Expert Analysis of the Lethality of Versatile Hospital up to 24 Hours

Pletenetskaya A. А.

FORENSIC MEDICINE

Scentific article

Stories of diseases of the dead persons, which were in archive of versatile hospital and accompany- ing coupons of crews of the emergency medical service from stories of diseases, were analysed in this research. Cases of a lethality up to 24 hours were analysed. These cases were distributed on age, sex, duration of finding of the patient (treatment) in a hospital, hospitalization in the different directions and other signs. Prehospital stage estimated in on some directions. Thus, the analysis of a lethality during time less than 24 hours in Kyiv City Clinical Hospital № 5 for 2009 indicates that: 1. The average age of the deceased was older than functional age (67,45 ± 1,73) Among the deceased patients the number of male and female was almost equal (49.01 % and 50. 99 %, respectively). 2. The greatest number of dead patients were among those who was in the treatment from 6 to 12 hours (31. 38 %); the highest number of deaths before 24 hours – was among those who came to the hospital in time span of 10 hours. 00 minutes. for 13 hours. 59 minutes. (27.45 % of patients), which accounts for the first half of the working day. All this may indicate the presence of organizational defects in the hospital. 3. Most patients were hospitalized in permanent establishment to direction of EMC (84,31 %) and only less part- to direction of policlinic, that can testify or at the low level of appeal of patients to policlinic establishments, or about insufficient level of preventive measures from doctors of out-patient’s clinics in relation to the offensive of the life threatenings. 4. Most deaths were ascertained in patients treated in the department of infarct (56.86 %), the maximum num- ber of diseases resulting in death, were circulatory system diseases (72.59 %), which generally coincides with the data of other literature on the reasons for mortality. At the same time, the majority of deaths in the autumn quarter of the year, coincides with the rise of acute diseases during this period. 5. Difference of diagnosis medical workers EMC and pathological diagnosis was observed in 21.57 % of cases, which may indicate the shortcomings of diagnosing and testify that incorrectly diagnosed could be the result of insufficient examination of patients in prehospital stage. 6. In the majority of cases (90.91 %) differences diagnosis of medical workers EMC and pathological diagnosis was due to the failure of ECG, it evidence of inappropriate regulations and regulatory documents to conduct diag- nostic procedures to confirm the diagnosis. 7. Treatment at prehospital stage is deemed inadequate, tactically wrong and spent not fully, as 37.26 % was not performed intravenous access 23.52 %, pharmacotherapy wasn’t performed in 68.62 %, oxygen inhalation wasn’t carried out, which is also torn down normative documents (standards of care and clinical protocols providing treat- ment etc.), approved by the Ministry of Health of Ukraine, which regulate the volume of the needed clinical – diag- nostic studies of patients with various diseases. In summary, there is reason to believe that the expert assessment lethality up to 24 hours in one of the general hospitals allow objectively analyze the defects of care and to identify the main causes of these defects in cases of forensic examinations of quality of medical care.

medical care, prehospital stage, diagnosis, forensic medical examination

• Александрова О. С. Ретроспективный анализ причин смерти пострадавших с открытой и закрытой травмами живота / О. С. Александрова, И. Р. Николайчик // Экстренная медицина. – 2012. – № 1. – С. 76-88.
• Оценка госпитального этапа оказания скорой медицинской помощи больным при досуточной летальности / Валеев З. Г. [та ін.] // Казанский медицинский журнал. Эпидемиология и организация здровоохранения. – 2013. – Т. 94, №1 – С. 111-114.
• Сміянов В. А. Визначення якості медичної допомоги та концепції її розвитку / В. А. Сміянов // Вісник соціальної гігієни та організації охорони здоров’я. – 2011. – № 1. – С. 86-95.
• Федчишин Н. Є. Вартісна оцінка швидкої медичної допомоги в Тернополі / Н. Є. Федчишин // Вісник соціальної гігієни. – 2011. – № 4. – С. 106-108.
• Чепелевська Л. А. Медико-соціальні особливості смертності населення України / Л. А. Чепелевська // Україна. Здоров’я нації. – 2010. – № 4 (16). – С. 37-42.
• Klein K. R. Mass medical evacuation: Hurricane Katrina and nursing experiences at the New Orleans airport / K. R. Klein, N. E. Nagel // Disaster Manag. Response. – 2007. – Vol. 5, №2. – Р. 56-61.
• Stroke mortality, clinical presentation and day of arrival: the Atherosclerosic Risk In Communities (ARIC study) / E. C. O’Brien, K. M. Rose, E. Shakar [et al.] // Stroke Res Treat. – 2011. – Vol. 2011. – P. 1-8.
• Weekends: a dangerous time for having stroke / G. Saposnik, A. Baibergenova, N. Bayer [et al.] // Stroke. – 2007. – Vol. 38. – P. 121-125.

«Bulletin of problems biology and medicine» Issue 3 part 3 (112), 2014 year, 336-339 pages, index UDK 340. 6: 614. 23/. 25: 616-036. 8