Features of the organization of medical care for residents of rural areas. Central District Hospital

The second stage of medical care for the rural population.

The main institution of the second stage of medical care for the rural population is the central district hospital (CRH). It provides the rural population with qualified treatment and preventive care, both inpatient and outpatient.

Main tasks of the central district hospital:

providing highly qualified, specialized inpatient and outpatient care to the population of the district and regional center;

operational, organizational and methodological management and control over the activities of all healthcare institutions;

planning, financing and organizing logistics for health care institutions in the region;

development and implementation of measures aimed at improving the quality of medical care for the population of the region, reducing morbidity, disability, hospital mortality, child and general mortality and improving the health of adolescents;

timely implementation of modern methods and means of prevention, diagnosis and treatment into the practice of health care facilities;

implementation of measures for the deployment, rational use and improvement of professional qualifications of personnel;

carrying out activities aimed at the effective use of funds and forces, strengthening the material and technical base of the district, improving the systems of organizational, methodological and operational management, management of all health care facilities in the district, using modern scientific achievements;

provision of ambulance and emergency care in the region.

The central district hospital, regardless of bed capacity, population size and service radius, has a hospital, a clinic, a pharmacy, a prosector, paraclinical and administrative services, an organizational and methodological office (OMK), an ambulance and emergency department.

The in-patient department of the Central District Hospital must have at least 5 departments according to specialties; therapy, surgery, pediatrics, obstetrics and gynecology, infectious diseases. In addition to the required minimum, large central district hospitals can organize departments for other specialties (neurology, otorhinolaryngology, ophthalmology, traumatology, etc.).

In the outpatient department of the Central District Hospital, specialized care is provided in 1015 specialties, and such departments often serve as inter-district specialized centers.

Patients living in an area assigned to a district hospital are served directly by the hospital. Patients living in other areas are admitted to the district hospital on the referral of doctors from local hospitals. Local doctors refer patients to the district hospital in cases where the necessary specialized care cannot be provided on site, when patients need consultation, clarification of the diagnosis, X-ray or laboratory clinical diagnostic examination. The participation of specialists from district hospitals during clinical examinations is widely used.

Rural residents turn to the district hospital following referrals from medical institutions in the rural area if they need specialized medical care, functional examination, or consultation with medical specialists.

Mobile assistance plays an important role in the work of the Central District Hospital. Mobile medical teams are formed by the chief physician and see patients in 5-7 specialties. The composition of the team's medical specialists is determined depending on the development of the network of outpatient clinics in a given territory, its staffing with doctors and the population's needs for appropriate types of medical care. It may include doctors: therapists, pediatricians, surgeons, obstetricians-gynecologists, ophthalmologists, neurologists, etc. The visiting team is provided with vehicles, including special ones, and is equipped with the necessary equipment (mainly portable) and equipment for examining and treating patients . The leadership of the mobile medical team is entrusted to one of the qualified doctors of the team who has experience in medical and organizational work. Fluorographic and dental offices, clinical diagnostic and bacteriological laboratories regularly visit the village.

Ambulance and emergency care is provided by the relevant department, which is part of the Central District Hospital, which is responsible for providing this type of assistance to the population of the district center and the settlements assigned to it.

One of the most important structural units of the Central District Hospital is the organizational and methodological office (OMK), headed by the deputy chief physician of the Central District Hospital for medical care of the population of the district. OMK is the main assistant to the chief physician in matters of management, organization and coordination of all organizational and methodological work of the Central District Hospital and other medical institutions in the region.

The main tasks of OMK include:

analysis and synthesis of data on the health status of the population and the activities of health care facilities in the district;

calculation of evaluation indicators and analysis of the activities of the Central District Hospital as a whole and for individual specialized services;

compiling a summary report on the network, personnel and activities of health care facilities in the district; identifying shortcomings in the work of health care facilities and developing measures to eliminate them; development of an action plan for medical care of the entire population of the district, monitoring its implementation;

implementation of measures to improve the quality of treatment and preventive work,

advanced training of specialists,

study and dissemination of new modern forms of work in medical care,

long-term planning for the development of healthcare in the region,

organization of work on off-budget commercial activities and health insurance.

The OMK work plan is actually a plan for the organizational and methodological work of the entire central district hospital. Its mandatory sections are:

analysis of demographic indicators and reporting materials on the network, personnel and activities of health care facilities in the area and on the health status of the population;

organization and implementation of measures to provide medical advisory and organizational and methodological assistance to medical institutions of the region;

carrying out activities to improve the qualifications of medical workers; strengthening the material and technical base of health care facilities in the region.

assessment of the activities and efficiency of the work of medical institutions of the district and departments of the Central District Hospital;

measures to improve the quality of medical care, ambulance and emergency care;

introduction of new types of diagnostics and treatment;

improvement of ethical and deontological aspects in the team of medical institutions.

On the basis of a systematic analysis of the state of health of the population of the region, plans of regional institutions, the cabinet draws up a comprehensive plan of measures to improve medical care and strengthen the health of the population of the region.

Ensuring the methodological guidance of accounting and statistical work and control over it in all institutions of the district is the most important function of the organizational and methodological office. The duties of the offices include receiving annual reports. Based on the data of the reporting forms and a special analysis, the organizational methodological office compiles an overview of the health status of various population groups and evaluates health indicators. The organizational method rooms should contain information about district conferences and classes with doctors and paramedical personnel, about seminars with the participation of district specialists, specialization and advanced training of medical workers.

The chief (district) specialists of the district, who are also heads of specialized departments of the central district hospital, work in close contact with the OMK of the Central District Hospital. Currently, in almost all regions there are regional specialists in therapy, pediatrics, surgery, obstetrics and gynecology, and phthisiology. They are appointed by the chief physician of the district in agreement with the chief regional specialists and report directly to the chief physician of the Central District Hospital or his deputy.

The main functions of district specialists are:

organizational and methodological management of the work of the relevant specialized service;

regular visits in accordance with the schedule to local hospitals, outpatient clinics and first-aid posts;

improvement of methods of diagnosis, treatment, prevention of specialized diseases;

observation and control of the dispensary population, especially persons in leading agricultural professions;

analysis of statistical reports on your service; advanced training of medical personnel.

In order to better provide specialized medical care, inter-district specialized centers (departments) equipped with modern equipment are being created. Interdistrict specialized centers provide medical and advisory assistance, carry out organizational and methodological work, improve the qualifications of medical personnel of district and local hospitals and clinics, analyze health indicators and risk factors that determine morbidity in a particular specialty

Structure of the Central District Hospital:

1. Polyclinic with specialized departments (up to 20 physician specialties).

2. Hospital.

3. Emergency department.

4. Pathology department.

5. Organizational and methodological office.

6. Auxiliary structural units.

Functions of the Central District Hospital:

1. Providing the population of the regional center and region with qualified specialized medical care.

2. Operational, organizational and methodological management, control over the activities of all healthcare institutions in the region.

3. Planning and financing the activities of medical institutions.

4. Carrying out activities aimed at improving the quality of medical care.

5. Advanced training of medical personnel.

The average bed capacity of the central district hospital is 300-320 beds.

CRH – main health care facility of the territorial medical association(II stage of providing medical care to the rural population).

Performance indicators of the central district hospital: See hospital performance indicators (question 73).

103. Rural medical station (SVU). Medical organizations SVU. Rural district hospital. Organization and content of treatment, preventive and anti-epidemic work - see question 30.

End of work -

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Answers to the state exam on public health and healthcare

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Central District Hospital (CRH)

It is the health/security management body for the entire district. Provides assistance to residents (sites. principle):

1. residents of the district center on a precinct basis

2. living in assigned areas on a local basis. Those settlements that are located near the central district hospital and are served by it are called assigned areas

3. living in rural areas (advisory assistance)

The second stage of service is not carried out according to the district principle, that is, you can get advice, specialized assistance. The Central District Hospital is also the organizer of the management of all medical institutions located in the district. Inter-district specialized departments will be opened on the basis of the Central District Hospital. The process of consolidation of the central district hospital is characteristic.

Structure of the Central District Hospital:

1. a hospital with departments in the main specialties, the number of which depends on the capacity of the Central District Hospital and the need

2. polyclinic with a laboratory (the number of specialties depends on the capacity, there is a specialty. MP)

3. treatment and diagnostic rooms and laboratories

4. pathology department

5. organizational and methodological rooms

6. various auxiliary rooms (pharmacy, kitchen, laundry, medical archive)

7. there may be an emergency department (substation)

Based on capacity (number of hospital beds), central district hospitals are divided into categories:

2k – 300 – 350;

3k – 250 –300;

4k – 200 – 250;

5k – 150 – 200;

6k – 100 – 150.

Tasks of the Central District Hospital:

Providing for the population of the district and district.ts. qualified, specialized stationary and outpatient medical care;

Development of measures to reduce morbidity, general and child mortality;

Operational and organ-methodological management of all divisions of the district;

Improving the qualifications of medical personnel;

Planning, financing and organization of logistics. provision of all health care institutions in the area.

The management of the Central District Hospital is carried out by the heads. a doctor who is also the chief physician of the district. He has: 1 – deputy medical officer. parts (head of medicine - responsible for the work of the hospital);

2 – deputy at the clinic;

3 – deputy according to ACh;

4 – deputy according to honey serving the population of the district (head of the organizational and methodological office, 1st deputy!);

5 – deputy for the protection of motherhood and childhood (in areas with a population of more than 70,000 people; in areas with fewer, this position is performed by a district pediatrician).

4.5 – deputy chief physician of the district

1,2,3 – deputy chief physician of the Central District Hospital

Organizational and methodological office:

1. deals with the analysis of general morbidity and mortality of the population, analysis of morbidity with temporary disability, analysis of performance indicators of health care facilities in the region, quality of medical care. assistance to the population, quality of diagnostics. Based on this analysis, conferences, meetings, analysis of medical errors are organized.

2. planning measures to improve medical qualifications. personnel, usually paramedics. personnel on the basis of the Central District Hospital, doctors conduct advanced training on the basis of the Regional Hospital.

3. planning of advisory assistance. For the implementation of qualified assistance, doctors - specialists carry out visits to the village district of the hospital, where they advise.

4. make calculations for planning and financing, material and technical equipment.

5. development of measures to improve the organization of MP for the population of the region

States are organized based on standards per 1000 population. Standards are determined for residents of the district center, assigned plot and other residents. Depending on the capacity, the recruitment of specialists in the central district hospital may vary. Categories 1 and 2 can conduct admissions in narrow specialties. The average capacity of the central district hospital is 280 beds.

Interdistrict specialized health care facilities

Their function:

1. consultation in clinics of patients referred from health care facilities

2. hospitalization of patients from attached health care facilities

3. methodological and advisory assistance to doctors, attached areas, including examination of working capacity

The number of beds is set depending on the population of the attached areas, the practical amount of work.

The staff is: 1 resident for 20 – 25 beds. To approach specialized honey. Mobile specialized teams are organized to provide assistance. In addition to key specialists, it may include mountain workers. Hospitals, dispensaries, maternity hospitals.

The capacity of the central district hospital and the profile of specialized departments within it depend on the population size, the structure and level of morbidity, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, central district hospitals have a capacity of 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatric, infectious diseases and obstetric-gynecological (if there is no maternity hospital in the area).

The chief physician of the central district hospital is the head of healthcare of the municipal district, appointed and dismissed by the administration of the municipal district.

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas and paramedics of FAPs is provided by specialists from central regional hospitals. Each of them, according to the approved schedule, goes to the complex therapeutic area to conduct medical examinations, analyze dispensary work, and select patients for hospitalization.

In order to bring specialized medical care closer to the rural population, interdistrict medical centers. The functions of such centers are performed by large central district hospitals (with a capacity of 500-700 beds), capable of providing the population of a given municipal area with the missing types of specialized inpatient and outpatient medical care.

The structure of the Central District Hospital has polyclinic, which provides primary health care to the rural population through the referrals of paramedics from FAPs, outpatient doctors, and general medical (family) practice centers.

The provision of out-of-hospital and inpatient treatment and preventive care to children in the municipal area is entrusted to children's consultations(clinics) and children's departments of central district hospitals. Preventive and therapeutic work in children's clinics and children's departments of district hospitals is carried out on the same principles as in city children's clinics.

The provision of obstetric and gynecological care to women in the municipal region is entrusted to antenatal clinics, maternity and gynecological departments of central district hospitals.

The functional responsibilities of medical personnel, accounting and reporting documentation, and the calculation of statistical indicators of the activities of the central district hospital are not fundamentally different from those in city hospitals and administrative offices.

Rice. 12.2. Approximate organizational structure of the central district hospital

Structure of the Central District Hospital:

Polyclinic with specialized departments (up to 20 medical specialties).
Hospital
Emergency room.
Pathoanatomical department.
Organizational and methodological office.
Auxiliary structural units.

Functions of the Central District Hospital:

Providing the population of the regional center and district with qualified specialized medical care.
Operational, organizational and methodological management, control over the activities of all healthcare institutions in the region.
Planning, financing the activities of medical institutions.
Carrying out activities aimed at improving the quality of medical care.
Improving the qualifications of medical personnel.

The average bed capacity of the central district hospital is 300-320 beds.

CRH – main health care facility of the territorial medical association(II stage of providing medical care to the rural population).

Organization and ways to improve outpatient care for women in accordance with the order of the Ministry of Health of Russia dated November 12, 2012 No. 578 “On approval of the procedure for providing obstetric and gynecological care”

The main institution providing inpatient obstetric and gynecological care is the united maternity hospital.

A modern maternity hospital, in addition to the obstetric hospital itself, should include a powerful multidisciplinary outpatient clinic (antenatal clinic, family planning center, medical genetic consultation, prenatal complex diagnostic units, territorial consultative and diagnostic service), resuscitation and intensive care service, departments Stage I of nursing newborns and premature babies, pregnancy pathology department (50% of the number of beds for pregnant women and women in labor), gynecological department, mobile specialized care teams.

Typically, maternity hospitals provide assistance to the population on a territorial basis. However, first and emergency care for pregnant women who come to the maternity hospital is provided regardless of their place of residence and departmental subordination of the health care institution.

Referral to the maternity hospital for emergency care is carried out by the ambulance and emergency care station (department), as well as by an obstetrician-gynecologist, doctors of other specialties and paramedics.

In addition, a woman can independently apply to the maternity hospital. Planned hospitalization of a pregnant woman in a maternity hospital is carried out by an obstetrician-gynecologist, and in his absence, by a midwife.

Pregnant women with extragenital diseases in need of examination and treatment are sent to hospitals according to the pathology profile.

Pregnant women (if there are medical indications), women in labor, and postpartum women in the early postpartum period (within 24 hours after birth) in case of childbirth outside a medical institution are subject to hospitalization in the maternity hospital.

For hospitalization in the department of pathology of pregnant women, the antenatal clinic (or other institution) issues a referral, an extract from the “Individual card of a pregnant woman” (f. 111/u) and “Exchange card” (f. 113/u) after 28 weeks of pregnancy.

Upon admission to the maternity hospital, a woman in labor or a postpartum woman is sent to the reception and examination block, where they present a passport and an “Exchange Card” (f. 113/u), if it has already been issued.

For each woman admitted to the maternity hospital, in the reception and examination block the following is drawn up: “History of childbirth” (f. 096/u), an entry is made in the “Register of admission of pregnant women, women in labor and postpartum” (f. 002/u) and in alphabet book.

A doctor sees women in the reception and examination unit.

In the reception and inspection block it is advisable to have one filter room and 2 inspection rooms.

One examination room is provided for the admission of women to the physiological obstetric department, the other is an observation room.

In the filter room, women are divided into two streams: those with an absolutely normal pregnancy, sent to the first obstetric department, and those who pose an “epidemiological danger” to others, sent to the observation department.

Pregnant women giving birth who have:

· acute respiratory diseases, flu, sore throat;

manifestations of extragenital inflammatory diseases;

· feverish condition;

· long waterless period;

· lack of a “Maternity Hospital Exchange Card” (F-113/u);

· intrauterine fetal death;

· fungal diseases of hair and skin, skin diseases;

Acute and subacute thrombophlebitis;

· pyelonephritis, pyelitis, cystitis and other infectious diseases of the genitourinary system;

manifestations of infection of the birth canal;

· venereal diseases;

· parturient women in the early postpartum period in case of childbirth outside a medical institution.

In the examination rooms of the physiological and observation departments, an objective examination of the woman is carried out, she is sanitized, a set of sterile linen is given, and blood and urine are taken for tests.

From the examination room, accompanied by medical personnel, the woman goes to the delivery unit or the department of pathology of pregnant women, and if indicated, she is transported on a gurney, always accompanied by a doctor or midwife.

The birth block includes: prenatal wards, delivery wards, intensive care ward, children's room, small and large operating rooms, sanitary premises.

In the maternity unit, midwife positions are provided at the rate of 1 round-the-clock post for 60 obstetric beds, but not less than 1 round-the-clock post.

In the prenatal wards, the number of beds should be approximately 12% of the estimated number of the postpartum physiological department, but not less than 2.

If there are two maternity rooms, births are performed in them alternately. Each maternity room is open for 1 - 2 days, then it is thoroughly cleaned. If there is one delivery room, births are carried out alternately on different Rakhmanov beds. The delivery room is thoroughly cleaned twice a week. A midwife attends a normal birth.

After finishing the treatment of the newborn, the midwife (doctor) fills out the necessary columns in the “History of Birth” and “History of Development of the Newborn.”

The “history of the development of a newborn” is filled out by the pediatrician on duty, and in his absence, by the obstetrician-gynecologist on duty. When completing the “History of Development of a Newborn,” its number must correspond to the “History of Birth” of the mother.

In the postpartum physiological department, in addition to the main beds, it is advisable to have reserve postpartum wards.

When filling the wards of the postpartum ward, strict cyclicity must be observed; one ward is allowed to be filled with women in labor for no more than three days.

The cyclicity of filling maternal wards should correspond to the cyclical filling of newborn wards, which allows healthy children to be discharged with their mothers at the same time.

When mothers or newborns show the first signs of illness, they are transferred to the second obstetric (observation department) or to another specialized institution.

Women are admitted to the observation department both through the reception and examination block of the obstetric departments and from the physiological obstetric department.

The following are placed in the observation department: sick women with a healthy child; healthy women with a sick child; sick women with a sick child.

Wards for pregnant and postpartum women in the observation department should, if possible, be profiled. It is unacceptable to place pregnant and postpartum women in the same room. Postpartum wards should be small.

Wards for newborns are allocated in the physiological and observational departments.

Pediatricians are allocated in the neonatal departments at the rate of 1 position per 35 beds of healthy newborns, or 25 beds for newborns in the observation department.

The positions of nurses are established:

· in the neonatal wards of the obstetric physiological department - 1 round-the-clock post for 20 beds for children;

· in the neonatal wards of the observation department - 1 post for 15 beds, but not less than 1 post;

· 1 nurse position is established for collecting breast milk if there are 80 postpartum beds and an additional 0.5 position for every subsequent 40 beds (over 80).

In a modern maternity hospital, at least 70% of the beds in the physiological postpartum department should be allocated for the joint stay of mother and child. Such a joint stay significantly reduces the incidence of diseases in postpartum women and the incidence of diseases in newborn children. The main feature of such maternity hospitals or obstetric departments is the active participation of the mother in caring for the newborn child. Staying together between mother and child limits the contact of the newborn with the medical staff of the obstetric department and reduces the possibility of infection of the child. With this regimen, early attachment of the newborn to the breast is ensured, and the mother is actively trained in the skills of practical nursing and caring for the newborn.

In case of an uncomplicated course of the postpartum period in a woman in labor and the early neonatal period in a newborn, with a fallen umbilical cord and good condition of the umbilical wound,

If there is a positive change in body weight, the mother and child can be discharged 5-6 days after birth.

Discharge is carried out through special discharge rooms, separate for postpartum women from the physiological and observational departments. These rooms should be located adjacent to the visitor area.

Discharge rooms must have 2 doors: from the postpartum ward and from the visitor area. Reception rooms should not be used for the discharge of postpartum women.

In the “History of the Development of a Newborn,” the nurse notes the time of his discharge from the maternity hospital and the condition of the skin and mucous membranes, and introduces the mother to the record. The entry is certified by the signatures of the nurse and mother. The nurse issues the mother a “Medical Birth Certificate” f. 103/u and “Exchange card of the maternity hospital, maternity ward of the hospital” f. 113/у.

The pediatrician is obliged to note in the “Exchange Card” basic information about the mother and newborn.

On the day the child is discharged, the head nurse of the neonatal department reports by telephone to the children's clinic at the place of residence basic information about the discharged child.

The department of pathology of pregnant women is organized in large maternity hospitals with a capacity of 100 beds or more.

The following patients are hospitalized in the pathology department of pregnant women: women with extragenital diseases, complications of pregnancy (severe toxicosis, threat of miscarriage, etc.),

with abnormal fetal position, with a burdened obstetric history.

This department employs: obstetricians-gynecologists (1 position for 15 beds), a maternity hospital therapist (1 position in a maternity hospital for 250 beds), midwives (1 24-hour post for 20 beds) and other medical personnel.

The layout of the department of pathology of pregnant women should provide for its complete isolation from the obstetric departments, the possibility of transporting pregnant women to the obstetric physiological and observation departments (bypassing other departments), as well as an exit for pregnant women from the department to the street.

It is advisable to have small wards - for 1-2 women. The department must have: a functional diagnostics room with modern equipment (mainly cardiological), an examination room, a small operating room, and a room for physical and psychoprophylactic preparation for childbirth.

Gynecological departments of maternity hospitals come in three profiles:

1. For hospitalization of patients requiring surgical treatment.

2. For patients in need of conservative treatment.

3. To terminate pregnancy (abortion).

The structure of the department should include: its own admission department, dressing room, manipulation room, small and large operating rooms, physiotherapy room, discharge room, intensive care ward. In addition, other departments of the maternity hospital are used for the diagnosis and treatment of gynecological patients: clinical laboratory, x-ray room, etc.

The gynecological department employs obstetrician-gynecologists (1 position for 15 beds), a general practitioner of the maternity hospital, and the anesthesiology and intensive care service of the maternity hospital (1 position of doctor for 100 beds) takes part in the work of the department. Nurse posts are organized at the rate of: 1 round-the-clock post for 30 beds, but not less than 1 post if there are at least 20 gynecological beds in the maternity hospital. In maternity hospitals where there are at least 20 beds for gynecological patients in need of surgical intervention, a nurse position is allocated to work in the dressing room, etc.

In recent years, attempts have been made to remove the abortion department from obstetric hospitals and create independent departments. Independent gynecological hospitals and day hospitals are being organized. Departments for cancer patients are usually located in appropriate hospitals,

The main feature of obstetric institutions is the constant presence of newborn children and women in the postpartum period who are highly susceptible to infections. Therefore, a special set of sanitary and hygienic measures must be organized and carried out in a maternity institution.

The work of a maternity hospital is assessed by general indicators of hospital performance (the provision of population with inpatient obstetric and gynecological care, workload per medical position, average annual bed occupancy, average length of stay in a bed, bed turnover, mortality). But there are also special indicators of the activity of the maternity hospital:

· mortality of pregnant women, women in labor and postpartum;

the level of perinatal mortality;

the level of morbidity in newborns;

the frequency of physiological (normal) births;

the frequency of complications in childbirth;

the frequency of postpartum diseases;

frequency of prematurity

frequency and validity of obstetric operations, benefits and others.

According to the standards, an obstetric bed should be open no more than 280 days a year, a gynecological one - 320. The lower occupancy rate for obstetric beds is due to the fact that in these departments the wards are thoroughly sanitized at least once every 10 days.

The average length of stay of women in the department of pathology of pregnant women is 22-28 days, in the maternity department - 5-7, and in the gynecological department - 3-4 days. The turnover of an obstetric bed reaches 55-60 times, and a gynecological bed - 65-75 times.

Organization and provision of qualified medical care to the population,
– organization and implementation of a set of preventive measures aimed at reducing morbidity, disability, maternal, child and general mortality,
– organizing and conducting events for sanitary and hygienic education of the population, widespread promotion of a healthy lifestyle,
– organizing and conducting quality control of patient treatment,
– pharmaceutical activities,
– control over the circulation of narcotic and (or) psychotropic substances.

To perform the main tasks and functions, the hospital, through its employees, organizes and carries out work to provide us with medical care, which we experience ourselves when we see a doctor (for example, timely hospitalization or referral for examination, etc.).

State Healthcare Institution “Efremovskaya District Hospital” includes the following structural divisions:

Polyclinic No. 1, st. Dachnaya, 4;

Polyclinic No. 2, st. Slovak Uprising, 18;

· women's consultation, st. Slovak Uprising, 18;

children's polyclinic, st. Dachnaya, 4;

· branch of the children's clinic, st. Druzhby, 26;

· Intermunicipal diagnostic and treatment center, st. Slovak Uprising, 18;

· outpatient hemodialysis department, st. Slovak Uprising, 18;

hospital with 325 round-the-clock beds according to the profile, including:
surgery department
infectious diseases department
maternity ward
cardiology department
day hospital with 43 beds according to the profile;
Stepnokhutorskaya outpatient clinic, Stepnoy Khutor village;
Bolsheplotavskaya outpatient clinic, Bolshie rafts;
Shilovskaya outpatient clinic, with. Shilovo;
twenty-three FAPs;
ambulance station

2. Purpose and tasks of the work:

Goal of the work: carrying out a generalized assessment of the provision of outpatient care in the Efremovskiy district and the related development of measures to improve the efficiency of the use of resources in healthcare, aimed at maintaining and improving the health of the population of the Efremovskiy district.

Tasks:

1. Select indicators for assessing the volume of outpatient care in the Efremov region for the period 2008-2012.

2. Compare the selected indicators with similar indicators for the Tula region.

3. Conduct a general assessment of indicators.

4. Make a conclusion about the effectiveness of medical care for children based on the results of the data obtained.

3. Analysis of selected indicators for the work of outpatient care in the Efremov district and the Tula region for 2008-2012.

1. Availability of outpatient clinics (units) in the Efremovsky district of the Tula region (per 10,000 population) 2008-2012.