In our country, medical care is organized according to the territorial principle; however, with the development of insurance and private medicine, this principle, especially in relation to planned care, begins to change.

Surgical care organizations

Feldsher Obstetric Station – provides emergency first aid, performs prevention of diseases and injuries of the inhabitants of one or more rural settlements.

The local hospital provides urgent and urgent medical care for acute surgical diseases and traumas, performs work for their prevention, manages the work of feldsher-obstetric points located in this area of the district.

Regional Hospital – provides surgical care for all patients with acute surgical diseases and trauma, performs planned treatment of the most common surgical diseases (hernia, gastric ulcer, Cholecystitis, etc.)

Regional hospital – in addition to the volume of assistance offered in regional hospitals, provides specialized surgical care: urological, traumatological, oncological, etc.

City hospitals – provide urgent and planned surgical care for residents of city districts.

Surgical departments of medical universities – in addition to providing surgical care, they carry out the scientific development of certain sections of General Surgery Instruments.

Research institutes – in accordance with their profile, offer special surgical care, carry out the scientific development of surgical problems.

Hospital surgical care is provided in three types of surgical departments: general, specialized, and highly specialized (centers).

General surgical departments are organized as part of district and city hospitals. They provide the main types of qualified inpatient surgical care for the majority of the country’s population. Various diseases are treated here, among which more than 50% are due to acute surgical pathology, and 20-40% are due to injuries and diseases of the musculoskeletal system.

Specialized departments are opening up in regional and city hospitals and serving from 50,000 to 3 million people. They aim to provide patients with surgical care in their respective specialties. The organization of specialized departments is based on similar principles that contribute to the concentration of patients on a certain basis:

* · For a disease of an organic system – departments of vascular surgery, lung surgery, proctology, urology, etc. .

* · From nosologically forms, taking into account localization – departments of burns, genitourinary and osteoarticular tuberculosis surgery, etc. .

* · According to the sections of surgical pathology – departments of oncology, emergency surgery, purulent surgery, etc.

* · According to the features of the methods of operations – plastic surgery.

* · According to age characteristics – pediatric surgery.

General surgical departments open, as a rule, for 60 beds or more, specialized ones – for 25-40 beds. An important part of the city and region hospitals are clinics, as the surgical clinics of medical institutes operate on their basis. Surgical beds are also available in special clinics of medical institutes that are not part of the city network, in research institutes under ministries and departments, in the institutes of the Russian Academy of Medical Sciences.

They are organizing urgent and urgent surgical care. In cities, it is performed according to the scheme: ambulance (health center or polyclinic) – surgical hospital. In the village: feldsher-obstetric station, district hospital – surgical department of the district hospital. Surgeons, anesthesiologists, and operating nurses are on duty at all times in the surgical departments to provide urgent surgical care.

ORGANIZATION OF THE WORK OF THE SURGICAL DEPARTMENT

Surgical departments should be located in the same building as the admission ward, operating unit, intensive care unit, and intensive care unit, as they are functionally interdependent. Neighborhood departments are organized for 60 or more beds. According to the Snip (Building Norms and Regulations, 1971), the departments in the new hospitals are planned by two impassable sections, which are separated by halls. The section should have 30 beds. The ward section includes an on-duty nurse (4 m 2), a treatment room (18 m 2), a dressing room (22 m 2), a dining room (with at least 50% of the number of beds), a room for the classification and temporary storage of dirty clothes, cleaning items (15 m 2), bathrooms (12 m 2), enemas (8 m 2), baths (for men, women, staff). Along with this, the department needs the office of the chief (12 m 2), the living room (10 m 2 for each doctor, in addition to an additional 4 m 2), the room of the head nurse (10 m 2), and the sister of the lady (10 m 2). The clinics offer offices for one professor, associate professors, assistants, and classes for 10-12 people.

The ward is the main place of stay of the patient in a medical institution. In the words of the surgical department, 7 m 2 are allocated for one bed. Most wards in the section are planned for 4 beds, 2 – wards with two beds, 2 – wards with one bed. The optimal number of beds in the ward is 3. Before entering the ward, a gate is planned, which is provided as a small anteroom, where there are integrated individual lockers for patients and an entrance to the toilet, with a sink, bath, or shower. The wards are equipped with metal beds, to which a transfusion stand, and a skeletal traction device can be attached. Most beds should be functional. The interior of the room is complemented by a desk, an ordinary table, chairs, and a wastepaper basket. The temperature in the ward should be 20 ° C. The optimum air humidity is 50-60%, and air mobility is about 0.15 m / s. Rooms should be well lit with natural light, the orientation of the windows should not be to the north. The ratio of the surface of the windows and the floor should be 1: 6. General and local electric lighting is provided. Each bed has a ward system in the ward.

The ward nurse post is placed in the hallway in order to provide a good overview of the rooms. The post is located in the center of the section. It is equipped with lockers for storing medicines, tools, care items, and documentation (medical appointment sheets, transfer of duty, etc.).

When placing patients, it is necessary to take into account the characteristics of the contingent, so clean and purulent departments should be distinguished. This will make treatment more effective, and most importantly, prevent complications.

Surgical departments should be equipped with forced ventilation and separate rooms with supply and exhaust ventilation or air conditioning. The premises of surgical departments should be cleaned with a damp method, using a disinfectant, twice a day: in the morning after patients get up and in the evening before going to bed. Once a month, it is necessary to carry out general cleaning, with wet disinfection of mattresses and pillows. Air samples should be taken monthly for bacteriological examination.

The organization of the work of the medical staff is regulated by the “Model internal regulations,” based on which rules are drafted for different institutions, depending on their purpose. Every surgical department has a daily routine that aims to create rational working conditions for medical staff and optimal conditions for healing patients.

Special requirements are imposed on the staff of the surgical department: the human qualities of the staff are no less important than their qualities as specialists. It is necessary to impeccably follow the principles of deontology and medical ethics. Deontology (Greek Deon -due, logos – doctrine) is a set of ethical and organizational standards for the performance of professional duties by health workers. The main elements of deontology are aimed at creating a special psychological climate in the surgical department. The main function of the psychological climate in a surgical institution is to create the conditions for a fast, high quality, and reliable recovery of patients. Two main goals come from this:

* · To minimize the effect of factors that slow down and qualitatively worsen the healing process of patients.

* · To maximize the degree of perception of patients for a more appropriate lifestyle for maintaining health.