Clinic - medical-preventive institution providing specialized medical aid coming to the sick, and the sick at home.
Clinic differs from dispensaries (see) large volume of activity and more specialized care (the number of specialized and auxiliary offices to provide skilled medical care in the clinic, much more).
In the USSR there are polyclinics in two types - United with hospitals (see) and independent.
The polyclinic has specialized offices (branches): therapeutic, surgical, obstetric and gynecology, ophthalmology, otorhinolaryngology, neurological, dermatological, trauma. Large walk-in clinics, in addition, there are also rooms: cardio-rheumatology, endocrinology, Oncology, tuberculosis, dental, teen, study of infectious diseases and other Auxiliary offices (branches) are: x-ray, physiotherapy, functional diagnostics, treatment; laboratories that conduct biochemical, clinical, bacteriological and other studies.
In the polyclinic is comprised of a reception area, reference section and administrative part, an office of statistics, library, health records. The clinic also includes health units (medical and paramedical) at enterprises, vocational schools, higher and secondary special educational institutions.
In the clinic providing medical and emergency treatment of acute and sudden illness, injuries and poisonings; medical treatment of ambulatory patients and patients at home with maintenance in necessary cases of hospitalization; conducting anti-epidemic measures (vaccination, identification of infectious diseases, the dynamic monitoring of persons who were in contact with infectious patients and convalescents, alarm, if necessary, authorities , and others).
Work of the clinic is based on dispensary method (selection of persons subject to dynamic monitoring, specialized treatment, a systematic study of working conditions and of life of the population). In the clinic are preventive measures that, in combination with the medical work are the main aims of polyclinics and play a crucial role in reducing the incidence among the population.
The clinic is dynamic control (preliminary and periodic professional examinations) over the state of health of workers of industrial enterprises and workers of adolescents and vocational school students. The selection of patients in need of sanatorium-and-Spa treatment.
An important part of the work of polyclinics is temporary disability examination of patients, liberating them from the work in necessary cases, timely referral in VTEC persons with evidence of persistent loss of ability to work.
The staff of the polyclinic conducts activities on organization of sanitary-educational work among the population served and workers of industrial enterprises and attracting public activists to help the clinic; maintains statistics of the activities of specialists in polyclinics and health indicators; reports on forms approved by the CSO of the USSR; conducting systematic analysis of statistic data, characterizing the activity of the clinic, in particular the analysis of overall morbidity and morbidity with temporary disability.
In the clinic regularly carries out activities to improve the skills of health workers. From a health guide doctors in the hospital in the system of rotation (at the time of the work of doctor in the hospital it is completely free from work in the clinic, and then the doctor comes back again to your medical area). In the clinic organizes seminars. Polyclinic physicians improve their qualification at the courses in the institutes of advanced training of doctors.
Clinic, combined with the hospital, managed by the chief doctor, which is the first Deputy of the chief doctor of the hospital. Independent polyclinics run by chief physicians and their deputies by a medical part.
Clinic in rural areas is mainly in the Central district hospital and is its part.
States of the doctors leading the admission to the clinic and providing care at home, as well as States nurses establish on the basis of norms stipulated by the order of Ministry of health of the USSR (see Medical area).
The nurses at the polyclinic conducts jointly with doctors care for the sick in the offices of district and the Guild of physicians and medical specialists; sisters are independent work in treatment, physiotherapy and other offices, performing doctor.
Nurses perform a doctor at home, in the health units and the patronage of patients and conduct vaccinations among the population on medical stations.
For reception of patients in cases of urgent need to watch the absence of a local doctor appointed doctors on duty. On weekends in the clinic are doctors on duty all major specialties.
One of the major functions of each clinic is providing medical care at home (see Help at home), including emergency.
For emergency after-hours care clinics with one or more district polyclinics are organized er, providing assistance both at home and out-patient in the evening, night and weekend (see Ambulance).
For treatment-and-prophylactic help to children (from first year to 14 years) organized a special children's polyclinics, which are all kinds of specialized care. Like medical sites for adults at children's clinics organized pediatric areas served by regular precinct pediatricians and attached to the sites by medical specialists.
All children's population of the serviced area is registered at children's clinics and actually dispanserization (nursery, pre-school and school age).
In major resort towns resort polyclinics, in which patients coming for treatment without permits, get specialist advice and medical assistance and recommendations on the use of local resort factors.
Polyclinic (from the Greek. polis town and klinike - treatment - treatment-and-prophylactic institution dedicated to providing specialized medical aid coming to the sick and to treat them at home. From dispensaries (see) clinic has a broad scope of business and taking on all medical specialties. As a rule, clinics are part of the merged hospitals (see) or health of the parts (see) industrial enterprises, but can exist as an independent institution.
Depending on the number of medical posts (from 100 to 30) P. fall into four categories (children P. - five).
In modern clinics are available: reception Desk; offices (or with less of a work - units) in the specialties - medicine, surgery, traumatology, ophthalmology, otolaryngology, neurology, dentistry, helminthology, infectious diseases, emergency care; cabinets and adolescent preventive examinations; auxiliary cabinets - x-ray, physiotherapy, physiotherapy, functional diagnosis (electrocardiography), procedural (prescription); lab - diagnostic, biochemical, bacteriological, denture; insulator; administrative part, book-keeping, office accounting and medical statistics, medical archive, library with reading-room. If the service area of P. no children's clinic, special dispensary (see) and antenatal clinics (see), they will be organised as part Pobycie in Petrograd there is a pharmacy or shop. The relevant specialized departments are established at the state P. at least 8 therapists and dentists, 6 surgeons, 4 ophthalmologists and laryngologic and others With fewer medical posts are arranged rooms.
When planning activities polyclinics and its States come from indicators such as the reception of patients, the attendance. To plan attendance P. essential to have accurate data on the population served. For this purpose, P. periodically (as needed) produces by its precinct honey. sisters account of the population living and working in the territory of operation of this Paragraph. All territory is served by P., divided by the medical areas. According to the standards set by the Ministry of health of the USSR, one of the medical therapeutic area should have 3-4 thousand people of the adult population (see Medical area). In the precinct principle maintained by the workers and the industrial enterprises with the medical unit. If the company does not have the medical unit, its workers and employees are entitled to receive medical care in the clinic, on-site service which is given company.
As the rules of needs of urban population in outpatient care at present, it is commonly thought of the calculation of an average of 10 visits P. one inhabitant per year. The Ministry of health of the USSR established norms hour load of doctors on separate specialities outpatient clinics. These standards are consistent needs dispensaries and clinics doctors.
Most of the work on the organization of reception and distribution of the coming P. sick lies on the main Desk. The centralized system of the device registry preferable decentralized. Concentration in one place of all the work on the documentation relating to the reception of patients, it is advisable that allows to reduce the waiting time of an appointment, shall maintain in Petrograd common history (see). Great attention should be paid to the external design of the room registries and optimizing the working place of the Registrar. Most convenient for storing medical records cabinets-drums rotating in the vertical axis. The main difficulty in the work of the registry is the right distribution between doctors of the patients in those cases when free places an appointment at the doctors already there. In such cases, patients are offered either preliminary record on another day, or (if you want to get an appointment on the same day) the question is left to the discretion of the physician on duty, who makes a decision according to medical indications. The rooms where patients expect to receive, should be furnished with beautiful furniture provided with fresh Newspapers, illustrated magazines, sanitary-educational literature. The main working place of a doctor in the polyclinic is the Cabinet, so it is the device should be paid proper attention. The area offices should correspond to conditions of work of the doctor, depending on the specialty. It arranged in a doctor's office cabins for undressing and dressing patients, which increases the useful time doctor.
Prevent medical work in the clinic of high and also uneven load. The main causes overload: a mismatch in the number of doctors needs of the population, unsustainable use of time doctor. Constantly working at the reception the nurse can help the doctor in the design of the records in medical documentation and execution of various procedures. As in hospitals, in P. it is necessary to implement taking into account the specifics of medical work the most rational methods of record keeping (see medical Documentation). To improve the skills of the doctor P. promotes his work in the hospital at the berths of the patient. The most rational recognized sequential operation of doctors in Petrograd and in the hospital, so-called system of rotation, at which the doctor directed to work in the hospital, completely free from work in the clinic, and then he returned to his workplace, on their doctor's plot. Promotes professional growth of doctors and the quality of public services, the principle of uchastkovoe. This principle is embedded not only in the work of physicians, but physicians of all other professions.
The largest Department in Petrograd - therapeutic, it accounts for up to 40% of all outpatient visits to polyclinics. Further specialization of outpatient care has led to the organization in the therapeutic Department cardiological and endocrinology rooms. A special place in the work of the therapeutic Department belongs to the Cabinet of infectious diseases, which replaced the so-called Cabinet of intestinal infections. Classrooms infectious diseases are organized for infectious disease specialists together with local doctors were actively involved in the treatment and prevention of all communicable diseases. Surgical Department P. provides up to 20% of all visits. The appropriateness of the allocation trauma of the Cabinet in the surgical Department has been confirmed by practice. In large polyclinics trauma rooms are working around the clock, providing emergency and medical trauma care for all patients attending about injuries.
One of the essential features of each city., and the most important part of the activities of all her doctors is to provide a medical home care, including emergency. Optionally, district nurses carry out in-home patient care, do physiotherapeutic procedures, take the material for laboratory research, provide dietary meals. Such a system service called hospital at home. An important part of the work of P. - organization of close ties with hospitals in the preparation of patients for admission. In treatment after persisting must be observed continuity.
Up to 40% of all patients visiting the clinic, occur in people with temporary disabilities. Accordingly is of great significance in the activity of P. medical assessment of disability and particularly the examination of temporary disability (see Review). The quality of medical assessment of disability in Petrograd, to some extent depends on the reduction of morbidity with temporary disability of workers and employees. In Petrograd in the presence in the state of 15 doctors and more, leading directly outpatient reception of patients, established a special post of a Deputy chief doctor on examination of ability to work and CWC, who is the leader of this branch of medical work in P.
Along with the medical work in the functions of polyclinics is still preventive activity: measures to improve conditions of work and life, the fight against infectious diseases. In medical examination (see) of certain populations combination of preventive and curative methods and goals. The staff conducts medical examinations in close cooperation with doctors enterprises. The Central figure, which provides in paragraph dispensary services to the population, is a district therapeutist both territorial and workshop areas, he had to bear the main responsibility for carrying out direct regular medical service of population of the area and for the involvement of dispensary observation of doctors of other specialities: surgeons, neuropathologists, otolaryngologists, ophthalmologists and dentists.
Analysis of activities of the clinic, i.e. summary and objective estimation of efficiency of its work is the basis for qualified management and control. The analysis of activity of Peterhof is conducted according to the official report, and on the set of source accounting materials. The main work on accounting and reporting in Petrograd are offices records and health statistics, major P. there is a doctor-statistician.
To analyze the activity of polyclinics usually use the whole system of indicators. Among them the most important are: oblojennosti population outpatient medical care (the number of outpatient visits per year per one inhabitant of the serviced area); dynamics of P. visit by year and individual medical specialties, seasonal and diurnal variations in load P.; the structure of visits and the ratio between the number of home visits and outpatient visits from individual medical specialties. The next group of indicators is intended to characterize the activities of doctors P.: load doctors (one hour), a measure of frequency, active follow-up visits at home and degree of oblojennosti various support departments. Among the important indicators include the rate of uchastkovoe of service of the population and, ultimately, the rate of paramount importance - the health status of the population served.
Directs the clinic on the rights of unity of command chief doctor, who has three deputies: by a medical part, examination of invalidity and administrative-economic part.
In all aspects of the P. involved the public, P. created public Council.
Cm. also out-of-Hospital services, Medical care, home care, emergency and First aid.