Сравнительная характеристика затрат рабочего времени врача-челюстно-лицевого хирурга, оказывающего помощь в стационарных условиях, в условиях организационного эксперимента.

Abstract

In the system of organization of provision of specialized medical care on the profile of maxillofacial surgery there are significant changes in connection with the digitalization processes, the introduction of new medical-diagnostic technologies, the development of surgical interventions, that has a significant effect on the working time of the doctor – maxillofacial surgeon. Purpose of the study is to study the working time of the doctor-maxillofacial surgeon, who provides assistance in stationary conditions with the help of photochronometric measurements in dynamics before and after the introduction of organizational measures. Materials and methods. The study was carried out in 2018 and 2023, before and after the introduction of organizational measures, on the basis of the department of maxillofacial surgery of the Penza regional clinical hospital. N. N. Burdenko». Doctors-maxillofacial surgeons took part in the study. The following methods were used: analytical, photo-time, organizational experiment, statistical. In the course of the photo chronometric research, all activities were studied: main activity, document processing, support activities, work, other activities, personal time required, unencumbered time. Results and Discussion. Analysis of the data obtained showed that doctors-facial surgeons in 2018 conducted an average of 9.75+0.1 hours at the workplace, which is 1.95 hours above the norm. According to the results of the study the article reveals an imbalance of working time expenditure, significant time spent on unusual functions (provision of medical assistance in the reception department, completion of medical documentation)There’s a lot going on. Problems in the regulation of work of doctors-maxillofacial surgeons, as well as shortcomings in the organization of medical care on the profile of «maxillofacial surgery» were revealed as a result of the photochronometric researchIt was possible to identify the main directions for improving the provision of specialized assistance in the field of PF. After the behavior of organizational arrangements (change of localization of the department, staffing, new patient routing, strengthening of continuity) The results of a repeated photochromic study conducted in 2023 showed that the structure of the working time expenditure has changed significantly: the share of main activities has decreased from 61,46% in 2018 to 59.7% in 2023, the duration of work with medical documents increased from 16.3% to 20.1%, costs for support activities decreased from 14,63% to 7.6%, The cost of performance increased from 4.59% to 5.6%, personal time required increased from 0.86% to 2.0% respectively. In 2023 there is no open time (late to work). The organizational changes made have had a positive impact on the quantity of quality of the bed. The average duration of treatment in 2018 was 7.92 days, and in 2023–5.53 days. In 2018, the pre-operative bed day was 1.05 days, and in 2023–0.17 days, decreased by 6.2 times. Conclusions. It was found that the organizational changes, directly related to the opening of the regional center of maxillofacial surgery, allowed to change the routing of patients, improve the continuity with specialists of dental, traumatological, oncological, pediatric profile, rational use of personnel resources, provide assistance to children. The optimization of doctors’ activities has had a positive impact on the quantity and quality of the bed. A comparative description of the work time spent before and after the organizational experiment shows that the activity of the surgeonmaxillofacial round-the-clock hospital has changed significantly due to the reduction of the cost of performing unusual functions.