Sergei Sobyanin to incentivise city hospital intensive care wards

Sergei Sobyanin to incentivise city hospital intensive care wards
Photo: Photo by the Mayor and Moscow Government Press Service. Denis Grishkin
Mortality rates in resuscitation and intensive care units have decreased from 10.7 to 9.6 percent from 2012, with patients spending an average of 2.1 days in ICU.

Moscow Mayor Sergei Sobyanin presented Dr Viktor Protsko, PhD (Medicine), , who specialises in traumatology and orthopedics, with a letter of thanks. Dr Protsko and his colleagues performed reconstructive surgery on a 15-year-old boy and restored his foot back to normal.

“Mr Protsko, I would like to thank you and your colleagues for performing this unique surgery. Although you say the surgery is simple, I get the impression that no one else could perform it. And what you have accomplished is amazing,” Mr Sobyanin said, while visiting the city’s Yudin Clinical Hospital.

The facility ranks among the largest city hospitals, he noted. “It is probably second only to city’s Botkin Clinical Hospital in terms of capability. The hospital has been upgraded over the past few years, it has received the most advanced medical equipment and the technology to perform this unique surgery,” he noted.

Complicated foot-correction surgery

In 2017, doctors performed complicated surgery to treat a foot with severe equinovarus deformity and dislocated bones. Prior to the surgery, patient Timur Dadayev from an orphanage in Makhachkala who has cerebral palsy was unable to walk or wear shoes, even custom-made footwear. The needed surgery wasn’t available in Dagestan, but orphanage officials who knew about Moscow doctors’ successful efforts to treat this type of deformity went to the Moscow- Capital of Health website and requested treatment for Timur.

The administration at the foot surgery centre at Yudin Clinical Hospital was prepared to operate on the boy who was then sent to Moscow.

After examining the patient, orthopedists Protsko, Tamoyev and Chernyshov decided to perform the following surgery:

  • exarticulation of the hucklebone and the scaphoid bone that were isolated along the joint fissure;
  • corrective arthrodesis of the shin-bone and the cuboid (fastening the bones);
  • tenotomy (intersection) of the left foot’s Achilles tendon.

Foot bones were aligned and corrected with submersible/embedded titanium implants.

The patient is recovering from the successful surgery, the postoperative period is proceeding smoothly, and the boy has been discharged with a corrective plaster cast that will be removed in two months. Once the cast is removed, he will be able to walk with his shoes on. The patient will now undergo physical therapy, and he will eventually be hospitalised again for doctors to evaluate the results and issue recommendations on further treatment.

The boy’s hospital treatment was financed by the compulsory medical insurance fund.

In 1999, Dr Protsko graduated with distinction from the therapeutic faculty of the Sechenov Moscow Medical Academy with a degree in Physical Therapy. In 2001, he completed an internship at the Academy’s traumatology and orthopedics faculty. In 2004, he completed a postgraduate course and defended his PhD thesis in traumatology and orthopedics at the People’s Friendship University of Russia where. the has worked his way up from assistant doctor to assistant professor at the traumatology and orthopedics faculty (2006). In 2008, he joined the Yudin Clinical Hospital as a traumatologist-orthopedist and has also been working there since then.

Assistant Professor Viktor Protsko heads the Russian Association of Foot and Ankle Surgeons (RUSFAS) and is a member of the Asian Association of Foot and Ankle Surgeons (AFFAS). He has written numerous research and methodological papers and also boasts various innovations in the area of foot and ankle surgery.

According to Dr Protsko, modern equipment makes it possible to correct deformities of the human foot’s front and rear sections and to restore the structure with implants.

“Diabetic foot is an important problem because there are patients with so-called myopathy and osteoarthropathy that cause foot defects. Few doctors are eager to treat diabetes cases. The feet become covered with ulcers and are deformed, and this generally leads to amputation. It affects relatively young patients with diabetes who are over 40. Doctors at our clinic can treat and cure these patients. Indeed, people recover, resume work and live normally, and we can avoid foot amputations,” Mr Protsko noted.

The Hospital has the latest diagnostic equipment for these patients, Yudin Clinical Hospital Head Doctor Denis Protsenko said.

“We have three computed tomography scanners, two magnetic-resonance tomography scanners, including one for resolving these difficult issues. The latter take selective scans of joints; and we also have a computed tomography scanner for patients in critical condition. Today, our equipment makes it possible to provide modern medical treatment,” he noted.

Grants for intensivists (resuscitators)

The quality of emergency medical treatment, including anesthesiology, resuscitation and intensive care, are among the main parametres for gauging the efficiency of the city’s healthcare system.

Moscow hospitals have 47 anesthesiology and intensive care units for adults, as well as 33 units for children and newborns, with 2,626 beds. Outpatient clinics have 12 such wards, including three for children. In addition, there are 25 mobile intensive care teams, including four pediatric and three for newborns.

Anesthesiology and intensive care wards employ 2,649 doctors, and experienced professionals with a ten-year-plus work record that accounts for 63 percent of this number.

In 2016, anesthesiology and resuscitation wards treated 346,800 patients, with post-operative cases accounting for 40 percent. Cardiology patients and people with respiratory insufficiency accounted for 28 percent and 8 percent, respectively. Other cases (including shock, coma, strokes, complications or multi-system organ failure) accounted for another 24 percent.

Patients spend an average of 2.1 days in intensive care wards. The mortality rates at intensive care wards have decreased from 10.7 to 9.6 percent from 2012. This is a good result for such wards.

Apart from traditional training centres, a simulator centre at the city’s Botkin Clinical Hospital is used to improve the performance of doctors and nurses.

The city is doing its best to improve the performance of intensive care wards that receive the best equipment on a priority basis. These wards should now be equipped with special systems for laying patients on beds and for placing them upright. This will make things easier for nurses and will reduce the number of complications in patients.

“As per your initiative, we have stipulated grants for resuscitation and intensive care wards at city hospitals. Each year, the ten best wards will receive 30 million roubles each to pay bonuses to their doctors and nurses,” Sergei Sobyanin told Dr Protsenko.

“I am confident this will motivate the city’s anesthesiologists and intensive care doctors,” Dr Protsenko replied.

The grants will be issued based on each ward’s efficiency, including mortality rates, the seriousness of patients’ conditions and the duration of medical treatment.

“I believe this will improve resuscitation and intensive care units dramatically because incentives and motivation for our doctors include both the newest equipment and a financial component. The newest technology includes world-class medical equipment for the city’s physicians, anesthesiologists and intensive care doctors. The grant is an additional material incentive,” Dr Protsenko noted.

Sixteen operating rooms and one helipad

The Yudin Clinical Hospital’s anesthesiology, resuscitation and intensive care service is the largest in the city, boasting 12 wards with 144 beds, 16 operating rooms, a helipad and an intensive-care ambulance.

A special ramp allows ambulances with patients in serious condition to reach the intensive care ward directly, bypassing hospital ER.

The service has a mobile computed tomography scanner for quickly diagnosing patients, without rushing them to the X-ray diagnostics ward.

It also has a room with extra-corporal detoxication (hemodialysis) equipment that effectively cleanses the blood of patients with acute kidney deficiency who have experienced compression injuries inside collapsed buildings and in other essential cases.

In various disasters and accidents, the intensive care ward starts working like an assembly line, treating as many patients as possible as quickly as possible. On 29 May 2017, a hurricane hit Moscow, with the hospital receiving 15 casualties. The four most affected patients were rushed to the intensive care unit. A multi-discipline team of medical specialists quickly inspected the others and decided not to admit ten of them. These people were later treated at outpatient clinics. 

Yudin Hospital’s Head Doctor Denis Protsenko is the chief expert on anesthesiology, resuscitation and intensive care at Moscow’s Department of Healthcare and therefore shares the positive experience of the hospital’s intensive care service to other hospitals.

Largest hospital in southern Moscow

The city’s Clinical Hospital No. 79 was established in 1961 in place of the Kolomenskaya Rural Hospital that opened in 1929. In 2015, the city’s Clinical Hospital No. 7 merged with Clinical Hospital No. 79 and was named after famous Soviet surgeon and researcher Sergei Yudin (1891-1954).

The hospital now ranks among the city’s largest multidiscipline hospitals and has 1,176 beds. Its intensive care ward has 144 beds; the hospital’s daytime inpatient facility has 50 beds, and there are also 20 beds for short-duration patients and 40 beds financed from extra-budgetary sources.

The hospital employs 2,800 people, including 675 doctors, 1,322 mid-level medical personnel and 479 junior medical staff. The doctors include one Merited Doctor of Russia, 15 with DSc (Medicine) degrees and 128 with PhD (Medicine) degrees.

The hospital is located on 23.7 hectares in southern Moscow and in the Nagatino-Sadovniki District and has 25 buildings with an area of 148,700 square metres, including:

  • a multidiscipline inpatient facility at 4 Kolomensky Proyezd with a daytime inpatient facility for 22 patients and 20 beds for short-duration patients;
  • a multidiscipline inpatient facility at 1 Akademika Millionshchikova Street;
  • outpatient clinics No. 1 and No. 2 with over 28,000 registered patients and also prenatal clinics.

The Hospital has three city-level specialised centres, including a primary vascular ward, a regional vascular centre and a perinatal centre.

The Hospital’s hemodialysis ward uses modern and safe extra-corporal blood-cleansing methods to treat patients with acute and chronic kidney deficiency, including 24 high-tech Fresenius 5008s systems and four reserve systems. Over 26,000 hemodialysis procedures are performed annually.

Since February 2017, the Hospital has been implementing a pilot project to establish facilities for short-term patients. The Hospital’s short-term inpatient facilities provide relatively simple surgery using advanced technologies and new equipment, including herniotomy to remove benign tumours, polyps and the like. After such surgery, patients stay at the Hospital for only a few hours and are discharged the same day. Since inception, these facilities for short-duration patients have performed over 700 standard and gynecological operations.

Since April 2017, the Hospital has been running the Cardio-Consultation expert centre, with medical specialists meeting every Friday at 1.30 pm and advising doctors and patients online in the Troitsky and Novomoskovsky administrative areas.

The Hospital employs skilled professionals from the city’s leading research and education centre faculties, including the Academician Kulakov Research Centre of Obstetrics, Gynecology and Perinatology, Sechenov First Moscow State Medical University and the Priorov Central Research & Development Institute of Traumatology and Orthopedics.

The Hospital is also involved in the University Clinic project and trains senior students from Sechenov First Moscow State Medical University and other leading medical universities majoring in obstetrics, surgery and therapy.

In 2011-2017, the city spent 1.2 billion roubles on upgrading and renovating the hospital buildings, including the therapy and surgery wards, outpatient clinics, kitchen and hall of ceremonies.

The hospital has received over 1,800 pieces of new medical equipment worth 1.3 billion roubles, including computed tomography and magnetic-resonance tomography scanners, ultrasonic systems, endoscopic poles and props, modern equipment for intensive care/resuscitation rooms, modern multirole medical furniture, operating tables, digital X-ray systems, lung ventilators, high-tech laboratory and other equipment.

The upgraded hospital with its new medical equipment now operates under streamlined systems and treats patients more effectively than before. In the first six months of 2017, hospital personnel have treated 36,015 patients, as compared to 65,483 in 2016. They have also performed 15,800 surgeries (31,729 in 2016) and delivered 3,001 babies (3,869 in 2016). Average treatment duration was 6.4 days, compared to 7.5 days in 2016.

“In the first six months of 2016, the Hospital treated 30,000 patients. New technologies, methods and  greater professionalism including a more pleasant bedside manner made it possible to treat 6,000 more patients during the same period of 2017. Regarding average hospitalisation times, patients had remained in the hospital for 7.5 days in January-June 2016, and now this is down to 6.4 days, with treatment quality remaining the same. And, most importantly, mortality rates have subsided,” Dr Protsenko explained.