The analysis was applied concerning distribution of patients' flow depending on nosology forms of diseases and departments of hospital. The integrated value included number of treated patients and duration of treatment. The study established that the main groups of diseases determining the load on corresponding departments of hospital are cerebro-vascular diseases in neurologic department; diabetes mellitus in endocrinology department; pneumonia, chronic bronchitis and asthma in pulmonology department; urolithiasis in urology department; abnormal bleedings of female genitals in gynecology department; trauma of femur in traumatology department; cholelithiasis and cholecystitis in general surgery department. The developed differentiation of patients' flows makes it possible to determine the demand of diagnostic and treatment technologies in the particular hospital.
The problem of emergent transportation and early surgical care of patients with aneurysmal SAH is well recognized due of high risk of fatal rebleeding. Currently, this problem is resolved in most of developed countries. The purpose of the study was to analyze causes of late admission of patients with ruptured cerebral aneurysms to highly specialized clinics such as Burdenko Neurosurgical Institute. The work is based on data of 101 patients with cerebral aneurysms admitted in 2007 within time period exceeding one month after SAH. 14% of patients were submitted from Moscow and near-by regions, 86% -- from far-off regions of the country. 29.7% had the history of recurrent bleedings. Primary admission to the local hospital in 65% of patients was on Day 0 and in 80% -- within the first week after SAH. Leading causes of the delay of primary admission were underestimation of the severity of patient's status by ambulance staff (52.5%) and delayed applying for medical help by patient (42.5%). After admission, in most cases treatment was conservative regardless of patients' condition. The median time of aneurysm diagnosis was 1.6 months and the median time to admission to Burdenko Neurosurgical Institute -- 3.7 months. The need for better organization of emergent care in cases of SAH is obvious. Possible decisions lay in establishing training programs for physicians; making neurosurgical care more accessible, developing neurovascular units in regional hospitals and easy-quoted federal financing coverage.
The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in order to identify important logistical and clinical areas for the duration of the hospital stay.
According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. This took place from late 2004 to mid 2005, and all written material and 25 journals from each department were evaluated, and interviews with the heads of the departments as well as the staff were conducted. The logistical set-up and the clinical treatment/pathway were examined in an attempt to identify logistical and clinical factors acting as improvements or barriers for quick rehabilitation and subsequent discharge.
Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more time on and up-to-date information including expectations of a short stay, functional discharge criteria) and clinical features (multi-modal pain treatment, early mobilization and discharge when criteria were met) facilitating quick rehabilitation and discharge.
Implementation of logistical and clinical features, as shown in this study in all departments, are expected to increase rehabilitation and reduce the length of hospital stay.