About measures to improve the provision of medical care to patients with combined and isolated traumatic brain injury in a city multidisciplinary hospital

INTRODUCTION. Despite the modern achievements of medicine and scientific and technological progress in the treatment and prevention of traumatic disease, the number of patients with traumatic brain injury remains high. According to statistics, in Russia it is 600 thousand people a year, of which 50 thousand die and another 50 thousand remain disabled. The majority of such patients end up in multidisciplinary hospitals. The tactics of examination and treatment of patients with isolated or combined traumatic brain injury, especially severe in a city hospital, have their own characteristics and require further improvement to improve the quality of care provided.

AIM. To analyze the medical histories of patients hospitalized for emergency indications who are admitted with unreasonably diagnosed brain injuries at the prehospital stage; to develop an algorithm for routing patients with isolated and combined TBI in a multidisciplinary hospital starting from the admission department; optimize indications for hospitalization of victims for inpatient treatment; to develop methodological measures aimed at improving the quality of emergency medical care for patients with combined TBI.

MATERIALS AND METHODS. The analysis of 352 case histories of patients hospitalized in St. Petersburg State Medical Institution “City Mariinsky Hospital” for emergency indications with TBI (isolated and combined) during 7 months of 2021 and 2022 was carried out. We also analyzed 302 medical records of patients who were delivered for emergency indications, with unreasonably diagnosed TBI in the direction of hospitalization.

RESULTS. The groups of patients who are most often delivered with unjustified diagnoses of brain injury, the severity of the condition and impaired consciousness of which are due to either decompensation of chronic diseases, intoxication, or other causes, have been identified. These categories included elderly patients with decompensated chronic diseases, people under the influence of alcohol or people without a fixed place of residence. An algorithm has been developed for routing patients with isolated and combined TBI, starting from the emergency department (OSMP). Indications for hospitalization of patients with TBI of varying severity in conditions of round-the-clock admission of patients in a multidisciplinary hospital have been optimized. Methodological measures have been identified to improve the quality of medical care for victims with combined TBI by a multidisciplinary team of specialists. The work is illustrated by clinical observations of patients with isolated and combined traumatic brain injury.

CONCLUSION. The exclusion of patients with unreasonably diagnosed TBI from the flow of incoming patients at the pre-hospital stage, the implementation of the algorithm of transportation, examination, first aid in the emergency department, conducting training of the multidisciplinary team for the examination and emergency care of patients with combined trauma using a level 6 Apollo simulator robot in a shock ward contribute to reducing the length of time patients stay in the emergency room and thereby improve the quality of medical care provided to patients with TBI in an urban multidisciplinary hospital.

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