Triage system, digital X-ray and 11 operating rooms: how the flagship center of the N. I. Pirogov City Clinical Hospital No. 1 is organized

A triage system, modern equipment, the concept of a digital clinic and 11 multi-disciplinary operating rooms—doctors of the flagship center of N.I. Pirogov City Clinical Hospital No. 1 provide emergency and scheduled treatment to patients with a wide range of diseases. During the first month of its operation, the medical institution treated almost six thousand people, and its specialists performed hundreds of high-tech operations and thousands of diagnostic tests.

Learn about how the new flagship center is organized and equipped, the advantages of the “doctor to patient” principle, how advanced equipment helps to save lives and how much the Moscow health care system has improved thanks to the opening of the fifth emergency center in this report by mos.ru.

Diagnosis and treatment in one place

The flagship center of the N.I. Pirogov City Clinical Hospital No. 1 opened on December 20, 2024, at 10 Leninsky Prospekt, building 7. The seven-story building is located on the territory of the First City Hospital, one of the oldest and largest clinics in the capital.

One of the hospital’s 27 buildings was completely reconstructed over the course of three years in order to house the new flagship center. It is easy to find it using the signposts and the blue sign bearing the logo of the capital’s Department of Health Care—the letter M enclosed in a heart. Heated elevated passageways connect the building to neighboring buildings.

Patients visiting the center are fully diagnosed, and if necessary undergo surgical intervention, followed by recovery in the intensive care facility and treatment in the hospital.

“Almost all medical specialties are represented in our flagship center, including surgery, trauma, ophthalmology, otorhinolaryngology, gynecology and urology. The staff employs 350 people, including highly-qualified doctors with the status of Academicians and doctor of science. About 2,800 items of medical equipment and furniture were purchased for the center, including an angiography system, a magnetic resonance tomography machine, a whole-body X-ray computed tomography system and a mobile X-ray C-arm machine. After providing the necessary treatment, patients are either discharged, after which they have their condition monitored through outpatient visits, or they are sent to inpatient departments for further treatment,” says Darya Tuul, head of the emergency medical care center of N.I. Pirogov City Clinical Hospital No. 1.

Priority (red) flow system for emergency patients

The flagship center of the N.I. Pirogov City Clinical Hospital No. 1 meets modern medical standards. The lobby and emergency room have cushioned chairs and sofas, lockers for patients’ personal belongings, water coolers and coffee machines, and white calla lilies blooming in wooden tubs. There are navigation strips on the floor—red, yellow and green—showing the directions of the respective flows, illuminated signs on the walls and large screens showing educational videos. The doors open at the push of a button.

To the right of the main entrance is the emergency room, where patients are brought by ambulances. In the spacious heated vestibule, patients are reloaded onto gurneys. Red category patients in need of urgent care are taken either to the shock room, where a team of intensive care specialists is already waiting for them, or to the operating room.

These patients are immediately hooked up to monitors that track their temperature, blood pressure, heart rate, oxygen saturation in the lungs and other vital indicators. The shock room is equipped with modern equipment including artificial ventilation and ultrasound machines, an indirect cardiac massage system, an anesthesia breathing machine and an external cardiac pacemaker.

“While the ambulance is bringing the patient in, the paramedics take notes of the patient’s history and relaying the information to us online, meaning we already know about the preliminary diagnosis and condition of the person being brought in, whether they have any chronic conditions, where they were transported from and how long the journey took. All of this information is displayed on screens in the shock room and the emergency room. According to the regulations, red flow patients should receive help in the first minutes after admission,” explains Roman Emelin, an anesthesiologist and resuscitator at the flagship center of the N.I. Pirogov City Clinical Hospital No. 1.

Operating rooms with telemedicine functions

At the heart of the flagship center is a multidisciplinary operating theater located on two floors. Now, for the first time, the N.I. Pirogov City Clinical Hospital No. 1 has an integrated digital operating room with automated data transfer, visualization and intelligent management. High-resolution sensors and video cameras allow medical professionals to observe the operation process in great detail on large screens and broadcast it anywhere in the world, and thus to consult with experts and train colleagues from Moscow and other regions.

The hybrid operating room makes it possible to perform simultaneous surgical interventions for several different pathologies. Thanks to the sophisticated angiography equipment, doctors can reach inside the thinnest vessels and perform parallel surgeries on the head, chest, abdomen or limbs without moving patients from one site to another.

“Apart from the digital operating room with its telemedicine, and the hybrid operating room, we have nine multi-disciplinary operating rooms with state-of-the-art equipment. Anesthesia breathing machines, defibrillators, endoscopic video cart stands, surgical microscopes, portable scanners, artificial circulation devices, X-ray C-arm stands and other items of advanced equipment allow specialists to perform any surgical interventions required,” explains Vadim Konstantinov, an emergency care physician and anesthesiologist at the flagship center of N.I. Pirogov City Clinical Hospital No. 1.

After surgery, patients are transferred to the intensive care unit on the second floor. This unit has 11 beds, including two single-person rooms. Patients remain under constant medical observation for twenty-four hours. The beds are separated by thick screens, and each bed has a syringe dispenser, artificial lung ventilation apparatus, monitor for the recording of the patient’s vital functions, and also, for the patient’s comfort, heated blankets working from the mains power supply. The department is equipped with defibrillators, electrocardiographs, portable ultrasound machines and pneumatic sample transportation system. Radiologists and endoscopists come in to see patients, so the patients only need to leave the intensive care unit in order to have CT or MRI scans. Once their condition is stabilized, patients are transferred to other hospital units where they stay until they are discharged.

Bracelets and clips

The allocation of other incoming patients is done using a digital triage system. At two medical stations patients’ temperature, blood pressure and pulse are measured and after a brief review of their medical history, they are assigned to the yellow or green flows. Every patient is given a bracelet in the appropriate color, and clips if needed. Red indicates a risk of the patient falling, yellow indicates the presence of chronic conditions such as diabetes, and turquoise denotes a medication or food allergy.

“The red flow takes patients to the shock ward, and the yellow and green flows take them to the examination rooms, which are on the first floor. There are seven such rooms, and in each room patients are seen by a surgeon, traumatologist, neurosurgeon, ophthalmologist, neurologist, otorhinolaryngologist, maxillofacial surgeon and urologist and gynecologist. The center has all modern equipment for diagnostics: computer tomography and digital X-ray apparatus, expert-class ultrasound machines, and monitors for the recording of vital functions,” says Marat Magomedov, deputy chief physician for urgent care at the flagship center of N.I. Pirogov City Clinical Hospital No. 1.

In addition to the examination rooms and the shock rooms, each with six beds, the first floor houses a diagnostic room, an isolation ward for infectious patients, and five multi-disciplinary operating rooms for emergency interventions, including a hybrid and a digital operating room. The second floor has six operating rooms for scheduled surgery, as well as an 11-bed intensive care unit. On the third to the sixth floors are the hospital’s inpatient departments: a neurosurgery department, two trauma departments and a cardiovascular surgery department. On the seventh floor is the diagnostic suite. The minus first and minus second level basement floors house technical premises.

Care at the center is organized according to the “doctor to patient” principle. After a quick registration process in the emergency department, further examinations and procedures other than CT and MRI are performed at the patient’s bedside. And digitalization allows specialists to access patients’ medical records online via tablet computers.

Employees of the capital’s state services centers help the doctors in their work. They perform administrative functions and also create a comfortable environment for patients and the family members accompanying them.