WORK ORGANIZATION OF HEALTH CARE INSTITUTIONS PATIENT ADMISSION INTO HOSPITAL - BASICS

1. WORK ORGANIZATION OFHEALTH CARE INSTITUTIONS PATIENT ADMISSION INTO HOSPITAL - BASICS

2. Healthcare institution • Institution that provides health care services

3. Services of health care institutions • Population health management • Disease prevention • Diagnostic • Therapy • Rehabilitation • Employee education programs • Health care programs conducting • Waste disposal • Improving quality of work

4. Health care services • Health technologies - technologies that are used in health care • prevention • diagnostic • treatment • rehabilitation Aim: POPULATION HEALTH IMPROVEMENT • HEALTH TECHNOLOGIES • proven • safe • checked • APROVED BY MINISTRY OF HEALTH

5. Health care institution may be founded by: • Republic • Autonomous province • Municipality • Legal entity • Individual

6. Types of medical facility • Community health center (Level III trauma center) • Hospital (Level II trauma center) • Pharmacy • Clinic • Clinical hospital center • Clinical center (Level I trauma center) • Institute • Public health institute

7. Conditions that healthcare organizations must meet: • Type and number of health care professionals • equipment • facilities • drugs • Medical devices • Healthcare services are delivered onthree levels

8. HEALTH CARE LEVELS Primary health care Secondary health care specialized consultative activities Hospital activities Tertiary health care The most complex specialized consultative activities Hospital activities science investigation activities • Health protection and promotion • Prevention and early diagnosis • Therapy and rehabilitation of patients • Health care of special social groups • health education and counseling

9. Traumatic injuries and levels of health carePyramidal structure of treatment URGENCY LEVELS TERTIARY HEALTH CARE Trauma center LEVEL I SECONDARY HEALTH CARE Trauma center LEVEL II Trauma center LEVEL III PRIMARY HEALTH CARE

10. Management of healthcare institution BOARDS PROFESSIONAL BODIES EXPERT COUNCIL - Questions of professional work - Program of professional work - Control and the quality improvement SENIOR STAFF - professional and doctrinal stance ETHICAL BOARD - ethics of medical work - Research - approval  - patient - health worker  relationship - advisory function  COMMISSION FOR IMPROVING THE QUALITY OF WORK - Annual Program of checking the quality of work • DIRECTOR - organize work - manage the activities - represent an institution • MANAGING BOARD - Statute - decisions on activities - development program • SUPERVISING BOARD - Monitoring work and performance

11. CLINIC • tertiary health institution • Patient health care to CERTAIN BRANCHES of medicine • RESEARCH – EDUCATIONAL ACTIVITY • EDUCATIONAL ACTIVITIES • at the headquarters of the University with Faculty of Medicine • activity of the General Hospital

12. INSTITUTE • all as CLINIC + • LAB – services • RTG - services • anesthesiology • resuscitation • transfusion

13. MEDICAL CENTRE • all as CLINIC + • activity of ONE or MOREbranches of medicine • hospital activity

14. CLINICAL CENTRE • It combines THREE OR MORE clinics in the functional unit • specialized consultative activities • patient health care • educational activities • research activities • HIGHEST LEVEL OF HEALTH SERVICES

15. PATIENTS ADMISSIONinto hospital

16. Patients admission into a health facility is result of the need to solve his medical problems.

17. Admitted patient • Should accept the proposals for diagnostic and treatment • Should be adjusted to the program of diagnosis and treatment • Needs to make difficult decisions about his health (major surgery, risky treatment, toxic drugs ...) • abide by the house rules during his stay in hospital

18. Ways to admission • URGENT ADMISSION • difficult general situation • Ambulance brings him • priority to establish and maintain vital functions • care of injuries

19. Ways to admission • CONDITIONAL EMERGENCY ADMISSION • AFTER INSPECTION AT THE CLINIC • deterioration of general condition, if not admitted • an unpleasant surprise for the patient • doctor has to introduce a patient with health risks in the reception delay

20. Ways to admission • ELECTIVE (scheduled ) ADMISSION • AFTER INSPECTION AT THE CLINIC • scheduled date of admission • the patient ismentally prepared • patient is medically prepared : previous examination by a specialist, LAB. examinations, additional diagnostic methods previously committed

21. Child admission to hospital • The unpredictable behavior of the parent-child • Separation of the child and parents - stress • The attitude during the admission (friendly, kindness, play, chat) • Importantconstant communication and cooperation between parents and doctors

22. MEDICAL RECORD

23. MEDICAL RECORD • „Case" of patient – all records about patient at one place • 1st page - personal data and insurance information • 2nd page - Anamnesis and Clinical findings on admission • 3rd and 4th page - "Decursus morbi" - description of the course of diagnosis and treatment and any changes in the patient - in chronological order • - "Epicrisis" - a brief description of the course of treatment

24. MEDICAL RECORD • Disposal of any additional findings ( LAB., RTG, consultative findings, other additional findings) • Forensic document! • It is kept in the archives for 10 years. • Electronic medical records - facilitates the monitoring of a disease, and scientific research

25. MEDICAL RECORD • Receiving for hospital admission - gives the physician that indicates acceptance - person responsible for the hospitalization and the treatment of the patient • „Consent to hospitalization“ - Signature of patient • A copy of the hospital dischargeu • Epicrisis - Suggestions for further treatment, controls...

26. BASIS FOR ADMISSON OF PATIENTS IN HOSPITALS

27. BASIS FOR ADMISSON OF PATIENTS IN HOSPITALS MEDICAL - need for DG, Th and rehabilitation  NONMEDICAL - social needs

28. Diagnosis Identification and determination of disease  Parts: • Anamnesis ( 70% ) • Clinical findings ( 20%) • Additional DG methods ( LAB, RTG, CT, MRI...) (10%)

29. Treatment • application of the technology of modern medical science Aim : disease removal. Achieving a harmonious interaction of physical, mental emotional and cognitive needs of man

30. Rehabilitation Aim : Avoiding the handicap or disability of the patient. • achieve body maximum after an illness or injury • MOTIVATION 

31. HOSPITAL ADMISSIONSOCIAL NEEDS • Often beyond the current physical condition  • elderly people with chronic illness, social welfare  • neurology, internal medicine, social psychiatry  • substance abuse, vocational rehabilitation...

32. Patient-illnes relations • Active-cooperating attitude • "fighter's stance"- extremely combative • Capitulatingattitude - givingup, there is no energy to fight the disease • Avoiding attitude - denies illness, does not accept the doctor's instructions  • Anxiety (suddenly emerged disease, severe pain ..) • Regression - withdrawal on the depending level of others • Depression • Agression

33. Evaluation of the patients condition • External appearance • Head and Neck • Thorax • Abdomen • Extremities • CONSCIOUSNESS • Somnolence • Sopor • Coma • VITAL SIGNS • Breathing • Heartbeat, circulation • Temperature • POSITION • Active • Passive • Compulsive

34. Position of patient • ACTIVE • PASSIVE • Difficult, immobile, dependent on someone else's care  • COMPULSIVE • dependent on the nature of the disease,DG and Th procedures • TEMPORARY • Fovler – half-sitting • Trendelenburg- leg elevation • Koleman - side • Quincke - knee-elbow • CONSTANT • extension • ophistotonus..

35. Consciousness • SYNCOPE - short period (acute cardiac condition, sunstroke, heat stroke) • SOMNOLENCE - sleepy, verbal contact preserved • SOPOR - partially wakes up on strong stimulus, verbal contact slow, brief  • COMA– no response on strong stimulus, loss of motor and sensory function

36. Consciousness • Some causes of disorder : • BRAIN TRAUMA • LIVER, KIDNEY DISEASE, ENDOCRINE AND METABOLIC DISORDERS  • CEREBROVASCULAR DISEASE  • CARDIOVASCULAR DISEASE • INTOXICATION • NEUROLOGICAL DISEASE • PSYCHIATRICDISEASE

37. COMA • Glasgow Coma Scale • 3-15 points

38. PHYSICAL PARAMETERS • CONSTITUTION - looks and body shape, body fluids, the character, the response to the adverse effects  • HEIGHT - a combination of genetics and environmental influences, important in pediatrics, rising to the closure of epiphyseal cartilage, decreases after the 60-year life • Mass of the body - bone, muscle, water, fat. Assessment of nutritional status, BMI

39. The level of nutrition • According to BMI values ​​of the degree of nutritional status is as follows : • malnutrition  < 18,5 kg/m2 • Normal nutrition 18,5 - 24,9 kg/m2 • Overweight 25,0 - 29,9 • Obese class I 30,0 - 34,9 • Obese class II 35,0 - 39,9 • Obese class III ≥ 40,0

40. VITAL PARAMETERS • TEMPERATURE • BREATHING • BLOOD PRESSURE

41. TEMPERATURE • elevation and lowering physiological and pathological • thermoregulatory center ( toxins, products of protein metabolism ) • > 37 C - HYPERTHERMIA • < 36 C - HYPOTHERMIA • mild : 32-35 • medium : 28-32 • „controled-therapeutic" ( postresuscitation syndrome)

42. ELEVATED TEMPERATURE • Hyperthermia passes through the following phases: • subfever - from 37.10 to 37.70 C • fever - from 37.80 to 39.00 C • high fever - from 39.10 to 40.90 C • hyperpyrexia - over 41.00 C

43. Temperature measurement • axillary • inguinal • popliteal • oral • rectal ( higher by 0.5 ) • vaginal • tympanic ( eardrum)

44. Temperature measurement • twice daily • thermometer with mercury • digital thermometers • entered in the TEMPERATURE CHART • monitored its PROGRESS • Stadium INCREMENTI - increase • Stadium FASTIGII - maximum • Stadium DECREMENTI – temperature lowering: • litical - gradual • critical - abrupt (sweating)

45. Types of temperature curves • Febriscontinua • oscillations of less than 1 C • abrupt increase • pneumonia, typhoid fever

46. Types of temperature curves • Febris remittens • oscillations greater than 1 C • minimal >37 C • pneumonia, typhoid fever • TBC

47. Types of temperature curves • Febrisintermittens • oscillations 2-3 C • minimal < 37 C • malaria

48. Types of temperature curves • Febrisseptica • oscillations 2-3 C • max. very high temperature • min. >37C • sepsis • Febris hectica abrupt fall to normal temperature severe TBC

49. Types of temperature curves • Febris recurrens • high all day, • then all day normal. • abrupt increase • purulent focuses, malaria

50. Types of temperature curves • Febris undulans • gradual increase • and gradual decrease to normal temperature • shape of „wave" • Brucelosis, MTU