a) cardiologist - 24 minutes;
b) endocrinologist - 19 minutes;
c) dentist-therapist - 44 minutes.
4. The time standards for a patient to visit a medical specialist for preventive purposes are set at 60-70% of the time standards associated with one patient visiting a specialist doctor in connection with a disease, established in a medical organization or other organization that provides medical activities(hereinafter referred to as the medical organization), in accordance with these time standards.
5. Time spent by a specialist doctor on registration medical documentation taking into account the rational organization of labor, equipping workplaces with computer and organizational equipment, should amount to no more than 35% of the time standards associated with one patient visiting a specialist doctor in connection with a disease and for preventive purposes in accordance with these time standards.
6. B medical organizations providing primary specialized health care in outpatient setting, the time norms specified in and are established taking into account the density of residence and age-sex composition of the population, as well as taking into account the level and structure of morbidity of the population by summing up the correction factors of time norms.
The following correction factors are applied:
a) the residential density of the attached population is above 8 people per square meter. km: -0.05;
b) the residential density of the attached population is below 8 people per square meter. km: +0.05;
c) the density of residence of the attached population of the Far North and equivalent areas is no more than 2.5 people per square meter. km:+0.15;
d) the morbidity rate of the population is 20% higher than the average value for the subject Russian Federation: +0,05;
e) the morbidity rate of the population is 20% lower than the average value for the constituent entity of the Russian Federation: -0.05;
f) the share of people over working age among the attached population is above 30%: +0.05;
g) the share of people over working age among the attached population is below 30%: -0.05.
_____________________________
* Order of the Ministry of Health and Social Development of Russia dated December 27, 2011 No. 1664n “On approval of the nomenclature medical services"(registered with the Ministry of Justice of Russia on January 24, 2012, registration No. 23010) as amended by orders of the Ministry of Health of Russia dated October 28, 2013 No. 794n (registered with the Ministry of Justice of Russia on December 31, 2013, registration No. 30977), dated December 10, 2014 No. 813n (registered in Ministry of Justice of Russia 01/19/2015, registration No. 35569) and dated 09/29/2016 No. 751n (registered with the Ministry of Justice of Russia 10/25/2016, registration No. 44131)
Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n “On approval of the Unified qualification directory positions of managers, specialists and employees, section “ Qualification characteristics positions of workers in the healthcare sector" (registered with the Ministry of Justice of Russia on August 25, 2010, registration No. 18247)
Document overview
Standard industry standards have been approved for the time required to perform work related to a patient’s visit to a cardiologist, endocrinologist, and dental therapist.
The standards are applied when providing primary specialized health care in an outpatient setting (not providing for round-the-clock medical observation and treatment) and are the basis for calculating workload standards, staffing standards and other labor standards for doctors.
For a cardiologist, the norm for one patient visit is 24 minutes, for an endocrinologist - 19 minutes, for a dental therapist - 44 minutes.
Depending on the density of residence and age-sex composition of the population, the level and structure of morbidity, adjustment factors may be applied to the standards.
In accordance with paragraph 3 of the Rules for development and approval standard standards labor approved by Decree of the Government of the Russian Federation of November 11, 2002 N 804 (Collection of Legislation of the Russian Federation, 2002, N 46, Art. 4583), and paragraph 19 of the action plan ("road map") "Changes in industries social sphere, aimed at increasing the efficiency of healthcare", approved by order of the Government of the Russian Federation of December 28, 2012 N 2599-r (Collected Legislation of the Russian Federation, 2013, N 2, Art. 130; 2013, N 45, Art. 5863; 2014, N 19, Art. 2468; 2015, N 36, Art. 5087; 2016, N 21, Art. 3087), I order:
Approve, in agreement with the Ministry of Labor and Social Protection of the Russian Federation, the attached standard industry standards of time for performing work related to one patient’s visit to a cardiologist, endocrinologist, or dental therapist.
Minister V. Skvortsova
Standard industry standards for the time required to perform work related to one patient’s visit to a cardiologist, endocrinologist, or dental therapist
1. Standard industry time standards (hereinafter referred to as time standards) for performing work related to one patient’s visit to a cardiologist, endocrinologist, or dental therapist (hereinafter referred to as a specialist doctor) are applied when providing primary specialized health care care in an outpatient setting (not providing round-the-clock medical supervision and treatment).
2. Time standards are the basis for calculating workload standards, headcount standards and other labor standards for medical specialists in medical organizations providing primary specialized health care in an outpatient setting.
3. Standards of time for one visit by a patient to a specialist doctor in connection with the disease, necessary for implementation on an outpatient basis labor actions to provide medical care(including time spent on processing medical documentation)*:
a) cardiologist - 24 minutes;
b) endocrinologist - 19 minutes;
c) dentist-therapist - 44 minutes.
4. Time standards for a patient to visit a medical specialist for preventive purposes are set at 60-70% of the time standards associated with one patient visiting a specialist doctor in connection with a disease, established in a medical organization or other organization engaged in medical activities (hereinafter - medical organization), in accordance with paragraph 3 of these time standards.
5. The time spent by a specialist doctor on preparing medical documentation, taking into account the rational organization of work, equipping workplaces with computer and organizational equipment, should be no more than 35% of the time norms associated with a visit by one patient to a specialist doctor in connection with a disease and preventive purpose in accordance with paragraphs 3 and 4 of these time standards.
6. In medical organizations providing primary specialized health care in an outpatient setting, the time standards specified in paragraphs 3 and 4 are established taking into account the density of residence and age and gender composition of the population, as well as taking into account the level and structure of morbidity of the population by summing up correction factors time standards
The following correction factors are applied:
a) the residential density of the attached population is above 8 people per square meter. km: -0.05;
b) the residential density of the attached population is below 8 people per square meter. km: +0.05;
c) the density of residence of the attached population of the Far North and equivalent areas is no more than 2.5 people per square meter. km: +0.15;
d) the morbidity rate of the population is 20% higher than the average value for the constituent entity of the Russian Federation: +0.05;
e) the morbidity rate of the population is 20% lower than the average value for the constituent entity of the Russian Federation: -0.05;
f) the share of people over working age among the attached population is above 30%: +0.05;
g) the share of people over working age among the attached population is below 30%: -0.05.
*Order of the Ministry of Health and Social Development of Russia dated December 27, 2011 N 1664n “On approval of the range of medical services” (registered with the Ministry of Justice of Russia on January 24, 2012, registration N 23010) as amended by orders of the Ministry of Health of Russia dated October 28, 2013 N 794n (registered with the Ministry of Justice of Russia on December 31. 2013, registration N 30977), dated December 10, 2014 N 813n (registered with the Ministry of Justice of Russia on January 19, 2015, registration N 35569) and dated September 29, 2016 N 751n (registered with the Ministry of Justice of Russia on October 25, 2016, registration N 44131).
Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 N 541n “On approval of the Unified Qualification Directory of positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the healthcare sector” (registered with the Ministry of Justice of Russia on August 25, 2010, registration N 18247).
Last spring, the medical community was rocked by the news that the Ministry of Health was introducing new admission standards. It was assumed that the time of direct contact between the patient and the doctor (questioning, examination) with a pediatrician and therapist should take 15 minutes, with a doctor general practice- 18 minutes. In January 2015, the draft order was put up for public discussion.
Several years ago, the US Centers for Disease Control and Prevention conducted a survey on how satisfied Americans are with making appointments and seeing doctors. primary care(excluding dentist). Only 41 percent of visits lasted more than 15 minutes. The doctor spent 11–15 minutes on every third patient. Up to 10 minutes - for every fourth person. At the same time, survey participants complained about a lack of attention from doctors. Let me remind you that in the USA, together with the doctor, there are 3-4 other people, for example, nurses. And the patient does not see the mountain of paperwork.
In domestic healthcare, until now, the latest official norm was indicated in the order of the USSR Ministry of Health dated September 23, 1981 No. 1000 “On measures to improve the organization of the work of outpatient clinics.” But by order of the USSR Ministry of Health dated July 22, 1987 No. 902 “On the abolition of planning and evaluation of the work of outpatient clinics based on the number of visits,” these calculation standards were canceled.
From that moment to the present day, heads of healthcare institutions were given the right to set individual workload standards for doctors in outpatient clinics (units) depending on specific conditions: demographic composition of the population, morbidity, etc. (clause 1.2 of the order).
And gradually from total duration of the working day of any doctor at the clinic, items such as the time allotted for work on the formation of healthy image life of the population (lectures, conversations), training in civil defense, organizational and methodological work, work with a dispensary group of patients, participation in production meetings and conferences, etc. The duration of the work shift was divided into a certain “standard visit”, based on which the doctor was given a plan.
Oh, this magical PLAN! These figures taken from the ceiling in the year one thousand nine hundred are “functions of a medical position”! Considering that this was “seriously and for a long time,” the clinics were paid for all “drawn” visits. At meetings, chief doctors never tired of boasting about hero doctors who can “make” 70–80 appointments in a day, as if not suspecting that in this case the doctor would take less than a minute to communicate with the patient - not to mention the quality of these appointments.
"Self-respecting" chief physician always found a way to squeeze a gigantic number of visits out of doctors, including by unjust means, by encouraging additions and falsifications. And even if there is only one doctor left in the clinic, the plan will be implemented 100%. Gradually, medical insurance organizations realized what was going on... and the prosecutor's office found new work. And the Ministry of Health panicked. The shortage of doctors in public medicine grew at a staggering rate. At some point it became simply indecent to talk about it...
And the stream of complaints on the Internet and in the media about quick-firing doctors who fit into the 8 minutes mercifully allotted for the patient also made me nervous. Plus, the “Italian strikes” started secretly by some doctors, when doctors brought VIPs “by the hand” by the administration, instead of “courting” them in full, examined exactly the time allotted for this... But at the same time, the number of Ph.D. theses and scientific articles on “How I cut my appointment time by three more minutes and achieved brilliant results.”
Therefore, today the Ministry of Health has chosen the most proven tactic, which is colloquially called “both ours and yours.” On the one hand, there will be strict admission standards, for failure to comply with which doctors will again begin to be mercilessly fined. On the other hand, it is declared that the doctor “must examine the patient as much as his health condition requires.” And the state of health and psychological discomfort among the population is such that every second patient requires “increased attention and special treatment.” Again, if the patient doesn’t like something, there’s a fine. Wherever you throw it, there is a wedge everywhere.
You may ask, why exactly should doctors break their spears? After all, many of them already combine work in public and private medicine. And in some private clinics the standards from the eighties of the last century have still been preserved. But here’s the problem: too many doctors have already tasted the happiness of working thoughtfully on a patient, without constantly looking at their watches.
Moreover, the Ministry of Health openly admits that these standards are not so much for “ordinary” doctors, but rather for the information of chief doctors. Just to know, for general, so to speak, development. Therefore, most likely, nothing will change either for my colleagues or for my patients.
Valentina Saratovskaya
Photo thinkstockphotos.com
Articles on the topic
In medicine, for the first time, standards for the time at which doctors see patients were approved. If we compare with the time standards that were in use earlier, we can see that the indicators for medical specialists have increased. Based on this, it can be assumed that the advent of updated standards will be followed by changes in the structure of clinic doctors and their total number.
New standards for doctor appointment times
Unfortunately, Order No. 290n of the Russian Ministry of Health dated June 2, 2015, which determined the time standards for seeing patients from doctors of certain specialties, suffers from vague terminology and wording. The consequence of this may be discrepancies in some paragraphs of the recently issued order.
Thus, paragraph 1 of Order of the Ministry of Health No. 290n states that standard standards and norms for the time of doctor’s appointments can be applied both for medical care in outpatient clinics and when a doctor visits potential patients directly at home.
This can be interpreted as the fact that we are talking about specific standards of time for doctors to see patients directly in the clinic or at home and as average standards for doctors to see patients anywhere.
But meanwhile, the time standards for doctors to see patients during “home” visits are usually two to three times more than the time standards spent visiting a patient in a clinic. The level of settlement of residents, the time that has to be spent moving around the site, the size of the site, even whether there are elevators in the entrances of patients’ houses, etc., play a role here. Because of this, it can hardly be stated unequivocally that these indicators of the required time can be similar to each other.
But the standard time for doctors to see patients is the average between the time spent visiting patients in the clinic and visiting the patient at home. And in each case, it will be necessary to separate these norms depending on the differentiation of the types of visits to potential patients at the place where medical care was provided, at the patient’s home or in the clinic. Depending on the results, the average time standards determined for patient visits will change.
Conclusion - the points of this recently adopted document clearly need detailing and clarification. Probably, the order of the Ministry of Health still talks about the time standards for doctors to see patients directly in the clinic. But then the order of the Ministry of Health must also define the required standard amount of time for a “home” visit. In addition, it is necessary to determine how these time standards will need to operate and how they will change if necessary. The question of the norms for the time at which patients are seen by doctors, which is strictly for preventive purposes, also requires clarification. Moreover, the conditions for the application of these standards are not defined in the order; it only says 60-70% of the norms of the time used associated with a visit by one patient medical specialist in connection with the disease. However, an appointment for each appointment of a potential patient with a doctor is made without connection with the purpose of his visit.
Thus, if a visit to a patient who has not yet become ill, for purely preventive purposes, takes place during a routine visit with the doctor receiving him, then the standard norms for receiving patients by doctors cannot be accurately differentiated by the purpose of the visit - whether it was due to the onset of the patient’s illness or was carried out with to prevent the onset of the disease. Based on the above, it is extremely necessary to clarify clause 6: “visiting a doctor for preventive purposes, performed on specially designated days or appointment hours.”
Standards for appointment times with medical specialists – expectations and reality
If we focus on timing data, the standard time spent on working with the preparation and analysis of medical documentation, which the order predicts, coincides with reality only for pediatricians. For example, a therapist's time spent on processing and analyzing patient data and other medical documentation is about 40%; a family doctor's time is another 3% more. It turns out to be very problematic to meet the specified time standards for visiting specialist doctors.
When distributing the time required to complete and analyze medical documentation in accordance with the standards in the order, in fact we are faced with a sharp decrease in the volume of collected statistical information. In the future, this is fraught with a lack of statistics on which important medical studies are based.
The order mentions adjustment factors that are more applicable to standards and plans for the number of patient visits, but not to the average standards of time for seeing specialist doctors, taking into account each visit. It is extremely difficult to imagine that in medical clinics will change entire industry standards for the time limits for appointments with medical specialists by just one or two minutes. For edits of this order, it is still advisable to use much more significant numbers.
For example, if you add up all the above amendments, then in total they will amount to only 0.15, i.e., only about two or three minutes. Table No. 1 compares the previously adopted, in force before the introduction of Order No. 290, estimated time standards for visiting, verified in accordance with the standards for such documents as:
- Order of the USSR Ministry of Health dated September 23, 1981 N1000 “On measures to improve the organization of work of outpatient clinics” (Order N1000)
- Order No. 290n of the Ministry of Health of the Russian Federation,
- statistical data obtained from analysts at the All-Russia Research Institute named after. N. A. Semashko.
Table 1. Comparative data on the norms of time for visiting specialist doctors for 1 visit, min.
www.dirklinik.ru
Workload norm for doctors in the outpatient department
Questions and answers on the topic
Could you please tell me the basis for approving the workload standards for doctors in the outpatient department in the Russian Federation?
Valentina Malofeeva answers: expert
Currently, there are no officially approved service standards for outpatient doctors at the federal level.
The latest officially approved standards were set out in the canceled order of the USSR Ministry of Health dated September 23, 1981 No. 1000, where in Appendix No. 59 “Calculated standards of service for doctors in outpatient clinics”, for example, for a general practitioner and a local general practitioner there was an admission rate/ visiting patients for 1 hour of work, namely: in clinics at appointments - 5 people, at medical examinations - 7.5; when serving patients at home - 2. However, these calculation standards were canceled by order of the USSR Ministry of Health dated July 22, 1987 No. 902.
From this moment on, heads of healthcare institutions were given the right to establish individual workload standards for doctors of outpatient clinics (units) depending on specific conditions - the demographic composition of the population, morbidity, etc.. The Russian Ministry of Labor released Guidelines designed to help in the development of labor standardization systems in institutions. Methodological recommendations for the development of labor standardization systems in state (municipal) institutions were approved by Order of the Ministry of Labor of Russia dated September 30, 2013 No. 504.
Thus, until standard labor standards are developed, institutions can independently develop appropriate labor standards, taking into account the recommendations of the organization performing the functions and powers of the founder, or with the involvement of relevant specialists in the prescribed manner (clause 16 of the Methodological Recommendations, approved by order Ministry of Labor of Russia dated September 30, 2013 No. 504).
Thus, a number of constituent entities of the Russian Federation have developed and established both methods for determining the workload norms for outpatient medical specialists in healthcare institutions of the relevant constituent entities, as well as recommended standards for the average time spent per visit and the share of other time for doctors in the context of specialties and levels of outpatient provision. outpatient care, or calculated workload standards for outpatient specialist doctors, for example: order of the Ministry of Health of the Altai Republic dated March 28, 2013 No. 82.
www.budgetnik.ru
Time standards for patient visits to individual doctors have been determined
In accordance with clause 19 of the Action Plan (“road map”) “Changes in sectors of the social sphere aimed at increasing the efficiency of healthcare,” the Russian Ministry of Health must annually clarify labor standards in the healthcare sector. This measure is aimed at improving labor standards for the purpose of determining the forecast number of employees of medical organizations required to provide services guaranteed according to the standard, and increasing labor productivity in medical organizations.
In order to implement this event, the Russian Ministry of Health approved standard industry standards of time for performing work related to one patient visiting a local pediatrician and a general practitioner, a family doctor, as well as a neurologist, an otolaryngologist, an ophthalmologist and an obstetrician. -gynecologist. The corresponding order of the Russian Ministry of Health dated June 2, 2015 No. 290n was registered with the Russian Ministry of Justice.
Where can a patient turn if his rights in healthcare are violated? Find out from the material “Types of violations of patient rights” of the Home Legal Encyclopedia Internet version of the GARANT system. Get free access for 3 days!
Thus, for one visit by a patient to a specialist doctor in connection with a disease, the following is allocated:
- 15 minutes each - to visit a local pediatrician or a local general practitioner;
- 18 minutes – general practitioner (family doctor);
- 16 minutes – otolaryngologist;
- 22 minutes – neurologist;
- 14 minutes – ophthalmologist;
- 22 minutes – obstetrician-gynecologist.
At the same time, the doctor should spend no more than 35% of the specified time on completing medical documentation. In turn, repeated visits to doctors by one patient should not exceed 70-80% of the specified time, and the time norms for one patient to visit a specialist doctor for preventive purposes should take 60-70% of the established time norms.
In medical organizations providing primary medical and primary specialized health care on an outpatient basis, the specified time standards should be established taking into account the density of residence and age-sex composition of the population, as well as taking into account the level and structure of morbidity in the population. For each indicator, certain adjustment factors for time standards are provided.
Let us recall that previously time standards were linked to the number of people a doctor must manage to see within a specified period. Thus, according to the order of the USSR Ministry of Health dated September 23, 1981 No. 1000, a therapist in a clinic was supposed to see five patients per hour, at medical examinations - 7.5 people per hour, at home - two people per hour. Then, by order of the USSR Ministry of Health dated July 22, 1987 No. 902, chief doctors were allowed to independently determine the workload for their subordinates.
Time standards will be applied when providing primary medical and primary specialized health care in an outpatient setting (not providing for round-the-clock medical observation and treatment), including when a medical specialist visits one patient at home. They will form the basis for calculating workload standards, headcount standards and other labor standards for doctors of such medical organizations.
Order on doctors' workload norms
In accordance with paragraph 3 of the Rules for the development and approval of standard labor standards, approved by Decree of the Government of the Russian Federation of November 11, 2002 No. 804 (Collection of Legislation of the Russian Federation, 2002, No. 46, Art. 4583), and paragraph 19 of the action plan (“road maps") “Changes in sectors of the social sphere aimed at increasing the efficiency of healthcare”, approved by Decree of the Government of the Russian Federation of December 28, 2012 No. 2599-r (Collected Legislation of the Russian Federation, 2013, No. 2, Art. 130; 2013, No. 45, Art. 5863; 2014, No. 19, Art. 2468; 2015, No. 36, Art. 5087; 2016, No. 21, Art. 3087), I order:
Approve in agreement with the Ministry of Labor and social protection of the Russian Federation, the attached standard industry standards of time for performing work related to a visit by one patient to a cardiologist, an endocrinologist, or a dentist-therapist.
Download the original document in PDF format
APPROVED
by order of the Ministry of Health
Russian Federation
dated December 19, 2016 No. 973n
Standard industry standards for time to complete work,
associated with one patient’s visit to a cardiologist,
endocrinologist, dentist-therapist
1. Standard industry time standards (hereinafter referred to as time standards) for performing work related to a visit by one patient cardiologist, endocrinologist, dentist-therapist (hereinafter referred to as specialist doctor), are used in the provision of primary specialized health care in an outpatient setting (not providing round-the-clock medical observation and treatment).
2. Time standards are the basis for calculating workload standards, headcount standards and other labor standards for medical specialists in medical organizations providing primary specialized health care in an outpatient setting.
3. Standards of time for one visit by a patient to a medical specialist in connection with a disease, necessary to perform labor actions in the provision of medical care in an outpatient setting (including the time spent on preparing medical documentation) *:
a) cardiologist - 24 minutes;
b) endocrinologist - 19 minutes;
c) dentist-therapist - 44 minutes.
4. Time standards for a patient to visit a medical specialist for preventive purposes are set at 60:70% of the time standards associated with a patient visiting a specialist doctor in connection with a disease, established in a medical organization or other organization engaged in medical activities (hereinafter - medical organization), in accordance with paragraph 3 of these time standards.
5. The time spent by a specialist doctor on preparing medical documentation, taking into account the rational organization of work, equipping workplaces with computer and organizational equipment, should be no more than 35% of the time norms associated with a visit by one patient to a specialist doctor in connection with a disease and preventive purpose in accordance with paragraphs 3 and 4 of these time standards.
6. In medical organizations providing primary specialized health care in an outpatient setting, the time standards specified in paragraphs 3 and 4 are established taking into account the density of residence and age and gender composition of the population, as well as taking into account the level and structure of morbidity of the population by summing up correction factors time standards
The following correction factors are applied:
a) the residential density of the attached population is above 8 people per square meter. km: -0.05;
b) the residential density of the attached population is below 8 people per square meter. km: +0.05;
c) the density of residence of the attached population of the Far North and equivalent areas is no more than 2.5 people per square meter. km: +0.15;
d) the morbidity rate of the population is 20% higher than the average value for the constituent entity of the Russian Federation: +0.05;
e) the morbidity rate of the population is 20% lower than the average value for the constituent entity of the Russian Federation: -0.05;
f) the share of people over working age among the attached population is above 30%: +0.05;
g) the share of people over working age among the attached population is below 30%: -0.05.
*
Order of the Ministry of Health and Social Development of Russia dated 27:12:2011 No. 1664n “On approval of the nomenclature of medical services” (registered with the Ministry of Justice of Russia 24:01:2012, registration No. 23010) as amended by orders of the Ministry of Health of Russia dated 28:10:2013 No. 794n (registered in the Ministry of Justice of Russia 31:12:2013, registration No. 30977), from 10:12:2014 No. 813n (registered in the Ministry of Justice of Russia 19:01:2015, registration No. 35569) and from 29:09:2016 No. 751n (registered in the Ministry of Justice Russia 25:10:2016, registration No. 44131)
Order of the Ministry of Health and Social Development of Russia dated 23:07:2010 No. 541n “On approval of the Unified Qualification Directory of positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the healthcare sector” (registered with the Ministry of Justice of Russia 25:08:2010, registration No. 18247)
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IN in this case It should be noted that the shift load does not fully reflect all the work of specialists medical institutions. B - working time budget for main activities per year (for each service, the value of this indicator is calculated separately).
Consequently, the labor regulation system medical personnel Diagnostic services need improvement.
In table 1 contains information on the medical service provided by the doctor functional diagnostics with echocardiography. Therefore, the next stage is determining the annual load. Example. Determining the normal workload of a nurse in the diagnostic room in which the echocardiography study is being carried out.
Tp, Td, To, Tk - the number of hours of work per day at an appointment in a clinic, at home, at a medical examination during designated hours, at a consultation appointment.
T - time spent on 1 visit. Therefore, the next stage is to determine the standard workload per year (functions of the medical position). Time for auxiliary activities is calculated based on the value of the indicator specific gravity operational time (0.923), and is 0.051 (1 - 0.923 - 0.026).
It is advisable to assign nurses a number of responsibilities of a doctor, which will increase the time he spends on work aimed at directly serving the patient.
The position of a local general practitioner deserves special attention. The distribution of the main flow of patients among narrow specialists occurs at the level of local doctors, therefore, the workload on the general practitioner will increase.
In connection with this, there was a need to create a new system for training medical personnel, organizing so-called advanced training courses.
Article 87 Labor Code The Republic of Belarus has determined that the establishment, replacement and revision of labor standards is carried out by the employer with the participation of trade unions.
Stage II. Medical services can be provided during the initial and repeat visits, as well as when visiting the patient at home and for the purpose of prevention.
Forming the number of medical personnel, establishing labor standards, rational placement and use of personnel are the priority tasks of today's healthcare in the republic.
Labor rationing is the establishment of a measure of labor expenditure (time) for employees to perform a certain amount of work. Load (service) norm - a set amount of work that must be completed per unit of working time in certain organizational and technical conditions activities.
1. Standard industry time standards (hereinafter referred to as time standards) for performing work related to one patient’s visit to a local pediatrician, a local general practitioner, a general practitioner (family doctor), a neurologist, an otolaryngologist, an ophthalmologist and an obstetrician-gynecologist (hereinafter referred to as a medical specialist), are used in the provision of primary medical and primary specialized health care in an outpatient setting (not providing for round-the-clock medical observation and treatment), including when a medical specialist visits one patient per home.
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
d) the morbidity rate of the population is 20% lower than the average value for the constituent entity of the Russian Federation: -0.05;
OPHTHALMOLOGIST AND OBSTETRIC-GYNECOLOGIST
Order of the Ministry of Health of the Russian Federation No. 290n on the time standards for outpatient appointments
7. In medical organizations providing primary medical and primary specialized health care in an outpatient setting, the time standards specified in paragraphs 3 and 6 are established taking into account the density of residence and the age and gender composition of the population, as well as taking into account the level and structure of morbidity of the population by summation of correction factors of time norms.
c) general practitioner (family doctor) - 18 minutes;
Clause 2 of Part 3 of Article 32 Federal Law dated November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442, 3446; 2013, N 27 , Art. 3459, 3477; N 30, Art. 4038; N 39, Art. 4883; N 48, Art. 6165; N 52, Art. 6951; 2014, N 23, Art. 2930; N 30, Art. 4106 , 4244, 4247, 4257; N 43, art. 5798; N 49, art. 6927, 6928; 2015, N 1, art. 72, 85; N 10, art. 1425; N 14, art. 2018).
DISTRICT, GENERAL PRACTITIONER (FAMILY DOCTOR),
Approve, in agreement with the Ministry of Labor and Social Protection of the Russian Federation, the attached standard industry standards of time for performing work related to a visit by one patient to a local pediatrician, a local physician, a general practitioner (family doctor), a neurologist, an otolaryngologist , ophthalmologist and obstetrician-gynecologist.
b) local therapist - 15 minutes;
4. Time standards for a repeated visit to a medical specialist by one patient in connection with a disease are set at 70 - 80% of the time standards associated with the initial visit to a medical specialist by one patient in connection with a disease.
3.3. The scope of medical care provided in a DS setting, as a rule, should include laboratory diagnostic examination and healing procedures, requiring special training and dynamic observation after their implementation (excretory urography, cholecystography, etc.). All diagnostic and therapeutic procedures provided must meet the requirements of the standards of medical care for a specific nosology.
“ON THE APPROVAL OF STANDARDS FOR THE LOAD OF OUTPATIENT DOCTORS AND THE REGULATIONS ON THE DAY HOSPITAL” (together with the “STANDARDS FOR THE NUMBER OF DAYS OF USE OF BEDS IN DAY HOSPITALS”, “REGULATIONS ON THE DAY HOSPITAL”)
1.1. Day hospital (DS) is designed to provide qualified medical care to patients with acute and chronic diseases, who do not need round-the-clock monitoring, but who are indicated for diagnostic and treatment assistance during the daytime.
3.2. Referral is carried out if the patient needs dynamic observation during the day, as well as a set of diagnostic and therapeutic measures. Referral of patients from 24-hour hospitals is aimed at follow-up treatment under active conditions until recovery.
4.4. The issue of providing food to patients in the hospital is decided on an individual basis in each case. It is advisable to organize meals in DS deployed on the basis of inpatient departments of hospitals for children, pregnant women, etc. in case of their long stay during the day.
2.6. Staffing is approved on the basis of: a doctor position for 20 patients, a nurse position for 15 patients, taking into account patients from all shifts. The nurse's rate can be calculated based on a smaller number of beds, depending on the profile of the hospital and the expected workload.
4. ORDER OF MEDICATION AND NUTRITION FOR PATIENTS
1.8. A patient's daily visits to the hospital are counted as bed days and are not counted as visits. The day of admission and discharge of the patient is counted as 2 days.
1.5. The following accounting and reporting documentation is established in the DS:
ORDER of the Smolensk Region Department of Health dated N 380 (ed.
1.4. The capacity of the hospital (number of beds) and profile are determined by the head of the medical institution in agreement with the relevant government authority, subject to taking into account the existing healthcare infrastructure and the population’s needs for a certain type of assistance.
5.1. DS financing is carried out in accordance with the approved tariff in the prescribed manner. It is allowed to increase the tariff at the expense of budget funds of the appropriate level and other sources in accordance with the current legislation of the Russian Federation.
3. Approve the Regulations on day hospital (Appendix 2) and the standard for the use of beds in day hospitals(Appendix 3).
1.1. When forming a territorial program of state guarantees for the provision of free medical care to the population Leningrad region for 2004, apply in practice the calculation of the standard medical workload for outpatient visits (Appendix 1 to this order).
It should also be noted that the time spent by the doctor during a preventive examination is less than that spent on the patient.
Order of the Leningrad Region Health Committee No. 156
In accordance with Decree of the Government of the Russian Federation dated February 14, 2003 N 101 “On working hours medical workers“depending on their position and (or) specialty,” doctors who provide exclusively outpatient treatment to patients are entitled to a reduced 33-hour work week.
2. The department for organizing medical care for the population of the Leningrad region (Budanov M.V.), in the process of forming a territorial program of state guarantees for providing citizens of the Leningrad region with free medical care, use the Methodology for calculating the standard medical load at an outpatient appointment, approved by this order, when calculating the volume of outpatient care medical care.
1.3. The order is to be brought to the attention of the heads of subordinate medical treatment preventive institutions.
Thus, knowing the annual budget of working time for diagnostic and treatment work of doctors (in hours), approved on the basis of calculations, taking into account the coefficient of use of working time (Table No. 2, group 5 x group 6 = group 7), we can calculate the planned hourly workload of medical specialists, linked to the federal standards of the program of state guarantees of free medical care to the population.
The average number of visits per resident does not exceed 6-7 visits, including visits to dentists.
For a doctor who continuously sees patients, the annual working time balance, taking into account the coefficient, will be 1518 hours x 0.909 = 1379.8 hours.
The calculation of the working time balance of clinic specialists was carried out taking into account work in a 5-day work week.
The calculation of the number of positions for district pediatricians and children's specialists of a “narrow” profile was carried out taking into account new approaches to determining the age of the child population in accordance with UN recommendations, i.e. childhood considered from 0 to 17 years, 11 months. and 29 days.
Calculation for the child population: table. N 2, gr. 8 should be multiplied by the number of children from 0 to 17 years old inclusive and divided by 1000 along the lines of each specialty.
For an adult: table. N 2, gr. 9 multiplied by the adult population and divided by 1000 along the lines of each specialty. The calculated data are presented in table No. 2, gr. 10 and gr. eleven.
Ministry of Health and Social Development of Russia from 0. Please note! Table of provision of medical and preventive institutions with staffing standards - see For the personnel officer: Regulatory acts» No. 4, 2.
For example, the standard time for one diagnostic and treatment visit to a general practitioner’s clinic is 1. UET. Load (service) standards are a set amount of work performed per unit of time by personnel or a group of personnel in specific organizational and technical operating conditions. Load (service) standards are expressed in the number of visits per hour, shift, year; number of patients served per day; number of studies, procedures per hour, shift, month, quarter, year or other period of time. For example, the workload norm for an allergist-immunologist at a clinic appointment is four visits per 1 hour of work, for a massage nurse – 3.
Provision of medical and preventive institutions with staffing standards. ON No. 1‘2. 00. 6In accordance with currently valid regulatory legal documents (Unified nomenclature of state and municipal healthcare institutions, approved.
For example, the position of a local general practitioner is established at the rate of 5.9 positions per 1. Regulations. Note! health care facility – therapeutic and preventive institution.
“On the abolition of planning and evaluation of the work of outpatient clinics based on the number of visits,” these calculated standards of service for doctors in outpatient clinics were declared invalid. However, in the absence of other officially approved indicators, they continue to be used in healthcare practice along with those approved by the State Scientific Research Institute of Public Health health RAMS labor standards for outpatient doctors. Workload (service) standards for some groups of medical personnel of the auxiliary treatment and diagnostic service in the form of the number of manipulations and procedures per day are given in a number of specified orders according to time standards. Thus, in the order of the Ministry of Health of the RSFSR dated 0. The Ministry of Health of Russia dated 2. Staff standards are established, as can be seen from Table 1, for all groups of personnel differentiated by type of institution.
For other groups of personnel, as can be seen from Table 1, time norms for individual species works are not approved at the federal level, except for the provision of outpatient care dental care. Conventional units of accounting for labor intensity dentists and dentists were approved by order of the USSR Ministry of Health dated 2. On the transition to new system accounting for the work of dental doctors and improving the form of organizing dental appointments.” Subsequently, these standards were repeatedly revised, mainly in the direction of increasing the content of the classifier of medical services (Methodological recommendations on the procedure for forming and economic justification territorial programs of state guarantees for providing citizens of the Russian Federation with free medical care, approved. Ministry of Health of Russia dated 2. FFOMS No. 5. 59. 4- 4. Methodological recommendations on the procedure for the formation and economic justification of territorial programs of state guarantees for the provision of free medical care to citizens of the Russian Federation, approved.
On approval of conventional units for the performance of physiotherapeutic procedures, time standards for massage, regulations on physiotherapeutic units and their personnel” - for physiotherapeutic procedures; Order of the Ministry of Health of Russia dated 0. On measures to further development reflexology in the Russian Federation” – according to therapeutic and diagnostic manipulations for a reflexologist; guidelines Department of State Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia dated 1. Time standards for performing main types of microbiological studies" - according to microbiological research in healthcare institutions for supervision in the field of consumer rights protection and human well-being. The date of approval of these documents, as can be seen from the list above, requires their revision. This problem is given particular relevance by the implementation of the national project “Health” when re-equipping healthcare institutions with modern equipment. Meanwhile, such work is not carried out at the federal level. Time standards for certain types of work for staff of employees and workers of healthcare institutions are determined, as a rule, according to documents approved at the intersectoral level.
News and analytics Legal advice (practice) Labor law It is planned to reduce the position of ‘nurse’, and
Order on the workload norms for outpatient doctors
BMN, Nurses to cleaners? BMN, Cleaning is one of the functions, but not the main one. According to the Order of the Ministry of Health of the Russian Federation dated July 23, 2010 No. 541n ‘Helps the elder nurse when receiving medicines, instruments, equipment and delivering them.
There are nurses in hospitals, and they are different: a nurse-cleaner (in her functional responsibilities includes cleaning of premises, but unlike an ordinary cleaner, she does the cleaning using disinfectants), a ward nurse (takes wards and cares for patients. The program automatically generates an order for enrollment, an order for transfer to the next course, an order for payment of tuition fees according to individual plan 1.1. Real job description determines the functional duties, rights and responsibilities of the cleaner. Doctors. Concerns were expressed that in connection with the complete transfer of nurses, by order of the Ministry of Health of the Russian Federation, a nurse - a cleaner, a nurse accompanying patients, a nurse - a utility model and an industrial design are being certified.
On measures for the further development and improvement of sports medicine and physical therapy" - according to physical therapy, sports medicine and by massage treatments; Order of the Ministry of Health of Russia dated 1. On measures to improve the organization of care for manual therapy in the Russian Federation” – in manual therapy; Order of the USSR Ministry of Health dated 2.
Number standards (staffing standards) - the required number of personnel to perform all functions assigned to the institution (division) and a certain amount of work, established by regulatory indicators and their combinations, calculated values. Number standards in healthcare are drawn up in the form staffing standards or model states. The main indicator and meter for establishing the positions of medical personnel in outpatient clinics is the size of the population or its individual contingents, for hospital institutions - the number of beds.
3. To the heads of regional health care facilities, health departments (departments, committees), TMO, Central District Hospital and health care facilities of the region:
Thus, the presented methodology can be used both in the development of a network of healthcare institutions and in the economic analysis of the activities of outpatient doctors
On the standardization of labor for outpatient clinic doctors in healthcare facilities of the region
4. Accordingly, the required number of visits to a particular population is determined according to the reporting and accounting documentation of health care facilities maintained both by the Ministry of Health of the Russian Federation and in the compulsory medical insurance system.
The actual function of a medical position is determined by summing up the number of initial visits and visits of other types (repeated visits, preventive examinations, home visits) converted to primary visits using conversion factors (Table 3).
In the presented formula, the planned function of a medical position is expressed in the number of visits carried out in the clinic. In a similar way, it would be possible to calculate the planned function of a medical position for the number of preventive examinations or for the number of home visits in order to subsequently, depending on the structure of the working day during the year, determine the total expression of the planned function in each specific case.
K is the coefficient of working time utilization.
1. Approve and approve the Methodological recommendations for standardizing the work of outpatient clinic doctors (hereinafter referred to as the Methodological Recommendations) in accordance with the appendix to the order and introduce them into practice in the work of healthcare institutions of the region, starting from September 1, 2000.
Planned function for the number of initial visits:
This methodology was developed on the basis of the Instructions for standardizing the work of outpatient doctors at the Research Institute named after. ON THE. Semashko RAMS, using the experience of outpatient clinics (departments of health care facilities).
800 + 948 + 285 + 514 = 2547 with a planning function of 3016 (6031: 2), i.e. the plan was completed by 84%.
(Order of the Department of Health Administration Stavropol Territory from 04.03.96 N 05-02/98)
The planned workload is determined for all staff positions of outpatient doctors provided for in the staffing schedule of a particular health care facility.
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
ORDER
On approval of standard industry standards of time for performing work related to a visit by one patient to a cardiologist, endocrinologist, or dental therapist
In accordance with paragraph 3 of the Rules for the development and approval of standard labor standards, approved by Decree of the Government of the Russian Federation of November 11, 2002 N 804 (Collection of Legislation of the Russian Federation, 2002, N 46, Art. 4583), and paragraph 19 of the action plan ("road maps") "Changes in sectors of the social sphere aimed at increasing the efficiency of healthcare" approved by order of the Government of the Russian Federation of December 28, 2012 N 2599-r (Collected Legislation of the Russian Federation, 2013, N 2, Art. 130; 2013, N 45, Art. 5863; 2014, N 19, Art. 2468; 2015, N 36, Art. 5087; 2016, N 21, Art. 3087),
I order:
Approve, in agreement with the Ministry of Labor and Social Protection of the Russian Federation, the attached standard industry standards of time for performing work related to a patient’s visit to a cardiologist, endocrinologist, or dental therapist.
Minister
V.I.Skvortsova
Registered
at the Ministry of Justice
Russian Federation
January 13, 2017,
registration N 45216
Standard industry standards for the time required to perform work related to one patient’s visit to a cardiologist, endocrinologist, or dental therapist
APPROVED
by order
Ministry of Health
Russian Federation
dated December 19, 2016 N 973н
1. Standard industry time standards (hereinafter referred to as time standards) for performing work related to one patient’s visit to a cardiologist, endocrinologist, or dental therapist (hereinafter referred to as a specialist doctor) are applied when providing primary specialized health care care in an outpatient setting (not providing round-the-clock medical supervision and treatment).
2. Time standards are the basis for calculating workload standards, headcount standards and other labor standards for medical specialists in medical organizations providing primary specialized health care in an outpatient setting.
3. Standards of time for one visit by a patient to a specialist doctor in connection with a disease, necessary to perform labor actions in the provision of medical care in an outpatient setting (including the time spent on preparing medical documentation)*:
________________
* Order of the Ministry of Health and Social Development of Russia dated December 27, 2011 N 1664n “On approval of the range of medical services” (registered with the Ministry of Justice of Russia on January 24, 2012, registration N 23010) as amended by orders of the Ministry of Health of Russia dated October 28, 2013 N 794n (registered with the Ministry of Justice of Russia on December 31. 2013, registration N 30977), dated December 10, 2014 N 813n (registered with the Ministry of Justice of Russia on January 19, 2015, registration N 35569) and dated September 29, 2016 N 751n (registered with the Ministry of Justice of Russia on October 25, 2016, registration N 44131).
Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 N 541n “On approval of the Unified Qualification Directory of positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the healthcare sector” (registered with the Ministry of Justice of Russia on August 25, 2010, registration N 18247).
a) cardiologist - 24 minutes;
b) endocrinologist - 19 minutes;
c) dentist-therapist - 44 minutes.
4. Time standards for a patient to visit a medical specialist for preventive purposes are set at 60-70% of the time standards associated with one patient visiting a specialist doctor in connection with a disease, established in a medical organization or other organization engaged in medical activities (hereinafter - medical organization), in accordance with paragraph 3 of these time standards.
5. The time spent by a specialist doctor on preparing medical documentation, taking into account the rational organization of work, equipping workplaces with computer and organizational equipment, should be no more than 35% of the time norms associated with a visit by one patient to a specialist doctor in connection with a disease and preventive purpose in accordance with paragraphs 3 and 4 of these time standards.
6. In medical organizations providing primary specialized health care in an outpatient setting, the time standards specified in paragraphs 3 and 4 are established taking into account the density of residence and age and gender composition of the population, as well as taking into account the level and structure of morbidity of the population by summing up correction factors time standards
The following correction factors are applied:
a) residential density of the attached population above 8 people per sq. km: -0.05;
b) the density of residence of the attached population is below 8 people per sq. km: +0.05;
c) the density of residence of the attached population of the Far North and equivalent areas is no more than 2.5 people per sq. km: +0.15;
d) the morbidity rate of the population is 20% higher than the average value for the constituent entity of the Russian Federation: +0.05;
e) the morbidity rate of the population is 20% lower than the average value for the constituent entity of the Russian Federation: -0.05;
f) the share of people over working age among the attached population is above 30%: +0.05;
g) the share of people over working age among the attached population is below 30%: -0.05.
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