department) of radiology diagnostics”, its divisions and personnel"... Appendix No. 1 to the order of the Ministry of Health of the RSFSR dated August 2, 1991 N 132 REGULATIONS ON THE DEPARTMENT (DEPARTMENT) OF RADIOLOGY DIAGNOSTICS 1. General provisions 1.1. Department (department) of radiology diagnostics is organized on the basis of treatment and preventive institutions, clinics of medical and research institutes and is their structural unit. magnetic resonance, radionuclide, ultrasound, pathomorphological and other types of diagnostics, depending on local conditions. radiology diagnostics 2. The management of the department (office) of ultrasound diagnostics is carried out by the head. 3. The work of the ultrasound diagnostics department (office) is organized in accordance with the Regulations on the radiology diagnostics department, these Regulations and other regulatory documents. 4. The main tasks of the department (office) are: 4.1. Providing patients with clinically based, highly qualified diagnostic and therapeutic care using ultrasound methods with the use of additional special techniques. 4.2. Integrating the results of work with other diagnostic and clinical departments in order to clarify the diagnosis and determine the scope of medical care. 5. Issuance of conclusions based on the results of an ultrasound examination no later than the next day after the examination. Appendix N 18 to the order of the Ministry of Health of the RSFSR dated August 2, 1991 N 132 REGULATIONS ON THE DOCTOR OF THE DEPARTMENT (OFFICE) OF ULTRASOUND STUDIES OF THE DEPARTMENT (DEPARTMENT) OF RADIOLOGY DIAGNOSTICS 1. A doctor is appointed to the position of doctor in the department (office) of ultrasound studies of the department (department) of radiology diagnostics. having special training in ultrasound diagnostics. 2. The ultrasound diagnostic doctor is directly subordinate to the head of the department (department) of radiology diagnostics, and in his absence - to the head of the institution or his deputy for medical work. 3. An ultrasound diagnostic doctor in his work is guided by the Regulations on the department (office) of ultrasound diagnostics, the Regulations on the department (department) of radiology diagnostics, these Regulations and other regulatory documents. 4. In accordance with the objectives of the ultrasound diagnostic room, the doctor provides and carries out: 4.1. Conducting ultrasound diagnostic studies according to clearly formulated indications and makes the final decision on its implementation, determining the required volume and rational methodology of the study, carrying out diagnostic and treatment-diagnostic invasive manipulations, including on-site visits. 4.2. Development and implementation of new diagnostic techniques and equipment. 4.3. Advisory work on the use of ultrasound in diagnostics and its capabilities in medical practice. Participation in the analysis of complex cases and errors in diagnosis, identification and analysis of the causes of discrepancies between ultrasound data and pathological and operational data. 4.4. Maintaining relevant medical and reporting documentation, analyzing quantitative and qualitative performance indicators. 4.5. Improving the qualifications of paramedical and junior medical personnel and monitoring their work, compliance with safety and labor protection rules. 4.6. Monitoring the safety and rational use of equipment and equipment, their technically competent operation. 5 . The ultrasound diagnostic doctor is obliged to: 5.1. Improve your qualifications in the prescribed manner, master new equipment and new techniques for conducting ultrasound diagnostic studies. 6 . An ultrasound diagnostic doctor has the right: 6.1. Give orders and instructions to middle and junior medical personnel. 6.2. Represent the administration of the institution of employees subordinate to it for promotion or punishment. 6.3. Make proposals to the administration of the institution on improving the work of the office and organizing working conditions. 6.4. Participate in meetings and conferences that discuss issues related to the work of the ultrasound diagnostic room. Appendix No. 19 to the order of the Ministry of Health of the RSFSR dated August 2, 1991 No. 132 REGULATIONS ON THE NURSE (DEPARTMENT) OF THE ULTRASOUND RESEARCH OFFICE OF THE DEPARTMENT (DEPARTMENT) OF RADIOLOGICAL DIAGNOSTICS 1. A nurse who has been instructed in the rules of using ultrasound is appointed to the position of nurse in the ultrasound diagnostic room. ova diagnostic equipment and safety equipment. A nurse with experience in a surgical or intensive care unit is appointed to the position of a nurse in an office where invasive manipulations are performed under ultrasound or x-ray ultrasound control. 2. In her work, the nurse in the ultrasound diagnostic room is guided by the Regulations on the radiology department, on the ultrasound department (room) by these Regulations. 3. The main tasks of the nurse in the ultrasound diagnostic room are the preparation of cleaning materials and lubricants, ultrasound equipment for the examination, preparation of the patient for an ultrasound diagnostic examination and participation in other procedures, photographic recording of images during the examination and registration of research data in the relevant accounting documents , regulating the flow of examined persons, maintaining a first aid kit with emergency medications, ensuring the safety of equipment, equipment, household equipment, maintaining a sanitary regime, participating in maintaining an archive and ensuring the safety of medical information. When carrying out invasive manipulations, her responsibilities include maintaining a clean dressing room or operating room in the office, preparing sterile instruments, materials, gowns, as well as the necessary set of medications, preparing the patient for the invasive manipulation and assisting the doctor during its implementation. 4. A nurse in an ultrasound diagnostic room is obliged to improve her qualifications in the prescribed manner, strictly follow safety rules, internal labor regulations, monitor the technical condition of the equipment and maintain the necessary accounting and reporting documentation.

Appendix No. 22 to the order of the Ministry of Health of the RSFSR

APPROXIMATE ESTIMATED TIME STANDARDS FOR ULTRASONIC INVESTIGATIONS

Ultrasound examination of the organs of the hepatobiliary system:

Liver + gall bladder 20 min.

Gallbladder with determination of function 60 min.

Pancreas 20 min.

Spleen 20 min.

Ultrasound examination of the genitourinary system:

Kidneys + adrenal glands 20 min.

Bladder with determination of residual urine 15 min.

Prostate gland + testicles 20 min.

Ultrasound examination of the female genital organs:

For gynecological diseases 25 min.

During pregnancy 30 min.

Ultrasound examination of the internal organs of the fetus:

in the second and third trimester of pregnancy 30 min.

Ultrasound examination of newborn organs:

Brain 30 min.

Internal organs 30 min.

Ultrasound examination of surface structures:

Thyroid gland 15 min.

Mammary gland 20 min.

Salivary glands 20 min.

Lymph nodes 20 min.

Peripheral vessels 20 min.

Vascular Doppler with spectral analysis

in constant wave mode 50 min.

Vascular examination with color Doppler

mapping 60 min.

Soft fabrics 20 min.

Ultrasound examination of the chest organs :

Mediastinum 20 min.

Pleural cavity 20 min.

Echocardiography with color mapping 60 min.

Echocardiography with Doppler analysis 60 min.

Pulsed Doppler ultrasound of blood vessels

mode 40 min.

Treatment and diagnostic studies under ultrasound control:

Percutaneous diagnostic puncture 45 min.

Percutaneous diagnostic puncture with

express cytological examination 70 min.

Therapeutic and diagnostic puncture of abdominal cysts

cavity and retroperitoneal space 70 min.

Therapeutic and diagnostic puncture of the abdominal and pleural

cavities 90 min.

Percutaneous drainage of the gallbladder 120 min.

Percutaneous drainage of the bile ducts under

ultrasonic and x-ray control 150 min.

Ultrasound hysterosalpingography

(echohydrotubation) 60 min.

Note:

Estimated workload for an ultrasound diagnostic physician

with a 6.5 hour working day - 33 conventional units.

A standard unit is taken to be work lasting 10

For combined studies of several organs, the calculated

the norms for each subsequent organ are reduced by 5 minutes.

When studying children, the time limit increases by 10%

The estimated time standard includes:

1. preparatory and final time

2. time of actual research

3. time for documentation and work analysis.

Ultrasound doctor working hours