Problematic issues of the development of hospital-replacing technologies in surgery at the prehospital stage and ways to solve them
Authors: Vorobyov V. V. , Novikov K. V. , Ovchinnikov D. V. 
Published: December 2024

Introduction. One of the main trends in the development of the healthcare system in the Russian Federation is a shift in the emphasis of care from inpatient to outpatient. At the beginning of 2000, this trend in healthcare was conﬁrmed by its development. However, the position on shifting the center of medical care from the inpatient to the outpatient level is currently not conﬁrmed, in particular, in outpatient surgery.

The purpose of the study: to analyze the work of day surgical hospitals and identify problematic issues in the development of hospital-replacement technologies in surgery at the prehospital stage and propose ways to solve them.

Materials and methods. The research materials were our own developments based on the results of the work of day surgical hospitals in the outpatient surgery clinic of the Military Medical Academy of S.M. Kirov, as well as statistical data, scientiﬁc works and publications presented in periodicals by the most authoritative representatives of domestic medicine in the ﬁeld of studying the development of hospital-replacement technologies (day surgical hospitals).

Results. During the study, it was revealed that the number of surgical interventions performed at the prehospital stage has been progressively decreasing since 2005. The average bed occupancy per year in day hospitals of hospitals and clinics is lower than that of 24-hour hospital beds, which indicates the idleness of day hospital beds and their underutilization. There is a low turnover of day hospital beds. All this conﬁrms the presence of problems and low eﬃciency of day hospitals. To solve problematic issues in the development of hospital-replacement technologies, the authors recommend establishing “normative indicators” for the work of day hospitals, determining the status of a day hospital bed, increasing bed turnover, establishing targeted funding for day hospitals, etc. To improve the system of providing inpatient replacement care at the prehospital stage, it is proposed to create a multidisciplinary center for inpatient replacement technologies. All clinics assigned to the multidisciplinary center for hospital-replacement technologies refer patients who cannot receive routine medical care in the clinic to the multidisciplinary center. The center selects patients who will receive care using hospital-replacement technologies. The remaining patients are sent to hospitals for treatment.

Conclusion. In order to increase the eﬃciency of day hospitals, it is necessary to establish standard indicators for their work. It is necessary to increase the turnover of day hospital beds. It is advisable to organize targeted funding for all day hospitals. An option for optimizing the organization of inpatient replacement care at the outpatient stage is the creation of a multidisciplinary center for inpatient replacement technologies, which will prevent the “outﬂow” of outpatients to hospitals and increase the eﬃciency of using day hospital beds.