ORDER OF THE MINISTER OF HEALTH AND SOCIAL DEVELOPMENT OF THE REPUBLIC OF KAZAKHSTAN

of December 28, 2015 No. 1034

About approval of the Standard of the organization of rendering the neurosurgical help in the Republic of Kazakhstan

According to the subitem 6) of Item 1 of article 7 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system", I ORDER:

1. Approve the Standard of the organization of rendering the neurosurgical help in the Republic of Kazakhstan.

2. Procedure to provide to department of the organization of medical care of the Ministry of health and social development of the Republic of Kazakhstan in the established legislation:

1) state registration of this order in the Ministry of Justice of the Republic of Kazakhstan;

2) within ten days after state registration of this order in the Ministry of Justice of the Republic of Kazakhstan the direction on official publication in periodic printing editions and information system of law of Ad_let;

3) placement of this order on Internet resource of the Ministry of health and social development of the Republic of Kazakhstan;

4) within ten working days after state registration of this order in the Ministry of Justice of the Republic of Kazakhstan submission to Department of legal service of the Ministry of health and social development of the Republic of Kazakhstan of data on execution of the actions provided by subitems 1), 2) and 3) of this Item.

3. To impose control of execution of this order on the vice-Minister of health and social development of the Republic of Kazakhstan Tsoi A. V.

4. This order becomes effective after ten calendar days after day of its first official publication.

Approved by the Order of the Minister of health and social development of the Republic of Kazakhstan of December 28, 2015, No. 1034

Standard of the organization of rendering the neurosurgical help in the Republic of Kazakhstan

1. General provisions

1. The standard of the organization of rendering the neurosurgical help in the Republic of Kazakhstan (further - the Standard) is developed according to the subitem 6) of Item 1 of article 7 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" (further - the Code).

2. This Standard establishes the general principles and requirements to the organization of rendering the neurosurgical help to patients in the medical organizations of health care at the out-patient and polyclinic, stationary and hospital-replacing levels, regardless of pattern of ownership and departmental accessory.

3. The determinations used in this Standard:

1) the portal of Bureau of hospitalization (further - the Portal) - single system of electronic registration, accounting, processing and storage of the directions of patients for planned hospitalization in hospital within GOBMP;

2) the consulting and diagnostic help (further - KDP) - specialized or highly specialized medical care without the round-the-clock medical observation;

3) primary health care (further - PHC) - the pre-medical or qualified medical care without the round-the-clock medical observation including complex of the available medical services rendered at the level of the person, family and society;

4) the guaranteed amount of free medical care (further - GOBMP) - the amount of the medical care, single on the list of medical services, provided to citizens of the Republic of Kazakhstan and oralmans, determined according to the subitem 7) of article 6 of the Code;

5) the patient - the physical person which is (being) the consumer of medical services;

6) prevention - complex of the medical and not medical actions directed to the prevention of emergence of diseases, progressing at early stages of diseases and monitoring already developed complications, damages of bodies and fabrics;

7) the stationary help - form of provision of qualified, specialized and highly specialized medical care with the round-the-clock medical observation;

8) the hospital-replacing help - form of provision of pre-medical, qualified, specialized and highly specialized medical care with medical observation.

2. Organization of rendering the neurosurgical help in the Republic of Kazakhstan

4. Neurosurgical help in the Republic of Kazakhstan is given within GOBMP approved by the order of the Government of the Republic of Kazakhstan of December 15, 2009 No. 2136 "About approval of the list of the guaranteed amount of free medical care".

5. The neurosurgical help (adult and children's) to the population appears in the form of KDP, the stationary, hospital-replacing help, recovery treatment and medical rehabilitation, and also emergency medical service and sanitary aircraft.

6. The medical organizations giving neurosurgical help (further - MO) provide accomplishment of the actions directed to prevention, early diagnostics, treatment of patients with respect for succession at all stages of delivery of health care.

7. The neurosurgical help at the consulting and diagnostic level includes:

1) survey by the doctor for the purpose of determination of condition of the patient and establishment of the diagnosis;

2) laboratory and tool inspection of the patient for the purpose of detection of disease of neurosurgical pathology;

3) matching and purpose of treatment according to the revealed nosology and clinical protocols (further - KP);

4) selection and the direction on planned hospitalization in MO for provision of specialized and highly specialized medical care;

5) the direction on hospitalization according to the emergency indications;

6) participation in medical rehabilitation of patients with neurosurgical pathology;

7) registration and maintaining primary medical documentation;

8) examination of temporary disability;

9) the organization of providing patients with medicines with neurosurgical diseases at the out-patient level;

10) issue of the advisory proceeding for medico-social examination in the presence of signs of permanent disability.

8. KDP is provided to patients in the form of preventive, diagnostic and medical services in the presence in the organization of health care of the license for implementation of the medical activities including conducting examination of temporary disability.

9. Rendering KDP to the patient is performed in the direction of the doctor of PHC or the profile specialist within GOBMP.

10. In case of the direction on rendering KDP the doctor of PHC or the profile specialist draws up the statement from the medical record out-patient, the inpatient.

11. The direction of patients with neurosurgical diseases on receipt of KDP at the republican level is performed by regional commissions of managements of health care of areas, and from the cities of Astana and Almaty - from the medical organizations.

12. In case of adoption of the positive decision on rendering KDP to the patient in the republican medical organization, regional commission issues the direction on receipt of the highly specialized consulting and diagnostic help at the republican level.

13. In case of refusal in rendering KDP to the patient at the republican level, regional commission returns in the directed medical organization documents with appendix of written motivated refusal.

14. The neurosurgical help at the stationary level provides:

1) carrying out laboratory and tool inspection according to clinical protocols (further - KP);

2) matching and purpose of treatment according to KP the attending physician, if necessary together with the manager of department with the subsequent organization and accomplishment of medical appointments;

3) daily survey by the doctor (if other frequency is not provided), treatment correction;

4) survey of the manager of department in case of receipt and - is at least further once a week;

5) carrying out consultations of other profile specialists (in the presence of indications);

6) the statement of the patient with execution of documentation and issue on hands to the patient of the statement from the medical record out-patient, the inpatient;

7) registration and maintaining primary medical documentation.

15. In the presence of medical indications for rendering specialized, highly specialized medical care with the round-the-clock medical observation patients with neurosurgical diseases, are hospitalized through the Portal in the medical organizations incorporating stationary neurosurgical departments, chambers (bed).

16. Planned hospitalization of the patient in hospital within GOBMP is performed:

1) in the direction of specialists of PHC or other medical organization;

2) according to the emergency indications regardless of direction availability.

17. Planned hospitalization of the patient in hospital is performed taking into account the patient's right to the free choice of the medical organization giving stationary help.

18. Specialized medical care appears neurosurgeons in stationary and hospital-replacing conditions, the including prevention, diagnostics, treatment of the diseases and conditions requiring use of ad hoc methods and difficult medical technologies, and also medical rehabilitation.

19. The highly specialized help appears doctors - neurosurgeons in stationary conditions and includes diagnostics, treatment of the diseases and conditions requiring use of innovative, low-invasive, ad hoc methods and difficult medical technologies, and also medical rehabilitation.

20. After completion of rendering specialized or highly specialized medical care in stationary conditions the statement from the medical record out-patient, the inpatient is issued to the patient.

21. Patients with neurosurgical diseases and injuries of the central and peripheral nervous system in the presence of medical indications go for holding rehabilitation actions to the specialized medical and sanatorium organizations.

3. Organization of rendering the emergency neurosurgical help

22. Hospitalization according to the emergency indications is performed within GOBMP in the direction of specialists of PHC, the medical organizations, the direction of emergency medical service, the self-address.

23. Emergency neurosurgical help is given in any medical organization having department of surgical profile in structure.

24. The emergency neurosurgical help appears the neurosurgeon. In the conditions of explicit threat of life of the patient owing to neurosurgical pathology and impossibility to involve the corresponding specialist in the shortest possible time, rendering the emergency neurosurgical help by specialists of surgical profile, had training on rendering the emergency neurosurgical help is allowed.

Also rendering the emergency neurosurgical help to children - the neurosurgeon (adult), the adult - the neurosurgeon is allowed (children's).

25. Emergency neurosurgical help is given in case of the following conditions:

1) craniocereberal injury (removal of intracranial hematomas, decompressive cranial trepanation, primary surgical processing of the pressed skull fractures, installation of the sensor of intracranial pressure, drainage of ventrikulyarny liquor);

2) intracranial not traumatic hemorrhages (removal of intracranial hematomas, decompressive cranial trepanation, gemikranioektomiya, bifrontal decompressive cranial trepanation, decompressive trepanation of back cranial pole, drainage of ventrikulyarny liquor, installation of the sensor of intracranial pressure, other transactions if necessary);

3) ischemic stroke (decompressive cranial trepanation, endovascular trombektomiya);

4) vertebral спиномозговая injury (elimination of sdavleniye of spinal cord, stabilization of vertebral and motive segment);

5) degenerative damages of backbone (elimination of sdavleniye of spinal cord);

6) brain new growth (removal of new growth in case of life-threatening dislocation of brain, drainage of ventrikulyarny liquor, decompressive cranial trepanation);

7) inflammatory diseases of TsNS (removal, drainage of abscess of brain, spinal cord);

8) inborn pathology of the central nervous system (transaction in case of gaps of spinal hernia);

9) patrimonial injuries of the central nervous system (removal of intracranial hematomas, removal of hematomas of covers of skull).

4. The organization of rendering the neurosurgical help in case of certain nosological forms

26. Organizations of rendering the neurosurgical help with the following nosological forms:

1) the Craniocereberal injury (in the presence of indications) - hospitalization in department of surgical profile of district hospital (in case of absence in the region of neurosurgical department) or neurosurgical department of city, regional hospital.

If necessary transfer from district hospital in neurosurgical department of city, regional hospital.

Patients with slight craniocereberal injury go to the medical organization providing medical care on the neurosurgery profile (adult, children's) for consultation of the neurosurgeon and carrying out computer tomography (in the presence of indications).

In the presence of medical indications for delivery of health care in stationary conditions patients go to neurosurgical department or, in the absence of that, to neurologic or traumatologic department.

In the absence of medical indications to delivery of health care in stationary conditions on the neurosurgery profile (adult, children's) the patient with slight craniocereberal injury medical care appears the neurosurgeon in out-patient conditions, in the absence of the neurosurgeon - the neurologist taking into account recommendations of the neurosurgeon, and in the absence of the neurologist - the therapist the district police officer, the pediatrician the district police officer, the general practitioner (the family doctor) taking into account recommendations of the neurosurgeon or neurologist.

Patients with craniocereberal injury of average weight and heavy severity for receipt of medical care in stationary conditions go to the medical organizations providing medical care on the neurosurgery profile (adult, children's).

In case of craniocereberal injury at children - hospitalization in department of surgical profile of district hospital (in case of absence in the region of neurosurgical department) or children's neurosurgical department of city, regional hospital.

In the absence of children's neurosurgical departments hospitalization in department of surgical profile (traumatology and orthopedics) of children's hospital with neurosurgical beds.

If necessary transfer from district hospital in city, regional hospitals;

2) vertebral спиномозговая injury (in the presence of indications) - hospitalization in department of surgical profile of district hospital (in case of absence in the region of neurosurgical department) or neurosurgical department of city, regional hospital.

In the presence of medical indications - hospitalization from district hospital in neurosurgical departments of city, regional hospitals, in National Center of Neurosurgery joint-stock company (further - NTsN);

3) vertebral and spinal injury at children - hospitalization in department of surgical profile of district hospital (in case of absence in the region of neurosurgical department) or children's neurosurgical department of city, regional hospital.

In the absence of children's neurosurgical departments hospitalization in department of surgical profile (traumatology and orthopedics) of children's hospital with neurosurgical beds.

If necessary transfer from district hospital in city, regional hospitals, in NTsN;

4) patrimonial injuries of the central nervous system - rendering the emergency neurosurgical help in the medical organizations of obstetric aid - in the presence of explicit threat of life and lack of possibility of transportation.

If necessary (in the presence of indications) hospitalization in children's neurosurgical departments of city, regional hospitals.

In the absence of children's neurosurgical departments hospitalization in department of surgical profile (traumatology and orthopedics) of children's hospital with neurosurgical beds;

5) inborn pathology of the central nervous system - rendering the emergency neurosurgical help in the medical organizations of obstetric aid in the presence of explicit threat of life and lack of possibility of transportation.

If necessary (in the presence of indications) hospitalization in children's neurosurgical departments of city, regional hospital, in NTsN.

In the absence of children's neurosurgical departments hospitalization in department of surgical profile (traumatology and orthopedics) of children's hospital with neurosurgical beds;

6) degenerative damages of backbone, vascular diseases of head and spinal cord, brain new growth (in the presence of indications) - hospitalization for neurosurgical transaction in department of neurosurgery of city, regional hospitals, in NTsN.

In case of suspicion of neurosurgical disease of oncological genesis and availability of indications to surgical treatment the patient goes to neurosurgical department, and in the absence of indications to surgical treatment the patient goes to oncological dispensary for determination of subsequent tactics of treatment.

In the presence of neurosurgical disease of oncological genesis treatment and observation of the patient is performed on the basis of interaction of specialists doctors: the neurosurgeon who had training concerning oncology and the oncologist.

Performing specialized oncological treatment (radiation therapy, chemotherapy) for patients with neurosurgical diseases is performed in the medical organizations giving help on the oncology profile (adult, children's);

7) degenerative damages of backbone, vascular diseases of head and spinal cord at children - hospitalization for neurosurgical transaction in department of children's neurosurgery of city, regional hospital, in NTsN.

In the absence of children's neurosurgical departments hospitalization in department of surgical profile (traumatology and orthopedics) of children's hospital with neurosurgical beds;

8) new growths of the central nervous system at children - hospitalization for rendering the emergency medical care (outside drainage of ventricular system of brain, ventrikuloperitoneostomiya, removal of ekhinokokkovy cyst and other transactions if necessary) in department of children's neurosurgery of city, regional hospital.

In the absence of children's neurosurgical departments hospitalization for rendering the emergency medical care in department of surgical profile (traumatology and orthopedics) of children's hospital with neurosurgical beds.

For carrying out the main stage of treatment (planned transaction on removal of tumor of head and spinal cord) hospitalization in NTsN. Tactics of treatment of children with brain tumors at the level of NTsN is solved multidisciplinary crew as a part of the neurosurgeon (children's), the doctor-neuropathologist (children's), the oncologist (children's) joint-stock company "National Scientific Center of Motherhood and Childhood".

 

 

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