Новое в профессиональных компетенциях персонала стационарного отделения скорой медицинской помощи

Abstract

The purpose of the study is to determine the professional competencies that are in demand among emergency medical personnel when they provide medical care in an inpatient department. Materials and research methods. We compared the impersonal reports on the work done by 20 doctors of specialized substations of the emergency medical service in St. Petersburg for 2015–2017 with the information about work in the mode of daily activities in 2017 of 10 doctors in the intensive care unit of the inpatient department of the Emergency Medical Service of the First St. Petersburg State Medical University named after academician I.I. Pavlov, stored in the qMS medical information system of the University. The volume of instrumental examination of patients who sought medical help, received it in the required volume and were discharged in a satisfactory condition within the first day, was assessed. We compared the results of ultrasound diagnostics performed by the emergency doctors in the screening mode using portable equipment with the results of the work of a consultant-specialist. 701 medical records of inpatients from among those admitted to the Medical University were analyzed. By studying 4573 medical records, possibility and effectiveness of independent primary triage of the incoming patients by the nursing staff was determined. In addition, with the help of the FlexSim HealthCare program, which allows to effectively predict and to simulate changes in work processes within medical institutions, computer simulation of the department’s work was carried out in the conditions of autonomous work of an emergency doctor. Statistical comparison was performed using the Mann-Whitney test, Student’s t-test for unrelated values, and analysis of four-field tables using the χ-square test. Research results and their analysis. Analysis of the research results showed: fundamental principles of work of the staff of inpatient department — multidisciplinarity, multitasking, autonomy. An ambulance doctor working in a stationary environment must be able to independently diagnose, to treat patients with various pathologies, and to simultaneously supervise several patients; having the level of practical and theoretical training specified in the professional standard, the emergency doctor can effectively provide resuscitation care in the volume of I – II levels, which is especially important, given the short time spent by patients in the department; professional standard of the emergency doctors requires to master ultrasound diagnostics to identify gross pathological conditions and to perform a number of manipulations; nursing staff working in the inpatient department must be able to work in an autonomous environment. Triage by nurses is effective and allows to identify patients who need an immediate examination by an EMS doctor. The use of a three-level sorting algorithm does not contradict basic principles of medical triage used in world practice.