A laminar flow and artificial climate, or how the Sklifosovsky Institute is changing

A laminar flow and artificial climate, or how the Sklifosovsky Institute is changing
A laminar flow, a computer workstation and laparoscopy equipment – this is how the surgery ward at the Sklifosovsky Institute looks today. Each room features X-ray and ultrasound equipment, while high-tech materials were used to create sterile areas.

A newly renovated surgery ward at the Sklifosovsky Institute, commonly referred to as Sklif, has recently re-opened. Nine rooms now are equipped with cutting-edge equipment, which will allow surgeons to do the most complicated operations in various areas.

The majority of people taken to this hospital are seeking emergency aid, however, patients are increasingly going into hospital rather for planned surgery than for urgent operations. In a year, their number of such patients topped 3,500 and the surgery ward has been renovated to receive as many of this kind of patients as possible.

Laparoscopy and artificial climate

After the renovation, the ward has nine operating theatres, including those for angiosurgery; surgical gastroenterology; liver, pancreatic gland and bile duct surgery; thoracic surgery; gynaecology; and traumatic surgery. Each room allows surgeons to carry out from two to six operations a day depending on how difficult surgery is.     

The facility has been redesigned and the old equipment has been completely replaced with new. Now each operating room has advanced X-ray and ultrasound diagnostic equipment, as well as equipment for the video laparoscopic, thoracic and arthroscopic surgery which are done through micro incisions.

An artificial climate system has been installed to ensure that each operating room can control its climate by using a laminar flow. This is a stream of ultrapure air, which serves as a barrier to minimise the number of particles transporting bacteria to a wound. Climate and lighting are controlled from a computer workstation where patients’ medical notes are also kept and the screen of which is capable of showing what surgeons are doing at the moment. This system is called an integrated operating theatre and requires just one person to connect to it and handle the equipment.  

From hospice to research centre

The famous Sklif started off as a hospice built with Nikolai Sheremetev’s money. In 1810, the hospital, which was also an asylum for the poor, could receive 100 people. The first in line for charity were petty officials, retired officers, priests and elderly philistines.  

The hospice started turning into a medical clinic with the arrival of new chief physician Alexei Tarasenkov in 1858. Later, a free out-patient clinic where patients could also obtain drugs opened there. By the end of the century, the Sheremetev Hospital, as the hospice had been referred to from the mid-19th century, developed into one of Moscow’s most advanced healthcare institutions. In 1918, the clinic launched a round-the-clock service and a year later it was used to establish the Moscow Emergency Aid Station. In 1923, the hospital was renamed Research and Development Emergency Aid Institute.

Today, the Sklifosovsky R&D Emergency Aid Institute is a major multifunctional research centre where theoretical knowledge is put into practice. Doctors working there have skills in emergency surgery, cardiology and intensive care, as well as skills to treat multiple serious injuries, burns and acute poisoning. Sklif is part of a network of seven vascular treatment centres where cerebrovascular diseases are treated.

The institute has ten research branches, 44 branch clinics and five municipal centres: for burn treatment, liver transplantation, acute poisoning, radiosurgery and vascular treatment. Patients in the gravest conditions and with the severest injuries undergo treatment in Sklif and often are transferred there from other hospitals. On average, 185 people seek medical aid from Skliff every day, of which 100 people are admitted to the hospital. Last year, 68,400 patients received medical aid at Skliff, including 34,500 patients who were treated and cured at its in-patient department.

The Sklifosovsky Institute provides highly technological aid: its Gamma-Knife equipment allows surgeons to remove benign and malignant tumors and treat vascular conditions of the brain without using a surgical needle or other surgical instruments.

Video laparoscopic operations to remove a kidney or part of a kidney are also performed in Sklif. This type of intervention – known for causing minimal damage to the tissue – more rarely gives rise to complications and this in turn leads to patients having shorter stays in hospital. Video laparoscopic operations are believed to be more effective than classic open surgery.

Robotics and radiosurgery are new health restoring technologies

The Moscow healthcare system is on target to reach a qualitatively new level, thanks to new technologies. Over the previous six years, the city’s clinics and hospitals have received 25,000 units of advanced surgical equipment, which has made it possible to do the most complicated operations and literally save lives.

The most advanced medical technology is now available to Muscovites, including operations using robotics and stereotactic radio surgery equipment, histoscanning, endovascular operations on heart and blood vessels, positron-emitting tomography and IVF. Over the past six years, the amount of high-tech medical aid provided to city residents has increased 365 times for oncology treatment, 15 times for heart and vessel surgery, 5.2 times for traumatic and orthopaedic surgery, three times for neurosurgery and abdominal surgery and 2.7 times for pediatrics.  

 

Thanks to an upgrade in first aid equipment, the creation of vascular treatment centres and new treatment methods, the hospital mortality rate from acute heart attacks has declined. Over five years, it has dropped by 66.7 percent. Nearly 92 percent of heart attack patients leave hospitals after being successfully treated and this figure meets the world’s best standards. 

Compared to the situation six years ago, the mortality rate for the working age population is down 20 percent and the maternal and infant mortality rate has dropped by 30 percent. Today, the life expectancy of Muscovites is 77 years, which is the city’s best indicator in recorded history.

Simulation centre for doctors and electronic sick-leave certificates for patients

The city has demonstrated its ability to provide the Moscow healthcare system with assets and facilities in order to ensure that doctors have more advanced hands-on training. For this purpose, a simulation centre was opened using the example set by Botkinskaya Hospital. The centre has robot patients that have the anatomical make-up similar to a man’s, have beating hearts and can both breathe and excrete. They also consume oxygen, emit carbon dioxide and respond to the drugs and treatment being administered.

There is also a virtual clinic simulating emergency situations. This is a separate facility for reproducing audio and visual effects of a fire, flooding and other accidents. At the new simulation facility, medical staff hone the very first aid techniques that they may require in an emergency situation.    

Moscow’s out-patient clinics have also changed: patients can make an appointment to see a doctor, change the appointment date or cancel a doctor’s visit by phone, through touch-screen information kiosks or by Internet. Ninety-eight percent of patients can book an appointment to see a GP or a pediatrician one or two days in advance, while the average doctor appointment wait has been reduced from 30 minutes to 16 minutes.

Electronic history cases, sick-leave certificates and prescriptions help patients and doctors save time. Over 2.6 million people have already received electronic history cases. Last year, Moscow doctors wrote out 1.3 million electronic sick-leave certificates and 18 million prescriptions.