The so-called «reformation» of the MHEM means the crippled fate of hundreds of patients and medical workers. Appeal of surgeon Golovin to Mykolaiv authorities

In our city may arise a difficult situation with urgent surgical care.

Mykolaiv Municipal Hospital of Emergency Medicine is a hospital that provides multidisciplinary emergency specialized medical care to the residents of the city, the region, and during the martial law to the residents of the neighboring Kherson region, in which, unfortunately, it is impossible to provide emergency specialized medical care due to hostilities (due to the lack of medical employees, lack of medical facilities). Therefore, it is impractical to pursue the goal of an even greater reduction in the number of employees at the present time.

This trend leads to a decrease in the quality of care for patients (delay of a full round-the-clock examination of patients (ultrasound, EKG rooms sometimes do not work around the clock). In such conditions, an objective delay in delayed surgical interventions is possible). Such a situation can contribute to the complaints of patients.

Currently, there is a tendency to increase the number of patients in surgical departments (the population in the city is increasing, that is, the number of patients is also increasing).

Taking into account the status of the MHEM (both in peacetime and in wartime), it is necessary to have a reserve of bed funds. In a day, 6-7 patients can be hospitalized, and there can be 12-15 patients who need inpatient surgical treatment.

A percentage of patients who are not indicated for urgent surgical intervention need to be hospitalized in surgical departments, but such patients must be under the surgeon's 24-hour supervision (patients with gastrointestinal bleeding, acute pancreatitis, intestinal obstruction, chest and abdominal injuries).

There is a percentage of patients who simply need dynamic supervision by a surgeon in a hospital to rule out acute surgical pathology in the future.

There is such a concept as polytrauma - when a person receives multiple complications of various organs and systems. And now the war is going on, and the question arises that the patient should receive emergency care from a surgeon, a traumatologist, a neurosurgeon, and an intensive care physician as soon as possible. The time counts down to minutes. The prepared personnel potential of the hospital, developed algorithms and accumulated work experience are yielding results — the indicators of providing care to patients with polytrauma have improved. It is impossible to provide such urgent actions in other surgical hospitals (there are no specialists available 24 hours a day, except for the medical center ).

Health care reform and its adaptation to European standards is underway in Ukraine. MHEM must keep up with the times. But in this difficult period for the country, during the reformation of the industry, questions arise that require immediate logical and well-considered solutions.

Funding of medical institutions, forming the number of personnel is also a challenge of time. On this basis, the problematic order of the director of the Ministry of Education and Culture Demyanov No.119 dated 07/25/2023. The text of the order raised a lot of questions among the hospital staff and in the surgical departments separately. Repeated meetings of the teams of surgeons of the MHEM with the administration did not lead to mutual solutions to the issues. No amount of our arguments, no amount of common sense can stop the «reformation» of the hospital. And these are the crippled fates of hundreds of patients and hospital workers.

It is impossible to retain trained nurses to work in such conditions and with such a salary. And this during the war! There will soon be no need to reduce the staff, the employees themselves will go to those medical institutions where the intensity of work is the same (or maybe less), and the salary is higher. Please help preserve our unique hospital, preserve the emergency surgical service, namely two departments, preserve and multiply what we already have in cooperation with the city and regional administration, do not give permission to destroy the existing one.

Doctors were shocked by the order

On July 25, 2023, the MHEM issued Order No. 119 (it was made public to managers and employees as early as September):

"Due to the insufficient financing of the enterprise in 2023 and the need to carry out the ratio of the number of personnel to the number of services provided, the introduction of the latest treatment methods, the effective use of equipment for the implementation of priority scopic packages of the National Health Service"

• merge surgical departments No. 1 and No. 2 into one unified one;
• create a department for endoscopic research and minimally invasive interventions;
• connect the patients of the gynecological and urological departments into a single center with the transfer of the gynecological department to the urology department on the 4th floor;
• transfer of departments to other floors.

After familiarizing the staff of the departments with the Order, employees and managers were, to put it mildly, in shock. The order, in my opinion, is, firstly, not legally valid. Secondly, by connecting two surgical departments into a single one, conditions are provided to reduce the comfort of patients staying in the wards. There will be no possibility of sanitary preparation of the department for the next hospitalization of new patients (preparation of bed stock, cleaning of wards and premises). In such conditions, it is not convenient to prepare documentation for patients discharged from the department in a timely manner. Ward day doctors still have separate surgical work (delayed and planned operations). Conditions are created either in the delay of operative interventions or in the delay of timely preparation of documentation.

The merging of patients with a urological and gynecological profile is also not desirable, because these are different pathological processes and different infectious agents.

Is an endoscopy department necessary?

In connection with insufficient financing of the enterprise in 2023, one point of the Order proposes the opening of a department of endoscopic research. This item contradicts the wording of the Order. Funds are not enough even for salaries, and the opening of an unnecessary department is proposed. It is possible to conduct diagnostic and therapeutic endoscopic examinations, but they are conducted (as in the entire civilized world) in specialized departments. Only a urologist should perform cystoscopies. There is a cystoscopy room in the urology department. Hysteroscopy should be performed only by a gynecologist and in the operating room. The hysteroscope is in the operating theater of the MHEM and continues to work. Endoscopic studies of the gastrointestinal tract (fibrocolonoscopy) are carried out in video endoscopy. The load of planned and urgent patients is such that one day endoscopist can easily cope with it.

At the same time, an emergency endoscopist is present on schedule (24/7), there is no problem. In an emergency surgical hospital, it is necessary to carry out endoscopic studies on the extrahepatic bile ducts for diagnosis and minimally invasive treatment of choledocholithiasis (stones in the bile ducts) and other diseases of the hepatopancreatobiliary system. The question is very relevant. There is a fibroduodenoscope for such studies in the MHEM, but it is underequipped with instruments and its use is possible only with an X-ray arch. Manipulations are performed in the operating room. This possibility also exists in our hospital, the problem is only in the additional equipment of the duodenoscope. No special coercion is needed for this.

To perform all types of endoscopic examinations in the hospital, you only need to find an office for fibrobronchoscopy. I believe that this problem is easy for the hospital administration to solve.

In the department of endoscopic studies, it was planned to separate patients for laparoscopic operations. Laparoscopy is not endoscopy. Laparoscopy is a minimally invasive technique for performing surgical, urological, and gynecological interventions. The majority of surgeons in both surgical departments have the laparoscopic technique of operations.

It is a mistake to separate such patients from general surgery (every laparoscopic operation can end with a conventional surgery).

Thus, the organization of a separate department of endoscopic research with insufficient funding of the hospital in 2023 is a planned inappropriate use of public funds in wartime conditions.

The status of MHEM allows you to have more than one surgical department (for example: in Kyiv MHEM there are 4 surgical departments, in Dnipro MHEM — 3 surgical departments, in Kropyvnytskyi MHEM — 2 surgical departments). Both surgical divisions of the MLSHMD are constantly in operation, filled with specialized patients and often help the neurosurgical department with beds when the latter is overcrowded. Work continues around the clock.

Alternating departments according to the schedule every other day allows :

• to carry out emergency, delayed, planned operative interventions in a timely manner without delays and queues;
• keep the premises of departments in a decent sanitary condition;
• timely prepare documentation for discharged patients;
• to have a stock of bed funds (especially during the period of active military operations with their consequences);
• to maintain the comfort of patients in the wards;

The issue of employee wages

Every day we hear the answer to the question «Why is the salary in the hospital lower than in other medical institutions»: The salary is formed by the National Health Service of Ukraine and depends on the number of cases of treated patients in the E-Health 24 system. According to the data of the National Health Service, I will give an example numbers of two hospitals in Mykolaiv:

Payment was provided under the Medical Guarantees program:

MLSHMD for 8 months of 2023 — 72,084,713 UAH.

ML No. 3 for 8 months of 2023 — UAH 69,437,455.

According to these figures, the salary of the staff of the MHEM should be no less than that of the employees of the MH M°3. Below are the data of employees of MHEM and MH No. 3 with average salaries:

The staff of surgical department No. 2 appealed to the head of the Mykolaiv Regional Military Administration, Vitaly Kim, with a request to pay attention to existing problems in the organization of work and its payment in surgical departments, and the hospital as a whole.

Ihor Golovin, head of the surgical department No. 2 of the Mykolaiv State Medical University