From Big Medical Encyclopedia

HOSPITAL — establishment for hospitalization of patients. Hospital in the USSR — state to lay down. - professional, the establishment rendering to the population the stationary qualified and specialized medical aid. In many foreign countries a number of stationary lech.uchrezhdeniye call hospitals. In the USSR hospitals are called only stationary institutions for treatment of the military personnel and disabled people of the Great Patriotic War (see. hospital military , Hospital for disabled people ).

A historical sketch

Hospitals arose in very remote historical times. Their problems, system of the organization and the nature of activity changed depending on the level of social and economic development of society, a condition of medicine and natural sciences.

The first in the history of medicine of hospital (clinic) appeared in Ancient Greece and the countries of the East (5 century BC). In Greece they accommodated in the certain, specially equipped rooms — so-called. yatreyakh (see) or settled in the temples devoted to god of doctoring Asclepius — asklepeyona (see. Asklepeyon ).

In Ancient Rome where big development was gained by military medicine, at the time of the emperor Augustus in the Roman military camps special rooms for treatment of wounded soldiers were organized — valetudinariya (see). At Romans for B. more rooms and volume were allocated to lay down. was wider than help given in them, than at Greeks. To Pompeii at excavation «the house of surgeons» where there were operating rooms, bathrooms, a drugstore and other rooms for treatment of patients is found.

In the east since 4 century AD for the pilgrims and wanderers going for worship of «holy sites» to Jerusalem hotels shelters were organized. Due to the frequent epidemics arising among pilgrims, hotel-gospitali (hospital, armor. hospitalis guest; hospitable) partially intended also for reception of patients.

According to an ascendent position of church in the Middle Ages the organization and B.'s maintenance concentrated in her hands. One of the first large B. was based in 4 century in east possession of the Roman Empire, in. To Caesarea (Caesarea) Cappadocian in Asia Minor. The charter of the monastery, at Krom there was the Caesarean hospital, provided an order of contempt and treatment of patients, training in medical business and so forth

B. in Caesarea, apparently, served as a prototype for creation of church hospitals in the east and in Western Europe. The first church B. in Europe was based in Italy, in Monte-Kassino, at the Benedictine monastery in 529 g. In France to the first B.' number, more precisely, than almshouses, (hotel-Dieu), belonged Lyons (6 century) and Parisian (7 century). The first B. in London (Albani-hospital) was based in 794 g. In 9 — 10 centuries B. and infirmaries arise in the Middle East — in Iran, Damascus, Baghdad, Jerusalem. Later in the east during crusades (from 1096 to 1270) in connection with a wide spread occurance of leprosy (under this name some other skin defeats also disappeared, in particular at syphilis) the church founded Saint Lazar's award for contempt of «leprous». The award organized special shelters for patients — infirmaries. Along with infirmaries there were shelters and for other infectious patients. B. arose from «ksenodokhiya» (literally «rooms for strangers»), shelters for travelers («hospices» in Russia). With development of the economic relations between the countries there were traveling merchants. At inns on main roads rooms for the diseased in way were arranged, and then special buildings were under construction. Hospitals grew also from shelters for crippled and incurable, so-called almshouses (in particular, for mentally sick). Clinics at temples in Ancient Egypt and other countries of the Ancient East were a prototype of similar institutions.

Due to epidemics of plague, cholera and leprosy in 12 — 15 centuries development of network B. and infirmaries in Europe accelerated. However the medical institutions which were under construction and functioning without elementary a dignity. - a gigabyte. conditions, were nurseries of infectious diseases. Not accidentally hospitals were called «houses of sufferings», the place of «vale» and «death».

In 17 — 18 centuries with development of trade and industrial capitalism, growth of the cities and accumulation in them the big mass of the population, deterioration a dignity. conditions, big requirement in B arose continuous growth of diseases and frequent flashes of epidemics. At the end of 18 century in France the question of elimination of density of patients in B. and need of accommodation of patients depending on the nature of a disease in certain buildings was for the first time raised. The commission of Academy of Sciences of France in 1788 developed the principles of construction of B. and made recommendations to build certain hospital buildings (pavilions) in parallel each other with sufficient intervals between them. Actually it formulated the idea of stage construction of B. (see. Hospital construction ). However the idea of stage construction was carried out only in 60 — 70 years; in 1846 in France by this principle the Lariboisier hospital was created. Further the stage system of construction of B. was widely adopted.

Hospital in France (the 18th century).

B.'s construction for a wide people at large was carried out by the bourgeois governments extremely slowly. Only at the end of 19 — the beginning of 20 century in those capitalist countries where social insurance on a case of a disease was entered, B.'s construction at the expense of the means of social insurance consisting generally of monthly contributions of working pases rendering medical aid to them extended a little.

In the territory of the USSR (in modern borders) B. arose in 9 — 10 centuries in Bukhara, Khwarezm, etc. There are data on earlier organization B. in the territory of present Armenia: the resolution of the Armenian church cathedral in 365 g provided the organization B. and leper colonies. In 11 century at Kiev Pechersk Lavra there was a shelter for «suffering and poor». In 1089, as appears from chronicles, the Kiev metropolitan Yefrem put

hospitals in Pereyaslavl and other cities of church at which were. B, in Novgorod and other cities of Russia were organized at Kirillo-Belozersky Monastery, Troitse-Sergiyevsky monastery. The organization B. in Kievan Rus' was regulated by the state what the Charter of the Kiev prince Vladimir Svyatoslavovich confirms (992). On the maintenance of hospitals in Ancient Russia the special tax on the population was established.

Gallery with loggias in Madzhiore's hospital in Milan (the 15th century).

St. Elizabeth's hospital in Lviv was one of the first churchless hospitals in the present territory of the USSR, the organization a cut is carried to the second half of 13 century. In 1404 the second B. (St. Stanislava) was open in the same place. These B. were organized generally by residents of Lviv (craft workshops and merchant guilds) and were controlled city magistrate.

Old Russian monastic hospital.

Due to frequent epidemics in 14 — 15 centuries the network B. extends. In Ivan IV's (Grozny) reign in the legislative collection rules of the device B. and keeping of patients in them are quite in detail stated to Stoglava (1551). There are instructions that in 1618 in Moscow along with almshouses on Tverskaya Street and Petrovka there was a hospital in «Kitay-gorod, a pas the Fire», i.e. a pas of Red Square. In one of decrees of 1643 it is told about hospital at Chudovo the monastery. The historian V. O. Klyuchevsky mentions that the first churchless B. in Moscow was constructed by one of the educated figures of the Moscow Russia F. M. Rtishchev in 1652 — 1654.

The temporary military hospital was open in Moscow on the Ryazan farmstead under the decree of the tsar Fedor Alekseevich in 1678. In 1682 in Moscow two hospitals («shpitaln») — one in Znamensky Monastery, another behind Nikitsky gate were constructed.

Large civil B. and military hospital began to be created at the beginning of 18 century during Peter I's reforms. The need for hospitals became especially acute in connection with long wars, epidemics, hunger, expansion of international relations and trade.

Under Peter I's Decree in 1707 in Moscow the military hospital, nowadays was open Main clinical military hospital (see), been one of the largest medical institutions of that time. In 1721 Peter I issued the Decree obliging to build magistrates «territorial dependence hospital for the sake of contempt orphaned, sick and crippled» therefore at his life 10 hospitals — Moscow were organized St. Petersburg (overland and Admiralty), Kronstadt, Kazan, Astrakhan, etc. also over 500 infirmaries.

Clinic of the Moscow university (in a crust, time of the 1st Moscow medical institute of I. M. Sechenov).

From the second half of 18 century construction large civil (churchless) B. Naiboley extended large B. were constructed in Moscow, St. Petersburg and some provincial cities. Outstanding architects were involved in their design and construction: M. F. Kazakov, V I. Bazhenov, O. I. Bowe, D. Kvarengi, etc. So, in Moscow in 1763 the Pavlovsk hospital of a pas of 50 beds was open, and in 1802 — 1807 M. F. Kazakov built the special big building for B. (the City hospital No. 4 now). In 1776 the hospital on 150 beds was open Ekaterina's (afterwards Old and Ekaterina's) (nowadays Moscow regional research clinical in-t of M. F. Vladimirsky). In 1834 from its structure the New and Ekaterina's hospital which became afterwards clinical base of medical faculty Moscow un-that was allocated — nowadays clinic of the 1st medical institute, in 1806 Mariinsky B. on 200 beds was constructed. The first psychiatric B. in Moscow — Preobrazhenskiy — was organized in 1808.

«the Sheremetyevsky hospice» (in a crust, time of Scientific Research Institute of Emergency Medicine of N. V. Sklifosovsky).

In 1810 the «hospice of Sheremetyevo» built by architects D. Kvarengi and E. S. Nazarov with hospital was open (nowadays scientific research institute of emergency medical service of N. V. Sklifosovsky). In 1834 in Moscow the Russia's first was open and one of the first in Europe children's B. (nowadays Children's hospital of Η. F. Filatova).

Large B. were constructed in St. Petersburg. So, in 1784 on the A.I project. Ruski is constructed Obukhovsk hospital (see). The first psychiatric B. in St. Petersburg was open in 1843.

From 1775 to 1865 hospital business preferential was under authority of orders of public contempt. For these years 519 B. on 17 351 beds and 33 houses were open for mad. The available hospitals did not provide the minimum needs of the population; there were not enough hospitals not only in the provincial cities, but also in capital — St. Petersburg and Moscow. The vast majority of the population, especially in the district cities, rural areas and on the former suburbs of the country, was almost deprived of the hospital help. Rendering the hospital help improved a little after creation of zemstvoes (see. Territorial medicine ). Though the service of territorial medicine was only in 34 provinces of Russia, she played a big role in increase in network of rural B. and out-patient clinics (tab. 1).

However this network of rural B. and infirmaries even in small degree did not provide with appropriate medical aid country people. Provincial and city B. were organized generally in the adapted buildings usually offered individuals and were in an advanced state of decay. B. «public contempt» (charitable) were in such started and unsatisfactory state that the population avoided these to lay down. institutions and only the extreme need forced to be treated in them.

At the beginning of 20 century from 224 cities with the population more than 25 thousand people of hospital were only in 81 cities. B. were under construction and provided with various departments. B.'s distribution and bed fund for departments in 1907 is presented in tab. 2.

From tab. 2 it is visible that the zemstvo had the greatest percent of B. and bed fund.

The big role the organizations of the hospital help in Russia was played by such outstanding Russian doctors as M. Ya. Mudroye, N. I. Pirogov, G. A. Zakharyin, S. P. Botkin, A. A. Ostroumov, Η. F. Filatov, B. F. Snegirev, S. S. Korsakov, whose efforts, despite neglect of the imperial government to questions of health care, created a number of the good B. rendering the qualified medical aid and the brought-up highly educated specialists doctors. The advanced figures of medicine quite often were large B.' creators; so, F. A. Getye was a founder, the organizer and the chief physician of Soldatenkovsky hospital in Moscow, nowadays hospital of S. P. Botkin (see. Botkina hospital ).

Hospitals in the USSR.

Hospital business from the first days of the Soviet power was based on philosophy of the Soviet health care: free treatment, general availability and high qualification of medical aid to the population of the city and village.

Development of network B. after Great October socialist revolution happened and happens the increasing rates according to tasks of socialist construction.

The young Soviet health care not only recovered, but also developed hospital network. Thanks to the taken measures by 1925 the hospital network destroyed during the civil war and foreign military intervention in Russia (1918 — 1920) almost completely was recovered. At the same time special attention was paid on the organization and expansion of network of provincial district hospitals, and also hospitals in rural areas.

Development of network of hospitals in the USSR is a part of the economic plan. The indicator (in the economic plan) characterizing development of health care is the number of the developed hospital beds (in absolute figures and per 1000 zhit.) and number of visits by patients of policlinic in one change (development of network of policlinics). By 1940 the number of medical institutions in comparison with 1913 increased by 2,6 times (in 1913 — 5,3 thousand, in 1940 — 13,8 thousand), and number of beds in them — by 3,8 times (from 207,6 thousand beds in 1913 — in modern borders of the USSR — to 790,9 thousand beds in 1940). At the same time more in high gear there was B.'s development in the republics of Central Asia, Kazakhstan and Transcaucasia that is one of examples of implementation of Lenin national policy of the CPSU.

In the period of the Great Patriotic War by fascist aggressors in the occupied territory it was destroyed apprx. 6000 hospitals. Thanks to care of Party and Government by 1950 the number of medical institutions and number of beds in them not only were recovered, but also considerably increased.

In 1949 the nomenclature of hospitals was accepted and their types and a profiling are established. Depending on administrative-territorial division distinguish the following types of hospitals in the USSR: regional (regional, republican), city, central regional and rural district police officers. On a profile distinguish multi-field hospitals with a number of specialized departments and one-profile, specialized, for treatment of patients only with certain forms of diseases: infectious, tubercular, psychiatric, oncological, physiotherapeutic, recovery treatment (medical rehabilitation), ophthalmologic, otorhinolaryngological. In 1968 in addition the nomenclature included hospitals of emergency medical service. Besides, exist one - and multi-field children's hospitals. Specialized hospitals of other profiles can be organized only with the permission of M3 of the USSR (the order of the Minister of Health of the USSR No. 358 of July 19, 1962).

Depending on the bed power of hospital are divided into 8 categories. Establishment of categorization is carried out differentially, depending on type and a profile of hospital: for rural local hospitals 5 categories, for regional (in the city are established and in the village) — 6, for city — 8, for psychiatric — 7 categories etc. B. which are bases of medical higher education institutions are called clinical if not less than 50% of bed fund of this B. are used for training of students. If in B. there is a bigger number of beds, than it is provided by the highest category (first), it is called as extra category.

Many B. are merged into policlinics. The integrated B. consist of two structural divisions — a hospital and policlinic. The hospital is intended for patients whose inspection and treatment cannot be made in policlinic or at home, and also for patients with infectious, venereal and nek-ry other diseases who need to be treated in the conditions of isolation. The policlinic (polyclinic department of B.) provides the population with medical aid at a pre-hospital stage and carries out preventive actions among the population in the serviced area (see. Policlinic ). Merging of hospitals and policlinics in uniform to lay down. - professional, institution reduces time of stay of patients in a hospital due to their pilot survey in policlinic, provides succession in treatment, allows to hold planned medical and recreational events more widely. Work of doctors in the conditions of the integrated B. promotes increase in their qualification.

B. carries out examination of working capacity (see. Medical and consulting commission), analyzes incidence and mortality of the population in the serviced territory and develops measures for their decrease. One of important problems of B. is the dignity. - a gigabyte. education and dignity. education of the population (see. Sanitary education ); it is carried out by doctors and paramedical staff during finding of patients in a hospital, at treatment of patients on an outpatient basis or at home. In B. plans of carrying out a dignity are formed. - a gleam. works among the population for what special time — 4 hours a month is allocated to doctors and paramedical staff. B. will organize medical examination (see), hold medical and recreational events among the revealed patients and watch the state of health of the persons which are on the dispensary account participate in holding anti-epidemic actions. Hospitals are under direct authority of public health departments of executive committees of Councils of deputies of workers which exercise control and the management them to lay down. - professional, and atm. - hoz. activity. The management B., an operating procedure, reception and an extract of patients, the right and a duty of medical staff are regulated by special state norms, provisions and instructions of the Ministry of Health of the USSR. Hospitals keep in a continuous communication with the population. At each of them are created public councils (see) where along with medics representatives of the enterprises, institutions, the trade-union and other public organizations located in the area (zone) of service of hospital enter.

Activity of a hospital is characterized by a number of indicators. Indicators of use of bed fund, average duration of stay of the patient on a bed, an indicator of a lethality on hospital in general and on departments, the indicators characterizing quality of diagnosis and treatment are the most important (see. Documentation medical , Reporting medical ).

From the second half of the 60th years the bed power of hospitals owing to construction of new hospital complexes, separate cases in the territory of old hospitals (50 — 60% of bed fund), and also reconstruction and modernization of the existing hospital buildings (35 — 40% of bed fund) began to increase considerably. In tab. 3 growth of network of hospitals and bed fund is presented to the USSR from 1940 to 1973.

Follows from tab. 3 that since 1960 the bed power of hospitals increased in many N due to their enlargement.

The resolution of the Central Committee of the CPSU and Council of ministers of the USSR (1968) «About measures for further improvement of health care and development of medical science in the country» and the resolution of the Supreme Council of the USSR (1968) «About a condition of medical care to the population and measures for improvement of health care in the USSR» defined need to increase efficiency of use of capital investments at construction of healthcare institutions and to build only large B. (in the cities on 300 — 1000 beds, in rural areas — on 200 beds and more) which can provide high quality of diagnosis and treatment with use of the modern medical equipment and equipment (see. Hospital construction ). Since 1971 the gain of bed fund occurs generally due to new construction.

Development of network B. allowed in necessary volume to provide the population with all types of the stationary help, including and emergency, to carry out precautionary treatment of the patients consisting on dispensary observation, rehabilitation actions etc. Since 1965 annually stationary help is received by 20% of the population. Since 1970 there was an alignment of indicators on the volume of hospitalization of urban and country people.

The number of hospital beds and security of the population with hospital beds grows in all federal republics (tab. 4 and 5). By 1970 there was an alignment of indicators of security with the stationary help of the population of federal republics that was reached by uniform system of creation of network B., the uniform principles of planning and standards of providing the population with the hospital help.

For 1975 in a stage of construction there were profile and specialized B. St. 70 large many on 800 and more beds everyone (from them 33 B. over 1000 beds), including 9 B. of emergency medical service on 800 and more beds, 8 oncological clinics with a hospital on 430 beds and boarding house for patients on 150 places and some other large B.

Process of differentiation, i.e. specialization of medical aid, began for a long time, but most intensively it is carried out since 1950. Growth of security with the specialized hospital beds in the USSR from 1940 to 1973 is presented in tab. 6.

The analysis of process of specialization of medical aid demonstrates that the greatest development was gained by the surgical specialized help (traumatology, urology, neurosurgery, cardiovascular surgery, etc.); differentiation of surgical types of the help began earlier, than therapeutic types of medical aid. At expansion of therapeutic types of the specialized help special attention is paid to development of cardiorheumatological departments and offices.

One of the major tendencies in development of hospital matter in the USSR and abroad is specialization and creation of the large specialized centers. Experience of the Soviet and foreign health care demonstrates that the organization of large specialized departments (centers) provides rendering highly skilled medical aid. At the organization of specialized departments (centers) the bed fund, medical shots and the medical equipment are more rationally used, modern diagnostic methods and treatments are more widely and more effectively applied. In the USSR the specialized centers of medical aid are created preferential as a part of large multi-profile B. on the basis of clinics of medical institutes.

Large specialized departments (on 90 — 120 beds) as a part of republican, regional and regional B. will be organized as the centers of specialized medical aid of the corresponding profile. They render to lay down. and the advisory help, carry out organizational and methodical work, training, etc.

Because the role of many centers of specialized medical aid because of their specifics is not limited to borders of the certain republic, edge or area, the organization of 3 types of the specialized centers is provided: all-Union, interrepublican (interregional) and republican (regional, regional).

The provision on hospitals (republican, regional, regional, city, central regional, rural local, children's, infectious) is approved by the order of the Minister of Health of the USSR «No. 395 of July 31, 1963. The same order approved regulations on officials of hospitals (the chief physician, the deputy chief physician managing department, the attending physician, the chief nurse, the senior nurse, etc.).

Opening, maintenance and B.'s closing are made by the decision of the relevant executive committee of Council of deputies of workers and higher body of health care.

Republican (regional, regional) hospital is the center of highly skilled, specialized medical aid almost on all clinical specialties, the center of advisory medical aid (in its structure there is an advisory policlinic), the center of the emergency and planned (exit) medical aid to the population of the republic, edge, area (as a part of B. there is a department of the emergency and planned and advisory medical aid to the population having means a dignity. aircraft and land transport); performs organizational and methodical management to lay down. - the prof. institutions of the republic, edge, area; is the center of collecting and processing of medical information for what in its structure there is an organizational and methodical department with department of medical statistics (see. Regional hospital).

Municipal hospital provides the population of a certain site with the qualified stationary and polyclinic medical aid, holds preventive and medical and recreational events, will organize and carries out medical examination of certain groups of patients and the healthy population, carries out a dignity. - a gleam, work among the population, also the analysis of incidence of the population systematically keeps account and studies quality of rendering hospital to lay down. - professional, the help to the population (see. Municipal hospital ).

In rural areas there are central regional B. which, as a rule, are located in the regional center; on the periphery of areas there are rural district police officers B.

Central regional hospital is to lay down. - professional, the establishment of the regional center providing the qualified stationary and polyclinic medical aid to the population of rural areas. It is the center of organizational and methodical and operational management of all healthcare institutions of the district, is responsible for the organization, statement and quality medical - a dignity. providing population of the district. The central regional B. in rural areas performs functions of public health department of the district, and her chief physician — the head of regional public health department (see. Central regional hospital ).

Rural local hospital renders stationary and polyclinic medical aid to the population rural medical site (see). The chief physician of rural local hospital is directly subordinated to the chief physician of the central regional hospital. Creation of interdistrict, and then central regional hospitals considerably brought closer highly skilled medical aid to country people.

It is improved also medical - a dignity. service of the working industrial enterprises, hospitals develop at medical and sanitary parts (see).

Specialized hospitals — see. Children's hospital , Infectious diseases hospital , Psychoneurological hospital , Ambulance hospital , Tubercular hospital , Physiotherapeutic hospital .

Structure of a hospital of hospital

In B.'s structure are provided: reception with diagnostic beds or the insulator, specialized departments, department of anesthesiology resuscitation, chamber of an intensive care, medical and diagnostic departments and offices: X-ray department (see), radiological department (see), physiotherapeutic office (see), departments of functional diagnosis to lay down. physical cultures, laboratories — clinical, biochemical, bacteriological, serological, immunological, etc. (see. Laboratory ), pathoanatomical department (see), atm. - hoz. a part — kitchen, a laundry, warehouses etc. (see. Hospital economy ).

In reception reception of patients is made: survey, inspection, medical sorting according to character and disease severity, rendering the first medical aid, sanitary cleaning, execution of primary documentation (filling of a case history and other documents), the direction in the relevant department B. For reception of somatic patients, as a rule, there is one reception. In a number of departments — infectious, maternity and children's there are receptions. In the large multi-profile B. constructed on stage system several receptions can be organized (on separate cases or specialized blocks). In reception of large B. there are beds for temporary stay of patients for the purpose of specification of the diagnosis (in cases when the emergency help is not required), and also resuscitation chamber. In B. power up to 500 beds for isolation of patients, observations and specifications of the diagnosis in receptions are provided insulators on 6 — 8 beds (at the rate of 1 — 2 bed on 100 hospital beds), in B. the power of St. 500 beds in reception will organize diagnostic departments (at the rate of 2 — 3 beds on 100 hospital beds).

Reception and survey of patients in reception is carried out by the doctor of reception (in small B. — the doctor on duty). In reception necessary laboratory, X-ray, tool and hardware inspections are conducted. For the purpose of specification of the diagnosis and consultation the doctor of reception can invite the corresponding specialist from a hospital. Through reception it is carried out as well an extract of patients.

The number of specialized departments depends on appointment and the bed power of hospital. Specialization of departments is established also depending on the power of hospital and need of the population for this or that type of the help. Psychosomatic department on 60 — 90 beds is provided in B. from 600 beds above.

The order of the Minister of Health of the USSR No. 63 of January 25, 1968 in B. creates the centralized clinical laboratories for carrying out the most difficult and labor-consuming laboratory researches demanding the special equipment. To implementation in practice of the automated systems for carrying out mass laboratory researches there is a centralization of laboratory service, integration of clinical diagnostic laboratories one laboratory serviced several B. (see. Laboratory business ).

One of structural divisions of B. (for adults — 500 beds and more, for children — with power more than 300 beds) is the anesteziologo-intensive care unit with chambers of an intensive care at the rate of 2 — 3 beds on each 100 beds of a hospital (see. Intensive care unit ). These beds do not enter the general bed power B. Organization of anesteziologoreanimatsionny departments expanded B.'s possibilities on rescue of life of patients at a number of a serious illness, terminal states, at disturbance of the vital functions of an organism. For continuous observation and carrying out to lay down. actions the seriously ill patient or the patient with disturbance of the vital functions of an organism (a myocardial infarction, a stroke and other serious illness) in hospitals will organize chambers of an intensive care which are equipped with the corresponding medical appliances and are staffed by specially trained medical and paramedical staff.

Each specialized department is headed by the manager appointed from the most experienced and trained specialists doctors. Manager. specialized department shall have not less than the first qualification category (see. Doctor ). In department on 60 beds and more manager. department exempts from direct maintaining patients and watches, in departments with smaller number of beds the manager. department performs work on direct maintaining patients of 50% of norm of load of the attending physician and brings the corresponding watches to evening and night time in necessary volume.

Manager. department will organize and provides timely inspection and treatment of patients, and also work of medical staff of department, increase in its qualification, is responsible for carrying out research, provides implementation in practice of work of department of new methods and diagnostic aids and treatment, monitors timely acquaintance and training in techniques of their use of attending physicians and paramedical staff. Manager. department otvetstven for the most rational and effective use of shots of department — doctors and paramedical staff, and also fixed assets of department — hospital beds, the medical equipment, diagnostic and medicines. It provides the organization of proper maintenance of patients and care of them, maintenance of the internal schedule, timely supply of department necessary diagnostic and to lay down. means, carrying out ought a dignity. - a gigabyte. and the anti-epidemic mode also carries out some other duties which are listed in the provision on the manager of department.

B.'s management is performed by the chief physician appointed by the relevant executive committee of Council of deputies of workers. Under the provision on the chief physician, he directs activity of hospital on the basis of one-man management, bears responsibility for all to lay down. - the prof., atm. - hoz. and financial activity

of B. V the provision on the deputy chief physician of city B. its obligations for the direct management of all lechebnodiagnostichesky departments, offices and laboratories of a hospital, by a drugstore, an office of medical statistics and council of nurses are determined by a medical part. The deputy chief physician by a medical part is responsible for quality of medical and diagnostic process and statement of all work of hospital on inspection, treatment and service of patients.

In B.'s hospitals the two-sedate system of service of patients is implemented: doctor and nurse. Since 1968 instead of the nurse the position of the junior nurse (the leaving nurse) is entered, more high level of preparation, than the nurse has edges (see. Nurse ). At this system the nurse not only carries out appointments of the doctor and carries out procedures, but also provides patient care.

In B. the great value is attached to creation of the optimum environment and favorable psychological climate for patients. To it fullestly there corresponds the system of the medical and guarding mode based on I. P. Pavlov's doctrine developed by the Soviet scientists; the most important principle of this mode is shchazheny mentalities of patients (see. Deontology medical , Ethics medical ). The actions protecting patients from those environmental factors which can negatively work on them are the cornerstone of the standard mode B. and complicate the course of a disease.

Providing the medical and guarding mode in B. requires systematic education of personnel on the correct understanding and implementation of this mode, strict implementation of regulations and rules of conduct. An indispensable condition of effectiveness of the medical and guarding mode is acquaintance of patients at receipt in B. with rules of the intrahospital schedule and observance of the hospital mode. The organization and quality of the medical and guarding mode substantially depend on the working schedule of personnel and a daily routine in a hospital. Therefore the schedule and a daily routine shall be strictly differentiated depending on a profile of department. The special attention is given to the working schedule of personnel in the conditions of 5-day working week. It is necessary to consider that lechebnodiagnostichesky process is continuous; the working schedule shall be sliding, i.e. in all days of the week in departments there have to be medical personnel, at the same time and loading is distributed evenly. The working schedule of paramedical staff is formed on two-shift or three-shift type, i.e. lasting watch the 6,5 or 12 hour. For therapeutic and surgical departments the three-shift working schedule is recommended. The round-the-clock watch of medical and paramedical staff is allowed only as an exception in receptions.

Budget and financial estimate of hospital. Hospitals are, as a rule, financed under the local budget — regional, city, regional, republican — depending on subordination of medical institution.

The budget is defined by the estimate of maintenance costs of hospital. Basic data for drawing up the estimate of maintenance costs of hospital are the following indicators of the annual plan: number of the regular hospital beds approved for fiscal year, and their profile; number of medical, average medical and junior service personnel, and also atm. - hoz. and technical. The estimate of maintenance costs of hospital includes Also articles and is formed under each article separately on the basis of the existing standards (on food of patients, medicines, soft and firm stock, overhauling of the building, etc.), and also according to tariffing of the salary of personnel.

Article I — the Salary of personnel

Article II — Charges on the salary

Article III — Clerical household expenses Article IV — Business trips and office traveling Article V — Research, acquisition of books, educational expenses Article IX — Expenses on food of patients

Article X — Expenses on medicines, dressing materials, reactants and a x-ray film

Article XII — Acquisition of the equipment, transport and firm stock

Article XIV — Acquisition of soft stock

Article XVI — Overhauling Article XVIII — the Other expenses

the Salary of personnel (article I) — the main article of budgetary appropriations of B. making from 52,0 to 58,0% of all budget of B. for settlement year (depending on the bed power, a profile and B.'s structure). On average for 1973 (on all hospital and polyclinic institutions) 56,4% of all budgetary appropriations were the share of this article. The wages fund is estimated on each group of service personnel separately on the basis of the monthly tariff rates approved by orders of the Minister of Health of the USSR (No. 585 of July 20, 1972 and No. 700 of August 25, 1972). Except the salary of permanent members of staff, the wages fund joins in addition payment of the persons replacing for the period of issues of permanent members of staff, payment to doctors of watches if they are not provided with the regular list of doctors, works in holidays, payment to the non-staff workers invited by B. for performance of separate works (consultants). The salary to the non-staff workers performing temporary economic job passes under the article «clerical household expenses», and performing repair work — under the article «capital repairs». On the basis of the resolution of the Central Committee of the CPSU, Council of ministers of the USSR and the All-Union Central Council of Trade Unions No. 522 of July 13, 1972. «About increase in rates and official salaries of doctors, teachers and tutors of preschool institutions» and orders of the Minister of Health of the USSR the differentiated official salaries of doctors are established to No. 700 of August 25, 1972 and No. 585 of July 20, 1973. Compensation of heads to lay down. - professional, institutions depends on structure of establishment and number of medical positions.

The sizes of the additional salary (except charges for harm and qualification category) charged by the manager of departments of hospitals and policlinic also of the manager of laboratories and offices over a salary depend on an experience.

Rates of the salary of average medical and other service personnel of B. and policlinics are estimated according to the instruction approved by the order of the Minister of Health of the USSR No. 496 of September 9, 1964.

Charges on the salary (article II) are provided of 5,5% of the general fund of the salary on hospitals and policlinics. They intend on the expenses connected with social insurance working (temporary disability, disability, etc.)

Clerical household expenses (article III) intend on payment of heating, water supply, the electric power, clerical expenses, employment and payment of rooms for service personnel, repair of stock and the equipment and other expenses.

Expenses on food (article IX) make from 10 to 13% to the total amount of the budget (estimate) of hospital. In 1973 countrywide expenses on food in B. health systems made 12,7% of all budget for the maintenance of hospitals and policlinics. Consumption rates on food depend on a profile of beds (ranging from 1 rub to 1 rub 98 kopeks on 1 bed a day).

Expenses on medicines (article X) take the third place (on volume) in the estimate of expenses of hospital. On average from 8 to 10% are spent for medicines. In 1973 over the country the expense on medicines in B. averaged 9,2% to the total amount of maintenance costs of hospitals and policlinics. Expenses on medicines are differentiated depending on a profile of beds (from 0,36 rub to 2 rub 50 kopeks a day on 1 bed).

Budgetary appropriations on medicines at the rate on one visit of the doctor are provided in estimates of policlinics. In a crust, time in policlinics the settlement form on medicines is established of 4 kopeks on one visit of the doctor (instead of 3 kopeks provided earlier); in dental policlinics the settlement norm on medicines is established of 8 kopeks on one visit of the doctor (instead of 3 kopeks provided earlier).

The estimate on acquisition of the medical equipment, transport, firm stock and the other equipment (article XII) makes from 2 to 3,5% to the total amount of allocations on hospital. Acquisition of soft stock is carried out under article XIV of the estimate of 3 — 4% to the total amount of allocations. Settlement standards on acquisition of the medical equipment, transport, firm economic stock are defined at the rate of 250 rubles on new network in the operating institutions and 33 — 50 rub on replenishment of the operating network; on acquisition of soft stock respectively 320 rub and 100 rub

Hospitals abroad

In the socialist countries the organization of the stationary help to the population is founded on the principles, the general for socialist health care (the state nature and planned character, the preventive direction, general availability, free of charge and high quality of medical aid, unity of medical science and practice, participation of the public and broad masses of workers in activity of bodies and healthcare institutions). Multi-profile, specialized and general B. are the leading types of stationary treatment and prevention facilities. Most medical institutions is merged into policlinics.

Hospitals in the capitalist countries — generally chastnopredprinimatelsky commercial institutions with the high cost of treatment and contents in them. On accessory and subordination of hospital are divided into the following types: B., consisting on the state budget (insignificant part B.), generally psychiatric and tubercular; B. in private maintaining (belonging to corporations or individuals); B. charitable. Recently provide small polyclinic departments for outpatient appointment and consultation of patients in projects B. of a number of the capitalist countries.

See also characteristic of B. in articles devoted to the certain countries (e.g., Austria , Bulgaria etc.).




Table 3. GROWTH of NETWORK of HOSPITALS AND BED FUND In the USSR from 1940 to 1973.

  • Some reduction of number of medical institutions is connected with their enlargement.



Table 6. GROWTH of SECURITY with SPECIALIZED HOSPITAL BEDS In the USSR from 1940 to 1973. On 10 000 POPULATION

Bibliography: Barkman E. M. and Sorts Ya. I. Management of hospital, M., 1972, bibliogr.; Burenkov S. P. The main directions of development of health care in the USSR, Owls. zdravookhr.: No. 4, page 3, 1975; Gotsiridze G. G. and Safonov A. G. Modern hospitals abroad, M., 1970, bibliogr.; Llevelin-Devis R. and Mack and at l of e y G. M. K. Planning and the organization of hospital services, the lane with English, M., WHO, 1967; Medical care to urban population, under the editorship of E. A. Loginova, M., 1972; Organization of hospital service, Report of committee of WHO experts, Geneva, WHO, 1971; Freud of l and nanosecond. Ya. Organization of work of a hospital of a municipal hospital, L., 1960.

A. G. Safonov.