Міждисциплінарний підхід до удосконалення організації хірургічної допомоги пацієнтам з патологією щитоподібної залози

Abstract

The interdisciplinary approach is recognized as the gold standard for organizing medical care for patients with oncological pathology. It is declared at the normative level in Ukraine, but the forms and methods of work, channels and methods of communication of specialists are not detailed. This requires further research, in particular, when providing surgical care to patients with thyroid pathology. The purpose of the study was to investigate the state of activity organization of multidisciplinary teams in the provision of surgical care to patients with thyroid pathology and to propose approaches for its improvement. Materials and methods: accounting forms No. 003 for 2019 (1208 units), constituent and administrative documents for the institution, department regulations, job descriptions, clinical pathway of patients (15 units in total). The base of research was communal non-profit enterprise "Kiev City Clinical Endocrinological Center". The methods, which were used, are systematic approach, medical and statistical, medical and geographical methods, content analysis, graphic. Results and discussion. Patients of the Department of Endocrine Surgery were from almost all regions of Ukraine. 3.5% of patients were referred by a general practitioner, 55.7% - by an endocrinologist, 40.1% - independently applied. Malignant neoplasm of the thyroid gland was detected in 33.9% of patients, non-toxic multinodular goiter – in 25.2%, benign neoplasm – in 16.3%. In 448 (37.1%) patients, 687 concomitant diseases and complications were identified. Their structure consisted of diseases of the heart and circulatory system – 40.0%, eye diseases – 3.1%, diseases of the nervous system – 2.0%. In order to meet the needs of patients, instrumental and laboratory studies, consultative examinations, consultations and surgical interventions were carried out. The low level of communication between inpatient doctors and outpatient doctors has been shown. This was the reason for the excessive length of stay in bed – 12.6 ± 2.7 days. There is a separate participation of specialist doctors in accompanying patients in the hospital. It was proposed to formalize the official status and develop a typical provision for a multidisciplinary team of specialists; joint discussion, debate, data exchange within the team and with outpatient doctors; afford access to corporate information for the team and coordinate the work of authorized employees. Conclusion. Improving the efficiency of multidisciplinary teams is possible by strengthening collaboration within the team and communication with outpatient doctors