CC BY
1«MEDICINE, SCIENCE AND EDUCATION», № 2, 2023
UCD: 614.2 DOI: 10.24412/1609-8692-2023-2-79-89
IRSTI: 76.75.02.
WORKLOAD MONITORING OF MEDICAL WORKERS IN PANDEMIC CONDITIONS ON THE EXAMPLE OF THE CENTRAL REGIONAL
HOSPITAL OF ILI
*D. Malikova, M. Baymuratova, M. Sarsenbaeva
LLP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan
Summary
Providing medical care to the population, the significant role is given to diagnostic methods of laboratory visual medicine. The ongoing transformations in the healthcare system require rational planning and organization of all aspects of inpatient care for the population. It is important to use diagnostic methods of diagnostic studies rationally to make a diagnosis in the context of the increased capabilities of modern technical means and due to the widespread use of visual diagnostics in the context of the coronavirus pandemic. Department of Radiology is one of the first to accept patients with suspected COVID-19 infection. Radiological methods of research used to diagnose patients with suspected coronavirus infection (COVID-19) and viral pneumonias are extremely important and include: computed tomography, radiography (stationary and portable apparatus), ultrasound of the lungs and pleural cavity. There has been an increase in medical services for visual diagnostics of diseases of the respiratory system, such as magnetic resonance imaging, computed tomography and ultrasound during the pandemic. The number of medical services provided for the purpose of diagnosing and confirming the diagnosis of Covid-19 during the pandemic increased by almost 2.3 times, which undoubtedly proves the fact that the burden on medical workers of this medical organization is increasing. At the same time, I would like to note the role of medical services provided by visual diagnostics, in dynamics it increased by 1.4 times more in 2021, compared to 2020, in all indicators presented.
Key words: pandemic, Covid-19, radiology department.
Introduction. The sphere of public health protection and medical care provision is currently in a state of transformation. Patients should be provided with the right to get quality medical care, which must meet modern quality standards, as are the principles of humanism and humanity concerning the patient and the medical service provider. Medical care is the activity of subjects that provide medical care to the population aimed at preventing, diagnosing, treating, and rehabilitating a person to preserve his physical and mental health due to the provision of appropriate medical services [1].
The labor activity of healthcare workers is associated with the negative impact of
various production factors: microclimate, insufficient lighting, various types of radiation, drugs and chemical compounds, biological agents, psycho-emotional stress, excessive stress on the analyzer systems (Burakova O A., Syurin S.A., Frolova N.M. 2011; Rostikov V.P., Rodkin V.P., Brusentsova A.V., Kapustina L.P., Butorin A.V. 2012) [2, 3]. The most common adverse factors in the working environment of medical organizations include physical factors - 84.0%, chemicals - 61.3%, labor intensity - 46.0% (N.A. Roslaya, E.G. Plotko 2013). It is no secret that the medical activity of healthcare workers is closely related to adverse conditions in medical organizations, and most often monitoring of
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the impact of harmful production factors is not carried out [5].
According to literature sources, the result of the negative impact of the production environment on the body of medical workers lead to a high frequency of occupational diseases, the life expectancy of medical workers becomes low, and the mortality rate, on the contrary, becomes high [5, 6].
Providing medical care to the population, significant role is given to diagnostic methods of laboratory visual medicine. The applied diagnostic technologies and methods depend on the volume and nature of the diagnostic search for pathology, the localization of the pathological process, the equipment used in the medical institution, and directly on the medical staff (Shelekhov P.V. 2019) [7].
Most often, health workers, by the nature of their activities, come into contact with various biological agents such as blood-borne infections and airborne infections [8].
Occupational diseases of infectious etiology occupy one of the first places in the structure of the disease of medical workers in Russia in 80.2% of cases [9].
Medical employees of laboratory services, along with biological and psychological harmful professional factors, come into contact with chemical factors of the laboratory environment. Thus, the working conditions of employees of medical laboratories of various profiles, such as microbiological, clinical diagnostic, biochemical, are associated with a number of harmful production factors [10].
The occupational morbidity of public health workers, according to statistics, is growing from year to year. According to various authors, only two percent of Russian doctors and paramedical workers (SMRs) are considered healthy. It is not the secret that this figure is much higher than statistics give [11, 12].
The Covid-19 pandemic, according to Russian researchers (2021), forced amendments to the legislation, specifically in the regulation of human rights in the health field [13].
Medical assistance to the population in the Republic of Kazakhstan was carried out according to the obligatory social health
insurance system and guaranteed free medical care. Since 2020, the method of compulsory social health insurance has been introduced. Therefore, if health care is financed at the expense of budgetary funds, then with the introduction of mandatory medical insurance, medical services will be paid in aggregate - at the cost of the state, employers, and citizens.
The obligatory social health insurance system provides the following:
1) consultative and diagnostic assistance on a wide range of health care (from now on -PHC) and specialized specialists;
2) inpatient care, for exceptional cases of treatment within the framework of guaranteed medical care, according to the geographical specialties of PHC or a medical organization;
3) planned inpatient care, except for cases of treatment of diseases within the framework of the guaranteed volume of medical care, in the direction of a PHC specialist or a medical organization within the planned number of hos-pitalizations;
4) medical rehabilitation and rehabilitation treatment in the direction of a PHC specialist or a medical organization according to the list of diseases (conditions) approved by the authorized body;
5) pathoanatomical diagnosis of diseases that are not included in the guaranteed amount of free medical care [14].
One of the costly and resource-intensive services of medical organizations are clinical laboratories, instrumental diagnostic laboratories, which are divided into radiation, functional, endoscopic, etc. carrying out the necessary research for the diagnosis of the disease by clinicians [15, 16, 17]. The number of x-ray studies in the world is growing day by day, which proves the important role of x-ray studies in medical practice today [18]. As a result of the use of the number of the latest technical equipment in medicine, their importance in medicine have grown, both for diagnosis and treatment. At the same time, we must not forget that with the use of the latest technical equipment in medicine, with an increase in opportunities in terms of information content and efficiency, the frequency of irradiation of patients is growing [19,20].
Shakhabov I.V., MelnikovYu.Yu., Smshlyaev A.V. (2020) shared the results of an analysis of the dynamics of performance indicators of the radiology departments of outpatient medical organizations of the Russian Federation over 9 years (2010-2018), presenting the volume of radiological examinations, which increased by 10.2%, conducted using computed tomography (computed tomography) - in 4.3 times, magnetic resonance imaging (magnetic resonance imaging) - 2 times [21].
Purpose of the study: to assess the dynamic changes over two years and the workload of medical workers in a pandemic using the example of The Central Regional Hospital Of Ili.
Materials and research methods:
1. Retrospective method - analysis of accounting and reporting documentation (Report-registry of medical organizations providing specialized medical care in the form of consultative and diagnostic assistance within the guaranteed volume of free medical care, paid for from the republican budget) for the period 2019-2021.
2. Statistical method - mathematical processing of the received data.
Results of the research. For the biennium 2020-2021, according to the data of The Central Regional Hospital of Ili, a total of 71,677 services were provided under the obligatory social health insurance, of which
21,410 (29.9%) services accounted for 2020 and 2022 year - 50267 (70.1%) services. The volume of services provided in this medical unit during the Covid-19 pandemic was the object of interest. When analyzing the types of studies performed, 19 services were diagnostic to confirm the clinical conclusion - coronavirus infection. A two-year comparative analysis over two years showed evident growth dynamics for all services, particularly consultations with specialists (pulmonologist, infectious disease specialist, tuberculosis specialist).
Request For Consultations Was distributed as follows: to a pulmonologist - 445 recommendations, of which 27 (6%) proposals for 2020 and (94%) requests for consultation in 2022, that is, an apparent 16 times increase. As for the infections' talks, there were only 6364 appeals, 2607 (40,9%), and 3757 (59%) in 2021. The consultation of the tuberculosis specialist for two years showed the dynamics of the decrease, i.e., during this period, the concern about tuberculosis infection has decreased comparatively. In total, 5656 consultations with a tuberculosis specialist were held, of which 3158 (55.8%) in 2020 and 2498 (44.2%). In dynamics, consultations of a radiologist showed an increase of 11 times, amounting to 36 out of the total number for two years, of which 3 (8.3%) were registered in 2020, and 33 (91.7%) were registered in 2021 (Figure 1).
Figure 1. Number of consultations of specialized doctors
Thus, the analysis of the consultations of specialized doctors such as a pulmonologist, an infectious disease specialist, and a radiologist for the period 2020-2021 showed an upward trend, while the consultation of a tuberculosis specialist was characterized by a decrease, from which it is permissible to conclude that there is a decrease in alertness to tuberculosis.
It should be noted that to confirm any infection, the bacteriological method is one of the leading methods of laboratory diagnostics since it allows you to determine the etiological bacterial agent if it is involved. Another advantage is a further step - detection of antibiotic susceptibility to antimicrobials. A bacteriological laboratory operates based on The Central Regional Hospital Of Ili, among which
Thus, the number of varieties of other research methods performed in bacteriological studies of the detachable pharynx, etc., increased markedly over two years.
The next indicator that we analyzed was the number of analyze of lung spirography: a
we analyzed the following indicators: the study of discharge from the pharynx, wounds, eyes, ears, urine, bile, etc., by the manual method (isolation of a pure culture), which in just two years (2020-2021) 3607 were carried out, out of 775 (21.5%), 2832 (78.5%). All samples of substrates from 60 studies were identified on the analyzer, of which 22 (36.7%) in 2020 and 38 (63.3%) in 2021, with an increase of 1.7 times. It is possible to conclude the activation of bacterial involvement from among the opportunistic flora. In fact, in 2020, a bacteriological study of discharge from the pharynx, wounds, eyes, ears, urine, bile, etc., by the manual method (without isolating a pure culture) was not carried out at all, while in 2021, this type of study was carried out in 33 (100%) cases (Figure 2).
study of the function of external respiration (spirography, body plethysmography) in total was carried out over two years 401 studies, of which 175 (43.6%) in 2020, 226 (56.4%) in 2021. Manual spirography was not carried out in 2020, in 2021 - 24 (100%) (Figure 3).
Figure 2. Bacteriological analyzes of discharge from the pharynx, etc. for the analyzed period
■ Spirographs on DOD-automated devices; 100%
Spirography; _ift%
■ Spirography; 43,60%
■ Spirography on non-automated
devices; Q ■ 2020 «2021
Figure 3. Number of spirography performed in a biennium
The instrumental method of studying external respiration as spirography was also more often used in 2021, and spirography of non-automated devices was not carried out at all in 2020. In 2022, an increase was noted by 24 times. The Department of Radiation Diagnostics is among the first to accept patients with suspected COVID-19 infection. Radiation research methods used for diagnosis in patients with suspected coronary viral disease (COVID-19) and viral pneumonia are essential and include computed tomography, radiography (stationary and portable apparatus), and ultrasound of the lungs and pleural cavity [22]. In addition to identifying and clarifying the nature of the disease, visual diagnostic methods are also tasked with assessing the results of conservative and surgical treatment, dynamic monitoring of the course of the pathological process, and the completeness of healing [23]. Chinese and expert experts in the field of radiology have identified several central units of the emergency service in conditions of the temporary COVID-19 pandemic, which include: recommendations for protecting the department, protecting patients, choosing the most reasonable method of X-ray examination,
standardized protocols for describing the detection of a common virus [24].
Next, we analyzed the number of visual laboratory studies performed. According to the reporting documentation based on The Central Regional Hospital Of Ili, the following types of visual diagnostics were performed in patients with suspected coronavirus infection:
- magnetic resonance imaging of the chest organs; - computed tomography of the chest organs with contrast; - computed tomography of the chest and mediastinum; - X-ray of the chest; - X-ray survey of the chest (1 projection);
- X-ray of the chest organs (2 projections); -Ultrasound of the lungs; - Ultrasound of the pleura and pleural cavity.
Comparative data on the number of imaging studies conducted over two years showed the following picture: a total of 17,038 imaging studies were conducted, which is 23.8% of all services provided for the two-year period in The Central Regional Hospital of Ili under the obligatory social health insurance program. A comparative analysis of the visual diagnostic services provided showed that in 2020, a total of 7088 (41.6%) examinations were carried out, in 2021 - 9950 (58.4%) examinations, which in total amounted to 17038 services.
Figure 4. The number of visual diagnostics performed for the analyzed period
As an analysis of the services provided in visual diagnostics over two years showed, there is a real burden on specialists in this field, which has increased in a pandemic, which may be the reason for the development of emotional burnout in medical workers in this specialty.
In addition to the above services, based on The Central Regional Hospital of Ili, tests were carried out to detect the ribonucleic
acid of the COVID-19 virus from biological material using the polymerase chain reaction method, in 2020 8881 (39.8%), in 2021 13425 (60.2%).
There were only 71,677 visits by a mobile team to patients with suspected COVID-19, COVID-19 disease over a two-year period, of which 21,410 (29.9%) in 2020, and 50,267 (70.1%) in 2021 (Figure 5).
Figure 5. Number of Covid-19 tests and mobile team visits for patients with suspected
Covid-19 cases
As can be seen from Figure 5, tests for the detection of ribonucleic acid of the Covid-19 virus in 2021 were carried out 1.5 times more compared to 2020, and there were more mobile team visits for patients with suspected Covid-19 and those with Covid-19 in 2021 was 2.3 times more than in 2020.
Summarizing the number of workloads performed by visual diagnostic doctors, that is, the services provided within the framework of the compulsory medical insurance system in The Central Regional Hospital Of Ili, it is permissible to conclude that the number of medical services offered for the diagnosis and confirmation of the diagnosis of Covid-19 in a pandemic increased by almost 2.3 times, which undoubtedly proves the fact increasing the burden on medical workers of this medical organization. At the same time, the role of medical services provided by visual diagnostics, in dynamics it increased by 1.4 times more in 2021, compared to 2020, in
all indicators presented.
Discussion. it was found that the provision of medical care to the population during the pandemic has grown in the following parameters: as a consultation of specialized doctors (pulmonologist, infectious disease specialist, radiologist), an increase in the number of bacteriological studies of the detachable pharynx was found, etc. both manual and automated methods, an increase in medical services for visual diagnostics of diseases of the respiratory system, such as magnetic resonance imaging, computed tomography and ultrasound during the pandemic, was revealed.
Conclusion. We consider it reasonable to study the workload on medical workers, including visual diagnostic workers during a pandemic, to improve the organization of work and rest conditions for medical workers, preventing the formation of the syndrome of emotional burnout.
1ЛЕ ОРТАЛЬЩ АУДАНДЬЩ АУРУХАНАСЫ МЫСАЛЫНДА ПАНДЕМИЯ КЕЗ1Н-ДЕГ1 МЕДИЦИНА КЫЗМЕТКЕРЛЕРШЩ ЖYКТЕМЕСIН БАЦЫЛАУ
*Д. Маликова, М. Баймуратова, М. Сарсенбаева
«^ДСЖМ» ^азакстанды; медициналы; университет ЖШС, Алматы, ^азакстан
Тушндеме
Тургындарга медицинальщ кемек керсету барысында лабораториялык визуалды ме-дицинаньщ диагностикалы; эдютерше ерекше орын бершедь Денсаулы; сактау жYЙесш-деп жалпы жYргiзiлiп отырган кайта курулар тургындарга стационарлы; кемек керсетудщ барлык салаларын утымды жоспарлауды жэне уйымдастыруды талап етедi. Замануи тех-никалы; куралдардыц мумкшдштершщ артуы жагдайында, сонымен катар коронавирусты инфекция пандемиясы жагдайында визуалды диагностиканыц кещнен колдануына байла-нысты диагноз кою Yшiн лабораториялык зерттеулердщ барлыц эдiстерiн утымды пайда-лану мацызды. Сэулелi диагностика белiмi COVID-19 инфекциясына кYдiктi наукастарды алгашкы кабылдайтын орынныц бiрi. Коронавирусты; инфекцияга (COVID-19) жэне ви-русты; пневмонияга кYдiктi наукастарды диагностикалау Yшiн колданылатын зерттеудщ сэулелi эдiстер ете мацызды жэне келесiлердi камтиды: КТ, рентгенография (стационарлык жэне тасымалданатын аппаратпен), ккпе мен плевра кууысыныц ультрадыбысты; зерттеуь Пандемия кезiнде МРТ, КТ жэне УДЗ сиякты тыныс алу жYЙесi ауруларын визуалды диагностикалау бойынша медициналы; кызметтердщ кебеюi аныкталды. Пандемия кезшде COVID-19 диагнозын аныктау жэне растау макстаында керсетiлетiн медициналы; кызметтердщ саны зерттеулер нэтижесi керсеткендей 2,3 есеге жауык артты, бул осы медицина-лык уйымныц медицина кызметкерлерше тYсетiн жYктеменiц артып келе жатканына дэлел. Бул ретте визуалды диагностика аркылы керсетiлетiн медициналы; кызметтердщ релi ту-ралы атап ету кажет, ол барлык керсеткiштер бойынша 2020 жылмен салыстырганда 2021 жылы 1,4 есеге ескенi белгiлi болды.
Tyrnndi свздер: пандемия, Covid-19, cdyneni диагностик 6oniMi.
МОНИТОРИНГ НАГРУЗОК МЕДИЦИНСКИХ РАБОТНИКОВ В УСЛОВИЯХ ПАНДЕМИИ НА ПРИМЕРЕ ИЛИЙСКОЙ ЦЕНТРАЛЬНОЙ РАЙОННОЙ БОЛЬНИЦЫ
*Д. Маликова, М.Баймуратова, М. Сарсенбаева
ТОО Казахстанский медицинский университет «ВШОЗ», г. Алматы, Казахстан
Аннотация
При оказании медицинской помощи населению значительная роль отводится диагностическим методам лабораторной визуальной медицины. Осуществляемые преобразования в системе здравоохранения в целом требуют рационального планирования и организации всех аспектов стационарной помощи населению. Важным является рациональное использование диагностических методов диагностических исследований для постановки диагноза в условиях возросших возможностей современных технических средств, а также в связи широким использованием визуальной диагностики в условиях пандемии коронавирусной инфекции. Отделение лучевой диагностики одно из первых принимает больных с подозрением на инфекцию COVID-19. Лучевые методы исследований, применяемые для диагностики у пациентов с подозрением на наличие коронавирусной инфекции (COVID-19) и вирусных пневмоний, чрезвычайно важны и включают: КТ, рентгенографию (стационарным и переносным аппаратом), УЗИ легких и плевральной полости. Выявлен рост медицинских услуг визуальной диагностики заболеваний дыхательной системы как МРТ, КТ и УЗИ в период пандемии. Количество оказываемых медицинских услуг с целью диагностики и подтверждения диагноза Covid-19 в условиях пандемии возросло почти на 2,3 раза, что несомненно доказывает факт повышения нагрузки на медицинских работников данной медицинской организации. При этом, хотелось бы отметить роль медицинских услуг оказываемой визуальной диагностикой^ динамике выросла по всем представленным показателям на 1,4раза больше в 2021 году, относительно 2020 года.
Ключевые слова: пандемия, Covid-19, отделение лучевой диагностики.
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Information about the authors
Corresponding author. Malikova Danagul Birikovna, - 2nd year master's student in the speciality «Public Health», LLP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan, E-mail: malikova15.05@inbox.ru, ORCID https://orcid.org/0009-0000-1310-1677.
Baimuratova Mairash Aushatovna - c.m.s, professor of the Department «Public health and social sciences », LLP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan, E-mail: mairash@list.ru, ORCID https://orcid.org/0000-0003-0219-7874.
Sarsenbaeva Maira Zamarbekovna - c.m.s, senior lecturer of the Department «Public health and social sciences», LLP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan, E-mail: maira.sarsenbaeva@mail.ru, ORCID https://orcid.org/0000-0002-0921-2224.
Article submitted: 13.03.2023.
Accepted for publication:.12.05.2023.
