Order on functional diagnostics 283. On improving the functional diagnostics service in healthcare institutions of the Russian Federation. Recommended staffing standards for the functional diagnostics room of the cardiovascular system
In the context of health care reform and the transition to health insurance citizens, the task of developing and implementing new medical technologies, including diagnostic systems and complexes that make it possible to increase the efficiency of the diagnostic and treatment process and reduce economic and labor losses.
In this regard, the role and importance of functional research methods, which are widely used for the purpose of early detection pathologies, differential diagnosis various diseases and monitoring the effectiveness of therapeutic and health measures.
In 1993, there were 10.7 thousand departments in medical and preventive institutions of the republic functional diagnostics, in which about 60 million studies are conducted annually.
Didn't receive it system development development of domestic diagnostic equipment necessary for the technical equipment of healthcare institutions at all levels. In medical and preventive institutions, metrological support of measuring instruments is carried out at an extremely low level.
It is necessary to take effective measures to strengthen the interaction of functional diagnostics with other diagnostic services and the introduction of diagnostic algorithms.
In order to improve the organization of the functional diagnostics service and improve the quality of its work, the rapid introduction of new diagnostic methods, as well as improving personnel training and technical re-equipment of units with modern equipment
I affirm:
1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and republics within the Russian Federation, regional (territorial), city departments, health departments (Appendix 1).
2. Regulations on the department, department, functional diagnostics room (Appendix 2).
3. Regulations on the head of the department, department, functional diagnostics room (Appendix 3).
4. Regulations on the doctor of the department, department, functional diagnostics office (Appendix 4).
5. Senior regulations nurse department, department of functional diagnostics (Appendix 5).
6. Regulations on the nurse of the department, functional diagnostics room (Appendix 6).
7. The estimated workload for a doctor and nurse in the department (office) of functional diagnostics for a 6.5-hour working day is 33 conventional units.
8. Estimated time standards for functional studies carried out in functional diagnostic rooms, therapeutic - preventive institutions(Appendix 7).
9. Instructions for the use of estimated time standards for functional studies (Appendix 8).
10. Instructions for the development of estimated time standards when introducing new equipment or new types of research (Appendix 9).
11. Qualification requirements for a doctor - specialist in functional diagnostics (Appendix 10).
12. Qualification requirements for a functional diagnostic nurse (Appendix 11).
15. Journal of registration of studies performed in the department (office) of functional diagnostics - form N 157/u-93 (Appendix 14).
16. Instructions for filling out a log of studies performed in the department (office) of functional diagnostics (Appendix 15).
17. Addition to the list of forms of primary medical documentation(Appendix 16).
I order:
1. To the ministers of health of the republics within the Russian Federation, heads of government bodies and health care institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.1. Organize the work of departments, departments, functional diagnostic rooms in accordance with this order.
1.2. During 1993-1994. organize functional diagnostics departments, including rooms for instrumental research functions of blood circulation, respiration, digestion, nervous and endocrine systems, as well as other types of functional diagnostics, taking into account the profile of institutions and local conditions; organize their work in accordance with the Regulations on the department, unit, functional diagnostics room and its personnel (Appendices 2 - 6).
1.3. Approve the position of the chief freelance specialist of the health authority in functional diagnostics, organize its activities in accordance with the Regulations on the chief freelance specialist in functional diagnostics (Appendix 1).
1.4. Ensure regular training of doctors of the medical network on topical issues functional diagnostics.
1.5. Together with territorial VET "Medtechnika" to ensure the organization of high-quality and timely service of diagnostic equipment and metrological support of measuring instruments.
2. Management medical care to the population of the Ministry of Health of Russia (Tsaregorodtsev A.D.) together with other interested departments:
2.1. Ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.
2.2. Carry out in 1994-1995. seminars for specialists in various areas of functional diagnostics.
3. Management educational institutions(Volodin N.N.) add learning programs training of specialists in functional diagnostics in medical and pharmaceutical universities, as well as in medical faculties universities, taking into account the introduction of modern equipment and new research methods into practical work.
4. Heads of healthcare institutions:
4.1. It is recommended to establish the number of personnel in departments, divisions, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).
4.2. Develop standardized and unified schemes diagnostic examination patients with various diseases taking into account the stages and continuity in the examination carried out in medical and preventive institutions of various levels.
5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of specialists and doctors of various profiles on functional diagnostics in accordance with the approved standard programs.
6. The State Central Scientific Medical Library of the Ministry of Health of Russia (Loginov B.R.) to create reference information and methodological centers to provide specialist doctors and cadets necessary information about modern effective methods functional diagnostics.
7. Management scientific research Ministry of Health of Russia (Samko N.N.):
7.1. Develop and approve in the prescribed manner a long-term program related to the creation various types devices for functional studies that meet modern technical and medical requirements for equipping medical and preventive institutions at various levels.
7.2. Ensure regular distribution to health authorities with the right to replicate in the required number of orders of the Ministry of Health of the Russian Federation on permission to use new devices and equipment and on the exclusion of obsolete equipment from the range.
8. All-Russian Scientific Research and Testing Institute medical equipment(Leonov B.I.).
"On approval of the Rules for conducting functional research"
Revision dated December 26, 2016 — Valid from July 1, 2017
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
ORDER
dated December 26, 2016 N 997н
ON APPROVAL OF THE RULES FOR CONDUCTING FUNCTIONAL STUDIES
1. Approve the Rules for conducting functional studies in accordance with the appendix.
Minister
IN AND. SKVORTSOVA
2. Functional studies are carried out for the purpose of: diagnostics;
timely detection of socially significant and most common diseases of internal organs;
identifying hidden forms of diseases.
3. Functional studies are carried out if available medical indications upon provision:
primary health care;
specialized, including high-tech, medical care;
emergency, including specialized emergency medical care;
palliative care;
medical care for sanatorium- spa treatment.
4. Functional studies are carried out when providing medical care under the following conditions:
outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);
in a day hospital (in conditions providing medical supervision and treatment in daytime, but not requiring round-the-clock medical supervision and treatment);
inpatient (in conditions that provide round-the-clock medical supervision and treatment).
5. Functional studies are carried out during the provision of medical care in emergency, urgent and planned forms.
6. Functional studies in the provision of emergency, including specialized emergency medical care are carried out in accordance with the Procedure for the provision of emergency, including specialized emergency medical care<1>.
<1>dated June 20, 2013 N 388n “On approval of the Procedure for the provision of emergency, including emergency specialized medical care” (registered by the Ministry of Justice of the Russian Federation on August 16, 2013, registration N 29422) as amended by orders of the Ministry of Health of the Russian Federation dated January 22, 2016 N 33n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016, registration N 41353) and dated May 5, 2016 N 283n (registered by the Ministry of Justice of the Russian Federation on May 26, 2016, registration N 42283).
7. The organization of the activities of medical organizations conducting functional research as part of the provision of primary pre-medical health care is carried out in accordance with Appendices N - to the Regulations on the organization of primary health care for the adult population<1>.
<1>Order of the Ministry of Health and Social Development of the Russian Federation dated May 15, 2012 N 543n “On approval of the Regulations on the organization of provision of primary health care to the adult population” (registered by the Ministry of Justice of the Russian Federation on June 27, 2012, registration N 24726) as amended, introduced by orders of the Ministry of Health of the Russian Federation dated June 23, 2015 N 361n (registered by the Ministry of Justice of the Russian Federation on July 7, 2015, registration N 37921) and dated September 30, 2015 N 683n (registered by the Ministry of Justice of the Russian Federation on November 24, 2015 , registration N 39822).
Organization of the activities of medical organizations conducting functional research within the framework of primary specialized health care, specialized medical care, palliative care and medical care for sanatorium-resort treatment is carried out in accordance with Appendices No. 1 - 15 to these Rules.
8. Functional studies are carried out at the direction of the attending physician or paramedic, midwife if assigned to them individual functions attending physician<1>taking into account the patient’s right to choose a medical organization<2>.
<1>Order of the Ministry of Health and Social Development of the Russian Federation dated March 23, 2012 N 252n “On approval of the Procedure for assigning to a paramedic, midwife by the head of a medical organization when organizing the provision of primary health care and emergency medical care certain functions of the attending physician for the direct provision of medical care to the patient during the period of observation and treatment, including the prescription and use of medications, including narcotic drugs medications and psychotropic drugs" (registered by the Ministry of Justice of the Russian Federation on April 28, 2012, registration N 23971).
9. Functional studies carried out as part of the provision of primary pre-medical health care are carried out by a paramedic or nurse.
The analysis of the results of these functional studies is carried out by a paramedic.
If the results of functional studies carried out as part of the provision of primary pre-medical health care are insufficient to achieve the goals specified in paragraph 2 of these Rules, the paramedic or midwife refers patients to medical organizations to provide primary specialized health care or specialized medical care in cases provided for by the procedures for providing medical care according to profiles<1>.
In the absence of a functional diagnostics doctor, the analysis of the results of functional studies is carried out by the attending physician, about which a corresponding entry is made in the patient’s medical documentation.
11. To conduct functional studies as part of the provision of primary specialized health care, specialized medical care, palliative care and medical care in sanatorium-resort treatment:
when providing medical care in conditions day hospital, inpatient conditions the attending physician (paramedic, midwife) makes an entry in the list of prescriptions and their implementation contained in the medical record of the inpatient (hereinafter referred to as the list of prescriptions), about the type of required functional examination or, in the case of referral to another medical organization, draws up a Referral;
when providing medical care during sanatorium-resort treatment, the attending physician makes an entry in the prescription sheet contained in the patient’s medical record about the type of functional research required or, in the case of referral to another medical organization, draws up a Referral.
12. Patients who receive medical care in an inpatient setting and in a day hospital, and whose movement in medical reasons limited, including due to the prescribed treatment regimen, functional studies can be carried out directly in the structural unit of the medical organization in which they are staying, using portable diagnostic equipment.
13. The direction for conducting a functional study in the medical organization in which it was issued contains:
the name of the medical organization in accordance with the charter of the medical organization referring the patient for a functional study, the address of its location;
last name, first name, patronymic (if any) of the patient, date of birth; number medical card patient receiving medical care outpatient setting <1>, or a medical record of an inpatient;
<1>Order of the Ministry of Health of the Russian Federation dated December 15, 2014 N 834n “On approval unified forms medical documentation used in medical organizations providing medical care on an outpatient basis, and procedures for filling them out" (registered by the Ministry of Justice of the Russian Federation on February 20, 2015, registration N 36160).
diagnosis of the underlying disease, diagnosis code in accordance with the International Statistical Classification of Diseases and Related Health Problems, 10th revision (hereinafter referred to as ICD-10);
additional clinical information (main symptoms, results of laboratory, instrumental and other types of studies, description of medical interventions (manipulations, operations) (if necessary);
type of functional study required;
last name, first name, patronymic (if available) and position of the attending physician (paramedic, midwife).
14. Referral to another medical organization, in addition to the information specified in paragraph 13 of this Procedure, contains:
name of the medical organization to which the patient is sent for functional testing;
contact phone number (if available), address Email(if available) attending physician (paramedic, midwife).
15. A functional study is carried out in a medical organization on the basis of an entry in the appointment sheet or a Referral submitted by the patient.
16. Based on the results of the functional study, on the day of its conduct, a functional study protocol (hereinafter referred to as the Protocol) is drawn up, which is filled out legibly by hand or in printed form, certified by the personal signature of the medical worker who conducted the functional study, and the functional diagnostics doctor or paramedic who analyzed the results functional research.
17. The protocol based on the results of a functional study, which was carried out in a medical organization that sent for a functional study, contains:
the name of the medical organization in accordance with the charter of the medical organization in which the functional study was carried out, the address of its location;
date and time of functional study;
last name, first name, patronymic (if any) of the patient, date of birth;
technological characteristics of the performed functional study;
a detailed description of the results of the functional study;
calculated indicators of functional impairment;
conclusion based on the results of a functional study;
last name, first name, patronymic (if available) of the medical worker who performed the functional study, and the functional diagnostics doctor or paramedic who analyzed the results of the functional study, contact phone number (if available), email address (if available).
18. The protocol based on the results of a functional study that was carried out in a medical organization following a Referral from another medical organization, in addition to the information specified in paragraph 17 of this Procedure, contains the name of the medical organization that issued the Referral.
19. The Protocol is accompanied by functional diagnostic curves, graphs or images obtained during a functional study.
20. When conducting a functional study as part of the provision of medical care in emergency form The protocol is drawn up immediately after the functional study and is immediately transferred to the attending physician (paramedic, midwife).
21. In diagnostically difficult cases when conducting functional studies as part of the provision of primary specialized health and sanitary assistance, specialized medical care, palliative medical care and medical care during sanatorium-resort treatment, the doctor of functional diagnostics, in order to make an opinion on the results of a functional study, for consultation may involve other medical specialists from the medical organization conducting the functional study, or medical specialists who referred the patient, as well as doctors from other medical organizations, including using telemedicine.
In this case, the Protocol is also signed specialist doctor who provided the consultation.
22. The protocol is entered into the patient’s medical documentation, drawn up in the medical organization that conducted the functional study.
23. If a referral for a functional study is issued to conduct a functional study in another medical organization, then the Protocol is drawn up in two copies, one of which is sent to the medical organization that referred the patient for a functional study, and the second remains in the medical organization that conducted the functional study study.
24. A copy of the Protocol upon oral request of the patient or his legal representative issued to the specified person by the medical organization that conducted the functional study.
3. Functional studies are carried out in the Office in accordance with the technological capabilities of the installed equipment.
requirements
requirements
7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 2 to the Rules for Conducting Functional Research, approved by this order.
8. The office is equipped with equipment in accordance with Appendix No. 3 to the Rules for Conducting Functional Research, approved by this order.
Conducting functional studies;
development and implementation in clinical practice modern methods functional diagnostics in order to improve the quality of diagnostic and treatment work of a medical organization;
ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies;
identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies with the results of other diagnostic studies, clinical and pathological-anatomical diagnoses;
<1> <2>.
Appendix No. 2
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
RECOMMENDED STANDARDS FOR THE FUNCTIONAL DIAGNOSTICS OFFICE
Appendix No. 3
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
STANDARD OF EQUIPMENT FOR A FUNCTIONAL DIAGNOSTICS OFFICE
| N | Name | Required quantity, pcs. |
| 1. | Electrocardiograph | 1 |
| 2. | 1 | |
| 3. | on demand | |
| 4. | on demand | |
| 5. | Spirograph | 1 |
| 6. | Electroencephalograph | on demand |
Appendix No. 4
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
RULES FOR ORGANIZING THE ACTIVITY OF THE OFFICE OF FUNCTIONAL DIAGNOSTICS OF THE CARDIOVASCULAR SYSTEM
1. These Rules determine the procedure for organizing the activities of the functional diagnostics room of cardio-vascular system(hereinafter referred to as the Office).
2. The office is created as a structural unit of a medical organization or other organization carrying out medical activities (hereinafter referred to as a medical organization), or as a structural unit of the functional diagnostics department of a medical organization.
3. In the Cabinet, functional studies of the cardiovascular system are performed in accordance with the technological capabilities of the installed equipment.
4. The management of the activities of the Cabinet is carried out by a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure he was created.
5. Appointed to the position of a functional diagnostics doctor in the Cabinet medical worker, meeting the Qualification requirements for medical and pharmaceutical workers with higher education in the field of preparation "Healthcare and medical sciences", approved by order of the Ministry of Health of the Russian Federation of October 8, 2015 N 707n (registered by the Ministry of Justice of the Russian Federation on October 23, 2015, registration N 39438), in the specialty "functional diagnostics".
6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016, registration N 41337), in the specialty "functional diagnostics".
7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 5 to the Rules for Conducting Functional Research, approved by this order.
8. The office is equipped with equipment in accordance with Appendix No. 6 to the Rules for Conducting Functional Research, approved by this order.
9. The main functions of the Cabinet are:
conducting functional studies of the cardiovascular system, including ultrasound studies;
development and introduction into clinical practice of modern methods of functional diagnostics of the cardiovascular system in order to improve the quality of diagnostic and treatment work of a medical organization;
ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies of the cardiovascular system;
methodological work with doctors of diagnostic and treatment units of a medical organization on the correctness and validity of issuing referrals for functional studies;
identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies of the cardiovascular system with the results of other diagnostic studies, clinical and pathological diagnoses;
submission of reports in accordance with the established procedure<1>, provision of primary data about medical activities For information systems in the healthcare sector<2>.
Appendix No. 5
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
RECOMMENDED STAFF STANDARDS FOR THE FUNCTIONAL DIAGNOSTICS OFFICE OF THE CARDIOVASCULAR SYSTEM
Appendix No. 6
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
STANDARD OF EQUIPMENT FOR THE FUNCTIONAL DIAGNOSTICS OFFICE OF THE CARDIOVASCULAR SYSTEM
| N | Name | Required quantity, pcs. |
| 1. | Electrocardiograph | 1 |
| 2. | Blood pressure measuring device | 1 |
| 3. | Device for Holter monitoring of cardiac activity | 1 |
| 4. | Device for 24-hour blood pressure monitoring | 1 |
| 5. | 1 | |
| 6. | 1 | |
| 7. | Bicycle ergometer | 1 |
Appendix No. 7
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
RULES FOR ORGANIZING THE ACTIVITY OF THE OFFICE OF FUNCTIONAL DIAGNOSTICS OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM
1. These Rules determine the procedure for organizing the activities of the office of functional diagnostics of central and peripheral nervous system(hereinafter referred to as the Office).
2. The office is created as a structural unit of a medical organization or other organization carrying out medical activities (hereinafter referred to as a medical organization), or as a structural unit of the functional diagnostics department of a medical organization.
3. In the Office, functional studies of the central and peripheral nervous system are performed in accordance with the technological capabilities of the installed equipment.
4. The management of the activities of the Cabinet is carried out by a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure he was created.
5. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by order of the Ministry of Health of the Russian Federation dated October 8, 2015 N 707n (registered by the Ministry) is appointed to the position of a doctor of functional diagnostics of the Cabinet. Justice of the Russian Federation October 23, 2015, registration N 39438), specializing in “functional diagnostics”.
6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016) is appointed to the position of a nurse in the Cabinet. ., registration N 41337), specializing in “functional diagnostics”.
7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 8 to the Rules for Conducting Functional Research, approved by this order.
8. The office is equipped with equipment in accordance with Appendix No. 9 to the Rules for Conducting Functional Research, approved by this order.
9. The main functions of the Cabinet are:
conducting functional studies of the central and peripheral nervous system, including ultrasound studies;
development and introduction into clinical practice of modern methods of functional diagnostics of the central and peripheral nervous system in order to improve the quality of diagnostic and treatment work of a medical organization;
ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies of the central and peripheral nervous system;
methodological work with doctors of diagnostic and treatment units of a medical organization on the correctness and validity of issuing referrals for functional studies;
identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies of the central and peripheral nervous system with the results of other diagnostic studies, clinical and pathological-anatomical diagnoses;
submission of reports in accordance with the established procedure<1>, provision of primary data on medical activities for health information systems<2>.
Appendix No. 9
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
STANDARD OF EQUIPMENT OF THE OFFICE FOR FUNCTIONAL DIAGNOSTICS OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM
Appendix No. 10
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
RULES FOR ORGANIZING THE ACTIVITY OF THE OFFICE OF FUNCTIONAL DIAGNOSTICS OF THE RESPIRATORY SYSTEM
1. These Rules determine the procedure for organizing the activities of the functional diagnostics room respiratory system(hereinafter referred to as the Office).
2. The office is created as a structural unit of a medical organization or other organization carrying out medical activities (hereinafter referred to as a medical organization), or as a structural unit of the functional diagnostics department of a medical organization.
3. In the Office, functional studies of the respiratory system are performed in accordance with the technological capabilities of the installed equipment.
4. The management of the activities of the Cabinet is carried out by a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure he was created.
5. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by order of the Ministry of Health of the Russian Federation dated October 8, 2015 N 707n (registered by the Ministry) is appointed to the position of a doctor of functional diagnostics of the Cabinet. Justice of the Russian Federation October 23, 2015, registration N 39438), specializing in “functional diagnostics”.
6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016) is appointed to the position of a nurse in the Cabinet. ., registration N 41337), specializing in “functional diagnostics”.
7. The staffing level of the Cabinet is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 11 to the Rules for Conducting Functional Research, approved by this order.
8. The office is equipped with equipment in accordance with Appendix No. 12 to the Rules for Conducting Functional Research, approved by this order.
9. The main functions of the Cabinet are:
conducting functional studies of the respiratory system; development and introduction into clinical practice of modern methods of functional diagnostics of the respiratory system in order to improve the quality of diagnostic and treatment work of a medical organization;
ensuring interconnection and continuity in work with other diagnostic and treatment units of a medical organization when conducting functional studies of the respiratory system;
methodological work with doctors of diagnostic and treatment units of a medical organization on the correctness and validity of issuing referrals for functional studies;
identification and analysis of the reasons for discrepancies in conclusions based on the results of functional studies of the respiratory system with the results of other diagnostic studies, clinical and pathological-anatomical diagnoses;
submission of reports in accordance with the established procedure<1>, provision of primary data on medical activities for health information systems<2>.
Appendix No. 11
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
dated December 26, 2016 N 997н
1. These Rules establish the procedure for organizing the activities of the department of functional diagnostics (hereinafter referred to as the Department).
3. The Department may create an office for functional diagnostics of the cardiovascular system, an office for functional diagnostics of the central and peripheral nervous system, and an office for functional diagnostics of the respiratory system.
4. The Department carries out functional studies in accordance with the technological capabilities of the installed equipment.
5. Management of the activities of the Department is carried out by the head of the department - a functional diagnostics doctor, appointed and dismissed by the head of the medical organization in whose structure it was created.
6. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by Order of the Ministry of Health of the Russian Federation dated October 8, 2015 N 707n ( registered by the Ministry of Justice of the Russian Federation on October 23, 2015, registration N 39438) (hereinafter referred to as Qualification Requirements), in the specialty "functional diagnostics".
7. A medical worker who meets the Qualification requirements for the specialty “functional diagnostics” is appointed to the position of functional diagnostics doctor of the Department.
8. A medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation dated February 10, 2016 N 83n (registered by the Ministry of Justice of the Russian Federation on March 9, 2016) is appointed to the position of nurse of the Department ., registration N 41337), specializing in “functional diagnostics”.
9. The staffing level of the Department is established by the head of the medical organization in whose structure it was created, based on the volume of diagnostic and treatment work, the size of the population served and recommended staffing standards in accordance with Appendix No. 14 to the Rules for Conducting Functional Research, approved by this order.
10. The department is equipped with equipment in accordance with Appendix No. 15 to the Rules for Conducting Functional Research, approved by this order.
11. The main functions of the Department are: conducting functional research;
comprehensive use and integration various types functional research, implementation diagnostic algorithms in order to obtain a minimum short time complete and reliable diagnostic information;
development and implementation of economically sound, clinically effective techniques functional research, new organizational forms of work;
providing advisory assistance to specialists from clinical departments of a medical organization on functional diagnostics of diseases and conditions;
implementation of measures to ensure the quality of functional studies and the correct functioning of diagnostic equipment;
submission of reports in accordance with the established procedure<1>, provision of primary data on medical activities for health information systems<2>.
<2>Part 1 of Article 91 Federal Law dated November 21, 2011 N 323-FZ (Collection of Legislation of the Russian Federation, 2011, N 48, Art. 6724).
Appendix No. 14
to the Rules
functional studies,
approved by order
Ministry of Health
Russian Federation
^ INSTRUCTIONS FOR APPLICATION OF ESTIMATED TIME STANDARDS FOR FUNCTIONAL STUDIES
Estimated time standards for functional studies are determined taking into account the necessary ratio between the optimal labor productivity of medical staff and high quality and completeness of functional diagnostic studies.
This instruction is intended for heads of departments and doctors of departments of functional diagnostics for use in rational use calculated time standards approved by order of the Ministry of Health of the Russian Federation dated November 30, 1993 No. 283 (Appendix 7).
The main purpose of the calculated time standards for functional studies is to use them when:
Resolving issues of improving the organization of activities of functional diagnostics rooms (departments);
Labor planning and organization medical personnel these units;
Analysis of labor costs of medical staff;
Formation of staffing standards for medical staff of relevant medical institutions.
1. Use of estimated time standards for functional studies for planning and organizing the work of medical personnel in functional diagnostics offices (departments).
The share of medical staff's work on direct functional research (main and auxiliary activities, work with documentation) for doctors and nurses is 84.0% of working time. This time is included in the calculated time standards. Time for another necessary work and the personal time required is not taken into account in the standards.
For doctors, this is a joint planned discussion with their attending physicians of clinical and instrumental data, participation in medical conferences, reviews, and rounds; supervising the work of nurses, mastering techniques, equipment, monitoring their work, working with archives and documentation, administrative and economic work.
For nurses, preparatory work at the beginning of the working day (preparing the workplace, group calling patients from departments, etc.), issuing reports, putting the workplace in order at the end of the shift, receiving necessary materials(medicines, special paper, tools), equipment care.
When determining the estimated workload standards for doctors and nursing staff, it is recommended to be guided by the methodology for rationing the work of medical personnel (M., 1987, approved by the USSR Ministry of Health). In this case, the ratio of the above-mentioned working time costs is taken as a basis.
To take into account the work of staff in functional diagnostics rooms (departments), the possibility of comparing their workload, etc., the calculated time standards and the determined workload standards for doctors and nursing staff are reduced to a common unit of measurement - conventional units. 1 conventional unit is 10 minutes of working time. Thus, the shift load rate is 33 conventional units.
In accordance with the clarifications of the Ministry of Labor of the Russian Federation dated December 29, 1992 No. 5, approved by Decree No. 65 dated December 29, 1992, the transfer of days off coinciding with holidays is carried out at enterprises, institutions and organizations that apply different work and rest regimes, with which work is not carried out on holidays.
Standard working hours for certain periods time is calculated according to the estimated schedule of a five-day work week with two days off, Saturday and Sunday, based on the following "duration of daily work (shift):
With a 40-hour work week - 8 hours, on holidays - 7 hours;
If the working week is less than 40 hours - the number of hours obtained by dividing the established working week by five days, the day before holidays in this case, working hours are not reduced (Article 47 of the Labor Code of the Russian Federation). For example, in 1993, with a five-day work week with two days off, taking into account additional days holidays on January 4, May 3, 4 and 10, June 14 and November 8 due to the coincidence of holidays on January 2, May 1, 2 and 9, June 12 and November 7 with Saturday and Sunday days off - 252 working days and 113 days off , incl. 4 pre-holiday days(January 6, April 30, June 11 and December 31).
Based on this, the annual workload of the doctor and nurse in the office (department) of functional diagnostics will be 8316 conventional units in 1993. units or on average - 8300 conventional units. units (252 days x 33 conventional units = 8316 conventional units).
When planning the activities of a functional diagnostics unit, it is important to distribute the workload between medical and paramedical personnel, taking into account the different time costs for performing the same types of studies. For example, it is incorrect to combine within a single team or one schedule a doctor analyzing electrocardiograms and a nurse recording an ECG on a multi-channel device in the office (department), because it takes a doctor more time to decipher 1 ECG than it takes a nurse to record an ECG and prepare data for its analysis. Depending on local conditions, the need for various types of electrocardiographic examination, the number of doctors and nurses it is necessary to choose a variant of their work schedule in which the sum of the products (according to the relevant research methods and techniques) of the number of planned studies for work shift for the estimated time standard established for this study, would be approximately the same. Failure to comply with this condition will result in the fact that part of the research performed by the nurse will not be completed that day by the doctor's analysis.
You can, for example, entrust a nurse with recording part of the ECG at home (in an outpatient setting) or in the ward (in an inpatient setting), to equalize the shift costs of working time for a doctor and a nurse.
The same approach should be used when scheduling physicians and nurses when scheduling other studies, including those that do not require same-day conclusions. These conditions must also be observed when developing weekly and monthly schedules.
Thus, the work schedules of employees and the schedule for performing various types of research must take into account the benchmark indicators of the unit’s activities, the needs of the medical institution in the structure and number of functional research methods, the different throughput during the work of medical and nursing staff, depending on the type of diagnostic techniques.
^ 2. Use of estimated time standards for functional studies to account for and analyze the activities of the functional diagnostics office (department).
Actual or planned annual volume of functional research activity, expressed in conventional units, is determined by the formula:
T = t 1 x n 1 +t 2 x n 2 + t i x n i, (1)
where T is the actual or planned annual volume of activity for conducting functional research, expressed in conventional units;
T 1 , t 2 , t i - time in conventional units in accordance with the approved estimated time standards for research (main and additional);
N 1, n 2, n i - the actual or planned number of studies during the year using individual diagnostic methods.
A comparison of the actual annual volume of activity with the planned one allows for an integral assessment of the unit’s activities, to get an idea of the labor productivity of its personnel and the efficiency of the unit as a whole.
Carrying out research throughout the year larger volume can be achieved by intensifying the work of medical staff, or by increasing the amount of time used for core activities, by significantly reducing the share of other necessary types labor. If this is not the result of using research automation tools and calculating physiological parameters, more techniques rational organization labor of doctors and nurses, then such intensification of work inevitably leads to a decrease in the quality, information content and reliability of conclusions. Failure to fulfill the plan for the volume of activity may be the result of improper planning, a consequence of defects in the organization of work and in the management of the department. Therefore, both failure to fulfill the plan and its excessive overfulfillment should be equally carefully analyzed by both the head of the office (department) and the management of the medical institution in order to identify their causes and take appropriate measures. Deviations of the actual volume of activity from the annual planned volume within +20% ... -10% can be considered acceptable.
Along with general indicators After completing the work, the structure of the research conducted and the number of studies on individual diagnostic methods are traditionally analyzed to assess the balance and adequacy of the structure, the sufficiency of the number of studies, and the actual need for them.
The average time spent on one study is determined by:
C = Ф/n, cu, (2)
where C is the average time spent on one study;
F - total actual time spent (on basic and additional diagnostic procedures) in total for all studies performed according to a certain diagnostic technique(in arbitrary units);
N is the number of studies performed using the same diagnostic technique.
The correspondence of the average time spent on research to the calculated time standards (in%) for a certain method is determined by the formula:
K = (C/t)x100. (3)
It is acceptable, along with those stated, to use other traditional and unconventional ways analysis with calculation and use of other indicators.
Heads of institutions and chief specialists also need to monitor rational use personnel of medical personnel and when determining staffing levels, be guided by the results of an annual or multi-year analysis of the actual or planned volume of activity of the department.
^ Head of the Department of Medical Assistance to the Population
HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection
DI. Zelinskaya
Appendix 9
To the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
^ INSTRUCTIONS FOR DEVELOPING ESTIMATED TIME STANDARDS WHEN IMPLEMENTING NEW EQUIPMENT OR NEW TYPES OF RESEARCH
When introducing new diagnostic methods and technical means their implementation, which is based on different research methodology and technology, new content of medical staff’s work, and the absence of estimated time standards approved by the Russian Ministry of Health, they can be developed locally and agreed upon with the trade union committee in those institutions where new methods are being introduced.
The development of new calculation standards includes taking time measurements of the actual time spent on individual elements of labor, processing this data (according to the methodology outlined below), and calculating the time spent on the study as a whole.
Before timing, a list of technological operations (main and additional) for each method is compiled. For these purposes, it is recommended to use the methodology applied in compiling a universal list of labor elements for technological operations. In this case, it is possible to use the “List..” itself, adapting each technological operation to the technology of a specific new diagnostic method.
^ A universal list of labor elements for technological operations, recommended when developing estimated time standards.
| №№ | Name of technological operations and labor elements | Who performs |
|
| Functional diagnostics doctor | Nurse |
||
| 1 | 2 | 3 | 4 |
| 1 | Calling the subject into the office | - | + |
| 2 | Registration of the subject | - | + |
| 3 | Studying the medical history (outpatient card) | + | , |
| 4 | Undressing the subject | - | + |
| 5 | Measuring and recording anthropometric data | + |
|
| 6 | Measuring and recording meteorological data | . | + |
| 7 | Blood pressure measurement and recording | - | + |
| 8 | Additional, clarifying survey of the subject | + | |
| 9 | Examination and auscultation | + | - |
| 10 | Preparation of the subject | - | + |
| 11 | Turning on, calibrating and setting up the device(s) | + |
|
| 12 | Application of electrodes | - | + |
| 13 | Measuring and recording the dimensions of individual areas of the body and the distances between electrodes (sensors) | + |
|
| 14 | Overlay, installation of sensors | - | + |
| 15 | Final adjustment and configuration of devices | + |
|
| 16 | Recording information curve | - | + |
| 17 | Application (installation) of electrodes or sensors at non-standard points | + |
|
| 18 | Recording information curves from non-standard points and leads | + | |
| 19 | Evaluating curves (data) and deciding whether to expand the scope of the study | + | |
| 20 | Performance functional test | + | + |
| 21 | Recording the information curve at the peak of the functional test | + | + |
| 22 | Recording an information curve upon returning the studied parameters to their original state | + | + |
| 23 | Elimination of the causes of forced research stops (forced technological break) | + | + |
| 24 | Removing the Electrodes | - | + |
| 25 | Turning off the device(s) | - | + |
| 26 | Dressing the subject | - | + |
| 27 | Special film processing | - | + |
| 28 | Preparing film (curves) for analysis | - | + |
| 29 | | ^ | + |
| 30 | Curve analysis and medical opinion | + | |
| 31 | Communication with your doctor | + | - |
| 32 | Consulting complex cases with a consultant | + | |
| 33 | Referring to specialized literature and reference books | + | |
Note: If labor operation is to be performed by a doctor and a nurse, it is carried out simultaneously.
Timing is carried out using sheets of timing measurements, which consistently set out the names of technological operations and the time of their implementation.
Processing the results of timing measurements includes calculating the average time spent, determining the actual and expert repeatability coefficient for each technological operation and the estimated time to complete the study under study.
The average time spent on an individual technological operation is determined as the arithmetic average of all measurements.
The actual repeatability factor of technological operations in each study is calculated using the formula:
K = n/N, (4)
where K is the actual repeatability coefficient of the technological operation;
N is the number of timed studies using a specific research method in which a given technological operation took place;
N is the total number of the same timed studies.
The expert coefficient of repeatability of a technological operation is determined by the most qualified functional diagnostics doctor who knows this technique, based on the existing experience in using the method and professional understanding of the proper repeatability of the technological operation.
The estimated time for each technological operation is determined by multiplying the average actual time spent on a given timing operation by the export coefficient of its repeatability.
The estimated time to complete the study as a whole is determined separately for the doctor and the nurse as the sum of the estimated time to complete all technological operations for this method. It, after approval by the order of the head of the medical institution, is the estimated time limit for performing this type of research in this institution.
To ensure the reliability of local time standards and their correspondence to the true time spent, not dependent on random causes, the number of studies subjected to time measurements should be as large as possible, but not less than 20-25.
It is possible to develop local time standards only when the staff of the office (department) have mastered the methods sufficiently well, when they have developed a certain automatism and professional stereotypes in performing diagnostic and analytical manipulations. Before this, research is carried out in the order of mastering new methods, within the time spent on other types of activities.
^ An example of determining the estimated time limit for conducting an initial ECG for a nurse (when recording on a manual 5-channel electrocardiograph).
| №№ | Name of technological operation | Average time spent (in sec.) | Process repeatability factor | Estimated time for carrying out a technological operation |
||
| Fact. | Expert | Fact. | Taking into account the data of F. 5 |
|||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 1 | Calling the subject into the office | 55,0 | 1,0 | 1,0 | 55,0 | 55,0 |
| 2 | Registration of the subject | 123,7 | 1,0 | 1,0 | 123,7 | 123,7 |
| 3 | Preparation of the subject | 93,0 | 0,29 | 0,02 | 27,0 | 1,9 |
| 4 | Turning on, setting up, adjusting and calibrating the device | 141,0 | 1,0 | 0,1 | 141,0 | 14,1 |
| 5 | Application of electrodes | 88,8 | 1,0 | 1,0 | 88,8 | 88,8 |
| 6 | Recording an electrocardiogram | 124,2 | 1,0 | 1,0 | 124,2 | 124,2 |
| 7 | Removing the electrodes, turning off the device and cleaning the workplace | 64,2 | 1,0 | 1,0 | 64,2 | 64,2 |
| 8 | Preparing curves for medical analysis | 105,2 | 1,0 | 1,0 | 105,2 | 105,2 |
| 9 | Search the archive of previous research data | 149,0 | 0,48 | 0,6 | 71,7 | 89,6 |
| 10 | Rewriting a medical report in form No. 157/u-93 | 132,6 | 1,0 | 1,0 | 132,6 | 132,6 |
| 11 | Rewriting a medical report into a medical history ( outpatient card) | 156,3 | 1,0 | 1,0 | 156,3 | 0,0 |
| Total: sec. | 1089,7 | 799,3 |
||||
| min. | 18,2 | 13,3 |
||||
| conventional units | 1,8 | 1,3 |
||||
Appendix 10
To the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
^ QUALIFICATION REQUIREMENTS FOR A SPECIALIST IN FUNCTIONAL DIAGNOSTICS
In accordance with the requirements of the specialty, a functional diagnostics doctor must know and be able to:
1. General knowledge:
Fundamentals of healthcare legislation and policy documents defining the activities of healthcare bodies and institutions;
General issues of organizing therapeutic, cardiological, pulmonological, neurological services in the Russian Federation, organizing a functional diagnostic service in medical institutions;
Classification and metrological characteristics of equipment for functional studies, nomenclature of the main instruments used in functional diagnostics, the use of electronic computer technology in functional diagnostic studies;
Clinical physiology of blood circulation and respiration and, depending on the profile of the institution, other sections of clinical physiology;
Etiology, pathogenesis and clinic of major diseases in the relevant field of functional diagnostic research (cardiology, angiology, pulmonology, neurology and other areas depending on the profile of the institution).
2. General skills:
Identify common and specific signs diseases;
Determine what functional methods of examining the patient are necessary to clarify the diagnosis;
Determine indications for additional consultations specialists or for hospitalization, as well as indications and contraindications for the choice of treatment method and tactics;
Prepare medical documentation approved in accordance with the established procedure.
3. Special knowledge and skills:
A functional diagnostics doctor must know the principles of the equipment on which he works, the rules of its operation, the method of recording curves and functional diagnostic parameters using this equipment, and write a conclusion on them;
Depending on the qualification category A functional diagnostics doctor must be proficient in all of the specified research methods for one of the following systems:
^ Second qualification category
of cardio-vascular system:
Electrocardiography (ECG), including examination in additional leads and functional tests;
Phonocardiography (PCG);
Rheovasography (RVG);
Determination of central hemodynamic parameters.
respiratory systems:
Electronic pneumotachometry with registration of the flow-volume loop;
Spirography in closed system(to perform residual lung volume testing and lateral position testing).
nervous system:
- Echoencephalography;
Rheoencephalography;
Routine electroencephalography with functional tests;
Determination of SRV by motor and sensory fibers of peripheral vessels.
^ First qualification category
of cardio-vascular system:
- Electrocardiography (ECG), including studies in additional leads and functional tests;
Phonocardiography (PCG);
Rheovasography (RVG);
Determination of central hemodynamic parameters;
Sphygmography (SFG);
Bicycle ergometry (VEM);
Holter monitoring.
respiratory systems:
- Electronic pneumotachometry with registration of the flow-volume loop;
Spirography in a closed system (to conduct a study of residual lung volume and a lateral position test);
Study of the structure of the total lung capacity;
Indirect photooximetry;
Lung rheography;
Study of exhaled air gases (O 2 CO 2 N 2,).
nervous system:
- Echoencephalography;
Rheoencephalography;
Routine electrocephalography with functional tests;
Neuromuscular transmission testing;
Determination of SRV by motor and sensory fibers of peripheral vessels;
Standard needle electromyography;
Thermal imaging;
Doppler vasography of the brain.
- Appendix 1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and republics within the Russian Federation, regional (territorial), city departments, health departments Appendix 2. Regulations on the department, division, office of functional diagnostics Appendix 3. Regulations on the head of the department, department, office of functional diagnostics Appendix 4. Regulations on the doctor of functional diagnostics of the department, department, office of functional diagnostics Appendix 5. Regulations on the head nurse of the department, department of functional diagnostics Appendix 6. Regulations on the nurse of the department, department, office of functional diagnostics Appendix 7. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical institutions Appendix 8. Instructions for the use of estimated time standards for functional studies Appendix 9. Instructions for the development of estimated time standards when introducing new equipment or new types of research Appendix 10. Qualification requirements to a doctor-specialist in functional diagnostics Appendix 11. Qualification requirements for a nurse in the office (department) of functional diagnostics Appendix 12. Recommended approximate list of the minimum set of methods and techniques for functional studies for medical institutions Appendix 13. Methods for calculating prices for diagnostic studies for departments departments, functional diagnostics rooms Appendix 14. Form N 157/u-93 "Registration log of studies performed in the functional diagnostics department (office)" Appendix 15. Instructions for filling out the "Registration log of studies performed in the functional diagnostics department (office)" ( form N 157/у-93) Appendix 16. Addition to the list of forms of primary medical documentation
Order of the Ministry of Health of the Russian Federation of November 30, 1993 N 283
"On improving the functional diagnostic service
in healthcare institutions of the Russian Federation"
In the context of health care reform and the transition to health insurance for citizens, the task of developing and introducing into practice new medical technologies, including diagnostic systems and complexes that make it possible to increase the efficiency of the diagnostic and treatment process and reduce economic and labor losses, becomes extremely urgent.
In this regard, the role and importance of functional research methods are increasing, which are widely used for the purpose of early detection of pathology, differential diagnosis of various diseases and monitoring the effectiveness of therapeutic measures.
In 1993, there were 10.7 thousand functional diagnostic departments in medical institutions of the republic, in which about 60 million studies are carried out annually.
The range of studies is constantly expanding, mainly due to highly informative methods of functional diagnostics. Their share in the total volume of instrumental research is only in diagnostic centers reaches 25-30 percent.
At the same time, in many medical institutions, especially in prehospital stage There has been a serious lag in the development of the functional diagnostic service.
As of 01/01/93 in the Russian Federation, out of 19.6 thousand outpatient clinics and inpatient institutions, only about half of the institutions had departments (offices) of functional diagnostics.
In the last three years, the growth in the exchange of functional studies has practically ceased, especially in clinics serving the adult population.
There has been a steady downward trend in the rate of provision of the population with these types of research from 5.6 in 1990 to 5.0 in 1992 per 100 visits.
Compared to 1991, the number of remote diagnostic rooms decreased from 354 to 286 and the number of ECG studies performed in them decreased from 887.7 to 857.1 thousand.
The possibilities of functional diagnostics are unjustifiably reduced due to the insufficiently clear organization of its work. structural divisions, irrational use of technical means, slow introduction into practice of new forms of management and labor organization of medical personnel, highly effective diagnostic programs and algorithms.
The effectiveness of using the information received in medical institutions is insufficient due to the poor preparedness of specialists in functional diagnostics and attending physicians, and the lack of proper continuity in their work.
To a certain extent, difficulties in organizing a functional diagnostics service are associated with the lack of the necessary regulatory framework, recommendations for optimizing the structure, staffing table and nomenclature of studies in departments and functional diagnostics rooms of medical institutions of various capacities. The principles of phasing with differentiation of levels and strict unification of the methods and techniques used at each stage, as well as accounting and reporting, which allow analyzing the activities of the service to the required extent, have not been worked out.
The development of domestic diagnostic equipment necessary for the technical equipment of healthcare institutions at all levels has not received systematic development. In medical institutions, metrological support of measuring instruments is carried out at an extremely low level.
It is necessary to take effective measures to strengthen the interaction of functional diagnostics with other diagnostic services and the introduction of diagnostic algorithms.
In order to improve the organization of the functional diagnostics service and improve the quality of its work, the rapid introduction of new diagnostic methods, as well as improving personnel training and technical re-equipment of departments with modern equipment, I affirm:
1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and republics within the Russian Federation, regional (territorial), city departments, health departments (Appendix 1).
7. The estimated workload for a doctor and nurse in the department (office) of functional diagnostics for a 6.5-hour working day is 33 conventional units.
8. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical institutions (Appendix 7).
10. Instructions for the development of estimated time standards when introducing new equipment or new types of research (Appendix 9).
15. Journal of registration of studies performed in the department (office) of functional diagnostics - form N 157/u-93 (Appendix 14).
16. Instructions for filling out a log of studies performed in the department (office) of functional diagnostics (Appendix 15).
I order:
1. To the health ministers of the republics within the Russian Federation, heads of government bodies and health care institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.1. Organize the work of departments, departments, functional diagnostic rooms in accordance with this order.
1.2. During 1993-1994. organize departments of functional diagnostics on the basis of treatment and preventive institutions and clinics of medical and research institutes, including rooms for instrumental studies of the functions of blood circulation, respiration, digestion, nervous and endocrine systems, as well as other types of functional diagnostics, taking into account the profile of institutions and local conditions; organize their work in accordance with the regulations on the department, unit, functional diagnostics room and its personnel (Appendices 2-6).
1.3. Approve the position of the chief freelance specialist of the health authority in functional diagnostics, organize its activities in accordance with the regulations on the chief freelance specialist in functional diagnostics (Appendix 1).
1.4. Provide regular training to medical doctors on current issues of functional diagnostics.
1.5. Together with territorial VET "Medtechnika" to ensure the organization of high-quality and timely service of diagnostic equipment and metrological support of measuring instruments.
2. The Department of Medical Assistance to the Population of the Ministry of Health of Russia (Tsaregorodtsev A.D.) together with other interested departments:
2.1. Ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.
2.2. Carry out in 1994-1995. seminars for specialists in various areas of functional diagnostics.
3. The Department of Educational Institutions (N.N. Volodin) should supplement the training programs for specialists in functional diagnostics in medical and pharmaceutical universities, as well as in medical faculties of universities, taking into account the introduction of modern equipment and new research methods into practical work.
4. Heads of healthcare institutions:
4.1. It is recommended to establish the number of personnel in departments, divisions, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).
4.2. To develop standardized and unified schemes for the diagnostic examination of patients for various diseases, taking into account the phasing and continuity of the examination carried out in medical institutions of various levels.
5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of specialists and doctors of various profiles on functional diagnostics in accordance with the approved standard programs.
6. The State Central Scientific Medical Library of the Ministry of Health of Russia (Loginov B.R.) to create reference information and methodological centers to provide specialist doctors and cadets with the necessary information about modern effective methods of functional diagnostics.
7. Directorate of Scientific Research of the Ministry of Health of Russia (Samko N.N.):
7.1. To develop and approve in the prescribed manner a promising program related to the creation of various types of devices for functional research that meet modern technical and medical requirements for equipping medical institutions at various levels.
7.2. Ensure regular distribution to health authorities with the right to replicate in the required number of orders of the Ministry of Health of the Russian Federation on permission to use new devices and equipment and on the exclusion of obsolete equipment from the range.
8. All-Russian Research and Testing Institute of Medical Equipment (Leonov B.I.)
8.1. Together with the chief metrologists of administrative-territorial health authorities, organize work on certification of measurement methods in functional diagnostics.
8.2. To provide, on a self-supporting basis, at the request of health authorities and institutions, information on the consumer characteristics of mass-produced domestic medical equipment, addresses and details of organizations and manufacturing companies.
8.3. Organize permanent and traveling exhibitions of medical equipment for functional diagnostics.
9. Heads and chief metrologists of territorial health authorities, heads of health care institutions, ensure timely Maintenance medical equipment products and verification of measuring instruments.
10. Consider as invalid for institutions of the Russian Ministry of Health the order of the USSR Ministry of Health dated August 12, 1988 N 642 “On the estimated time standards for functional studies”, the order of the USSR Ministry of Health dated July 7, 1989 “On the addition to the order of the USSR Ministry of Health dated August 12, 1988 year N 642.
"Regulations on the electrocardiology room", approved by the Main Directorate of Medical preventative care USSR Ministry of Health April 21, 1954.
11. Entrust control over the execution of the order to First Deputy Minister A.M. Moskvichev.
|
E.A.Nechaev |
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ORDER of the Ministry of Health of the Russian Federation dated 30-11-93 283 ON IMPROVING FUNCTIONAL DIAGNOSTICS SERVICES IN HEALTHCARE INSTITUTIONS... Relevant in 2018
Order
In the context of health care reform and the transition to health insurance for citizens, the development and implementation of new medical technologies, including diagnostic systems and complexes that make it possible to increase the efficiency of the treatment and diagnostic process and reduce economic and labor losses, becomes extremely urgent.
In this regard, the role and importance of functional research methods are increasing, which are widely used for the purpose of early detection of pathology, differential diagnosis of various diseases and monitoring the effectiveness of therapeutic measures.
In 1993, in medical and preventive institutions of the republic there were 10.7 thousand departments of functional diagnostics, in which about 60 million studies are carried out annually.
The development of domestic diagnostic equipment necessary for the technical equipment of healthcare institutions at all levels has not received systematic development. In medical and preventive institutions, metrological support of measuring instruments is carried out at an extremely low level.
It is necessary to take effective measures to strengthen the interaction of functional diagnostics with other diagnostic services and the introduction of diagnostic algorithms.
In order to improve the organization of the functional diagnostics service and improve the quality of its work, the rapid introduction of new diagnostic methods, as well as improving personnel training and technical re-equipment of departments with modern equipment
I affirm:
1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and republics within the Russian Federation, regional (territorial), city departments, health departments (Appendix 1).
2. Regulations on the department, department, functional diagnostics room (Appendix 2).
3. Regulations on the head of the department, department, functional diagnostics room (Appendix 3).
4. Regulations on the doctor of the department, department, functional diagnostics office (Appendix 4).
5. Regulations on the head nurse of the department, department of functional diagnostics (Appendix 5).
6. Regulations on the nurse of the department, functional diagnostics room (Appendix 6).
7. The estimated workload for a doctor and nurse in the department (office) of functional diagnostics for a 6.5-hour working day is 33 conventional units.
8. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical and preventive institutions (Appendix 7).
9. Instructions for the use of estimated time standards for functional studies (Appendix 8).
10. Instructions for the development of estimated time standards when introducing new equipment or new types of research (Appendix 9).
11. Qualification requirements for a doctor - specialist in functional diagnostics (Appendix 10).
12. Qualification requirements for a functional diagnostic nurse (Appendix 11).
15. Journal of registration of studies performed in the department (office) of functional diagnostics - form N 157/u-93 (Appendix 14).
16. Instructions for filling out a log of studies performed in the department (office) of functional diagnostics (Appendix 15).
17. Addition to the list of forms of primary medical documentation (Appendix 16).
I order:
1. To the ministers of health of the republics within the Russian Federation, heads of government bodies and health care institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.1. Organize the work of departments, departments, functional diagnostic rooms in accordance with this order.
1.2. During 1993-1994. organize departments of functional diagnostics on the basis of treatment and preventive institutions and clinics of medical and research institutes, including rooms for instrumental studies of the function of blood circulation, respiration, digestion, nervous and endocrine systems, as well as other types of functional diagnostics, taking into account the profile of institutions and local conditions; organize their work in accordance with the Regulations on the department, unit, functional diagnostics room and its personnel (Appendices 2 - 6).
1.3. Approve the position of the chief freelance specialist of the health authority in functional diagnostics, organize its activities in accordance with the Regulations on the chief freelance specialist in functional diagnostics (Appendix 1).
1.4. Provide regular training to medical doctors on current issues of functional diagnostics.
1.5. Together with territorial VET "Medtechnika" to ensure the organization of high-quality and timely service of diagnostic equipment and metrological support of measuring instruments.
2. The Department of Medical Assistance to the Population of the Ministry of Health of Russia (Tsaregorodtsev A.D.) together with other interested departments:
2.1. Ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.
2.2. Carry out in 1994-1995. seminars for specialists in various areas of functional diagnostics.
3. The Department of Educational Institutions (N.N. Volodin) should supplement the training programs for specialists in functional diagnostics in medical and pharmaceutical universities, as well as in medical faculties of universities, taking into account the introduction of modern equipment and new research methods into practical work.
4. Heads of healthcare institutions:
4.1. It is recommended to establish the number of personnel in departments, divisions, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).
4.2. To develop standardized and unified schemes for the diagnostic examination of patients for various diseases, taking into account the phasing and continuity in the examination carried out in medical and preventive institutions of various levels.
5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of specialists and doctors of various profiles on functional diagnostics in accordance with the approved standard programs.
6. The State Central Scientific Medical Library of the Ministry of Health of Russia (Loginov B.R.) to create reference information and methodological centers to provide specialist doctors and cadets with the necessary information about modern effective methods of functional diagnostics.
7. Directorate of Scientific Research of the Ministry of Health of Russia (Samko N.N.):
7.1. To develop and approve in the prescribed manner a long-term program related to the creation of various types of devices for functional research that meet modern technical and medical requirements for equipping medical and preventive institutions at various levels.
7.2. Ensure regular distribution to health authorities with the right to replicate in the required number of orders of the Ministry of Health of the Russian Federation on permission to use new devices and equipment and on the exclusion of obsolete equipment from the range.
8. All-Russian Scientific Research and Testing Institute of Medical Technology (Leonov B.I.):
8.1. Together with the chief metrologists of administrative and territorial health authorities, organize work on certification of measurement methods and functional diagnostics.
8.2. To provide, on a self-supporting basis, at the request of health authorities and institutions, information on the consumer characteristics of mass-produced domestic medical equipment, addresses and details of organizations and manufacturing companies.
8.3. Organize permanent and traveling exhibitions of medical equipment for functional diagnostics.
9. Heads and chief metrologists of territorial health authorities and heads of health care institutions should ensure timely maintenance of medical equipment products and verification of measuring instruments.
10. Consider as invalid for institutions of the Russian Ministry of Health the order of the USSR Ministry of Health dated August 12, 1988 N 642 “On the estimated time standards for functional studies”, the order of the USSR Ministry of Health dated July 7, 1989 “On the addition to the order of the USSR Ministry of Health dated August 12, 1988 year N 642."
“Regulations on the electrocardiology room”, approved by the Main Directorate of Medical and Preventive Care of the USSR Ministry of Health on April 21, 1954.
11. Entrust control over the execution of the order to First Deputy Minister A.M. Moskvichev.
Minister of Health
Russian Federation
E.A.NECHAEV
