In March this year, the experience of Xiangtan Sixth People's Hospital (hereinafter referred to as "Xiangtan Sixth Hospital") was identified by National Health Commission as "the typical experience of combining medical care with nursing care in China". From a once struggling secondary hospital to a dynamic combination of medical care and nursing, the annual occupancy rate of convalescent beds exceeds 95%.
From home care to hospital rehabilitation
At 6: 30 in the morning, the sun shone on the balcony, and the 85-year-old Yang was washing, with the door ajar.
"Teacher Yang, do you need to bring breakfast?" As usual, the door came the voice of Zhou Xuequn, a nurse.
"I don't need it today. I'll do it myself. " Yang strolled into the kitchen. Behind her, there is a small living room with simple furnishings, complete household appliances and orderly items.
This is the place where Yang lives every day-the elderly rehabilitation area of Xiangtan Sixth Hospital. The hospital is located in the center of the city, less than 1.5 kilometers away from the winding Xiangjiang River, surrounded by green trees, and quiet in the middle of the noise.
Two sons and a daughter, a dutiful son, why did Yang come to the hospital for the aged?
This should start with an acute disease. 20 16 after his wife died, his physical condition was also greatly worse than before. The child is working and can't be with him 24 hours a day. One night at the beginning of 20 19, the old man suddenly became dizzy, but no one was around. With strong support, she moved the desk and chair to the telephone and dialed the neighbor's phone for help. From then on, Yang felt that living at home was not an option. In March of that year, she was admitted to the Sixth Hospital of Yang Kang District, Xiangtan City.
What is the difference between here and home?
"hey!" The old man stretched out his hand and pointed. The wall of the room was equipped with handrails, the threshold leading to the balcony was smoothed, and the bedside of the living room was equipped with an emergency call device. ......
The aging transformation of hardware facilities made Yang live comfortably, and what reassured her was the rehabilitation services provided here.
On weekdays, like at home, Yang will go for a walk in the Woods downstairs in the morning and chat with the old people in the same building. In the afternoon, I read books and newspapers in my room. The difference is that there are nurses such as Zhou Xuequn waiting 24 hours, but whenever there is an emergency, they can always get to the old man at the first time.
"The most practical thing is that medical care is guaranteed." Yang said that since she stopped coming, she and her children have never worried about her medical care. "Living here, doctors and nurses are around, don't worry." Because he often checks cardiovascular diseases, Yang also added the WeChat of Zhou Cuiqin, a department doctor, who can consult at any time.
There are more than 500 elderly people in Yang Kang Campus of Xiangtan Sixth Hospital. Most of them have faced the same problem as Yang: when they are in good health, they walk around and talk at home, and everything is as usual, but they are as sick as a mountain. The trend of overlapping needs of medical and health services and life care for the elderly is becoming more and more obvious. However, the reality is that most pension institutions and medical institutions are independent of each other. "The nursing home can't see the disease, the hospital can't raise the elderly, and it's rare to meet such a place where you can see a doctor and support the elderly." Yang said to him.
What is the cost of combining medical care with nursing care?
"The medical and health care expenses mainly consist of three parts: bed expenses, basic meals expenses and nursing expenses." According to Xiang, the president of Xiangtan Sixth Hospital, the monthly expenses of a single old-age bed are divided into three grades: 1.300 yuan, 1.500 yuan and 1.600 yuan. Food expenses are 660 yuan per month; Nursing standards are divided into five grades according to the different health levels of the elderly, and each grade carries out different charging standards according to the different situations of nurses, such as one-to-one, one-to-two or even one-to-many. The nursing level of the elderly with total disability is the highest. If one-on-one nursing program is selected, the monthly nursing fee is 4,800 yuan. With the decrease of grade and the increase of nursing objects, the remaining nursing expenses decrease, with the lowest monthly 900 yuan.
Yang, who can still take care of herself, chose a nursing program, 900 yuan every month. With a monthly pension of about 5,000 yuan, she can bear the cost of rehabilitation.
From general hospital to combination of medical care and nursing care
"Pension+medical care" has won the favor of a large number of elderly people in Xiangtan Sixth Hospital. "Now look, this road, we are on the right track." Looking back on the road of hospital transformation, Ming Kai deeply touched me.
June 5438 +2009 10, the second day after Xiang took over as dean. He took a deep breath when he opened the hospital account. Including retired employees, there are 256 people in the hospital, but the annual business income is only 2.95 million yuan. "Even if the hospital operates at zero cost, it is difficult to pay employees in full."
Xiangtan No.6 Hospital was founded in 1962, formerly known as Xiangtan Staff Sanatorium of Hunan Provincial Federation of Trade Unions. In the reform at the end of last century, I tried to take the development road of general hospitals. However, due to medical conditions, talent team and other factors, it is impossible to attract many patients to seek medical treatment, and it is always difficult to get better.
Where are you going? At the beginning of taking office, I made an in-depth investigation with the hospital staff, and unexpectedly found that there was no hospital focusing on the elderly in Xiangtan City. Xiangtan, as an old industrial city, ranks in the forefront of Hunan Province and has a great demand for old-age services.
"Hospitals are public welfare institutions, but even if they serve the society, they must take the road of differentiated development." In the big investigation and discussion, Xiang asked, "Can we focus on the diagnosis and treatment of chronic diseases in the elderly and develop rehabilitation for the elderly?"
When the idea came out, there were many voices of doubt-in the early years, the hospital also tried to provide old-age care services, but more than 20 beds were not satisfied.
"Most elderly people who still have the ability to take care of themselves do not accept hospitalization for the elderly. It is naturally not feasible to support the elderly with the idea of running a hospital. " Explain and communicate with patience, "Now the Sixth Hospital of Xiangtan City implements the administrative supervision of the Civil Affairs Bureau and the industrial supervision of the Municipal Health and Health Commission, and builds a hospital focusing on providing for the elderly. It can be said that it is close to the water tower to get the moon first. "
The nursing level of the disabled elderly is the highest. If you choose one-on-one nursing program, you need to pay 4800 yuan a month. With the decrease of grade and the increase of nursing objects, the remaining nursing expenses decrease, with the lowest monthly 900 yuan.
At the end of 2009, this public second-class first-class hospital began a firm transformation: strengthening the "Gigi Lai", striving for "serious illness can be cured, minor illness can be cured, and no disease can be raised" to provide integrated medical, rehabilitation and nursing services for the elderly; Create "face", "the room can't be made like a ward, and the clothes can't be made like a hospital gown". More than 200 beds have been renovated in this hospital in Zhang Kang, and the wards have been aged to create a comfortable environment like home.
From medical treatment to health management
"Liang Laobo!" Dr. Tang Bingxin, who is being examined in Yang Kang Campus of Xiangtan Sixth Hospital, walked into Room 10 12 to check Liang's physical condition. Tang Bingxin a year ago is vivid in my mind.
On the day of house patrol, Tang Bingxin found that Liang, who had always been talkative, was crooked and inarticulate, and immediately suspected that he had a cerebral infarction. "Nurse, cart!" 10 meters away, the nurses and paramedics on standby on the floor came quickly.
"Do a CT examination immediately and inform the emergency department to prepare!" Tang Bingxin made the necessary rescue treatment for the elderly while arranging.
The old man was sent to the emergency department. After examination, it turned out to be acute cerebral infarction, and he was immediately arranged for hospitalization.
A month later, Liang got better and was discharged from the hospital. To everyone's relief, due to timely diagnosis and treatment, the elderly have no sequelae.
"The acute diseases of the elderly, gold processing time is the key." Husai, director of the emergency department of Xiangtan Sixth Hospital, said that in order to ensure that the elderly can be treated as soon as possible when they are sick, the hospital has a floor supervisor transferred by professional nurses on each floor in Yang Kang District, and at the same time, it is guaranteed that every elderly person admitted to the hospital has a doctor in charge of the emergency department for docking service.
At first, the hospital tried to manage the elderly in the inpatient department, but soon after the trial, a new problem was found-the inpatient department classified patients according to departments, and patients and specialties had a strong correspondence, while the elderly in the hospital might suffer from various chronic diseases, so it was difficult to live in different levels and manage them in different regions according to the corresponding departments.
Later, the hospital transferred 30 medical staff from relevant departments to serve the elderly. In this way, due to the length of hospitalization of the elderly, the allocation of medical resources is fixed, which increases the operating cost.
Finally, the emergency department is responsible for the elderly. "10 doctors in the emergency department are mostly general practitioners, and they have certain ability to deal with various diseases that may occur in the elderly." Hussein said: "There is a convenient passage from the emergency department to Yang Kang District, and it only takes three minutes to walk. In case of emergency, you can treat the elderly in the first time. "
What should I do if my condition is seriously beyond the hospital's treatment capacity? In recent years, relying on the construction of medical association, the Sixth Hospital of Xiangtan City has unblocked the referral channels with other hospitals such as Xiangtan Central Hospital.
In addition to emergency medical treatment, Xiangtan Sixth Hospital has also established a relatively complete chapter system for house patrol, examination and treatment to strengthen the daily health management of the elderly.
"Sheng Grandma!" In the corridor, Hussein shouted to Sheng Sulan, who was sitting and resting.
Sheng Sulan walked slowly in front, and Hersey watched the old man carefully behind. "Grandma sheng had hip surgery and couldn't move some time ago. Now she can walk. "
Hussein is well aware of the old man's physical condition. At least twice a week, she takes time out to check Sheng Sulan's health status, evaluate her health, and give guidance to the elderly on medical medication, diet and nutrition.
"In addition to realizing it, there are documents." As he spoke, Hussein took out Sheng Sulan's medical file, which recorded the physical examination report from the first admission of the old man to the later examination and the changes of various indicators.
"From the handling of emergencies to the diagnosis and treatment of daily diseases, integrating professional medical resources into all aspects of old-age care can effectively improve the quality and level of the combination of medical care and nursing." I was deeply moved by Ming Kai.
From skill training to college cooperation
"Is it not to take care of people? Who won't do it? " Before joining the Sixth Hospital of Xiangtan City, Cao Lijun did not think that nursing was a technical job. In her hometown of Yiyang, Hunan, she cleans crops and works quickly.
The work went smoothly two years ago, but the hospital didn't let her get started directly, but took classes first.
Li Kunyu, director of the work department of the aged care worker, came to give a lecture. The content of the course is to help the elderly turn over. Close the doors and windows first to prevent wind; Communicate with the old man and tell him to turn over; The old man is weak in bones and muscles, so he can't use brute force, so he has to use dexterity; Turn over and lie on your side, pad the quilt and wipe your body with the prepared towel; Then take this opportunity to massage the muscles that have been pressed for a long time ... After the first class, Cao Lijun was surprised. "There are so many stresses on turning over!"
In the office of the nursing department, Li Kunyu dug up the training plan and nursing procedures for nearly three years. The training contents recorded in a thick stack of documents, from blood pressure measurement to cardiopulmonary resuscitation, cover all aspects of nursing requirements-every Wednesday, Yang Kang District will organize nursing workers to train in rotation, or listen to lectures by specialists, or be demonstrated by the director of nursing department.
Cao Lijun still remembers the embarrassment he met when he first changed clothes for an old man who had suffered from stroke and hemiplegia. Just about to take off the sleeves for the old man, the old man gave a cry of "Ouch", which scared her to ask for advice at once.
This made Cao Lijun realize that "there is no trivial matter in nursing, and everything has a doorway": it seems simple for the hemiplegic elderly to dress and undress, but it is not. Half of the limbs of the elderly are incapacitated. When undressing, they must first take off the side that can move healthily, and then take off the side that has lost the ability to move. Dress in reverse order.
In the Sixth Hospital of Xiangtan City, nursing workers have been able to handle most of the service matters except routine injections, medication and other matters directly related to diagnosis and treatment. "At present, there are only 1 station doctors and 3 station nurses in Yang Kang District every day, and the rest are free to engage in other medical services." Li Kunyu said.
The shortage of employees, uneven level, and reluctance of talents to come and stay are common problems faced by medical institutions. The Sixth Hospital of Xiangtan City set up the work department of elderly nursing staff in public hospitals earlier in China, which is responsible for the daily management and training of elderly nursing staff, and at the same time, it determines the salary and treatment with reference to the market level to improve the occupational attractiveness. "The monthly salary of most caregivers is basically more than 5,000 yuan." Li Kunyu said.
In 20 17, Xiangtan Sixth Hospital also cooperated with Xiangtan Medical and Health Vocational and Technical College to set up nursing-related majors and "medical order classes" to train professional and young medical service talents.
Liu Hui, Dean of the Clinical College of Xiangtan Medical and Health Vocational and Technical College, said: "Starting this fall semester, we will also set up a clinical medicine major (medical nursing direction), and initially plan to start classes to recruit 50 people."