MEDICAL AND ORGANIZATIONAL ASPECTS OF OPTIMIZING THE ADMITTING DEPARTMENT ACTIVITIES IN AN EMERGENCY HOSPITAL

Introduction. Public medical care accessibility and quality are strategic objectives of domestic healthcare. Successfully solving these problems is greatly facilitated by the efficient operation of 24-hour hospitals, which largely depends on the quality of the admitting department that significantly impacts the efficiency of the entire hospital. Aim of the study is to optimize the admitting department activities of a multidisciplinary emergency hospital, based on reasonably organized admission of patients, differentiated sorting, and subsequent routing of patients depending on their condition severity. Materials and Methods. The study was carried out based on Voronezh City Clinical Hospital of Emergency Medical Care No. 1, which is a 24-hour multidisciplinary hospital with a capacity of 800 beds. The study was aimed at the main activities of the admitting department of the said hospital and ways to optimize them. To achieve our goals, we used analytical, statistical, and system analysis research methods. Statistical data processing was carried out using the StatSoft STATISTICA software program. The assessment of the study results is presented in the M±SD format (M – mean, SD – standard deviation). Results and Discussion. An analysis of the structure of the medical advice-seekers in the hospital showed that 42 % of patients were delivered to the hospital by an ambulance team, 32.7 % were admitted by the medical institution, and 25.3 % appeared by “self-referral”, which, taking into account their varying condition severities and comorbidity pathologies, required additional time spent on re-issuing medical documents, re-entering patients’ personal data into the medical information system, and providing different scopes of medical care. To increase the efficiency of the admitting department and the entire hospital, the position of a hospital administrator on duty was introduced; the medical triage system (triage) was developed and implemented, which, at contacting them, allows dividing patients into 3 streams differing in the demand for homogeneous treatment and prevention measures, and queuing for such activities, which made it possible to develop universal standard operating procedures and significantly improve the key indicators of hospital activities. Conclusions. As a result, innovative approaches have been proposed to optimize the admitting department activities of an emergency hospital, related to the elements of lean healthcare, which allows differentiated medical triage followed by patients’ routing depending on their condition severity