Maintenance and improvement of health of citizens is a fundamental priority of the government in the current conditions and is vital for the preservation of society and national security. Reforming of the health care system requires the adaptation of classic approach and search for new methods of adequate health care management on a scientific basis. As we are talking about direct impact on human health, patience safety is particularly important in this case. The ensuring of patience safety is achieved primarily through the use of clinical interventions with maximum efficiency and minimum risk for the patient, which is the basis of evidence-based medical practice.
The report of the U.S. Institute of Medicine, "To err is human: Building a safer health system" (1999) stated that in the U.S. hospitals, medical treatment errors result in death of 44 - 98 thousand people every year. The working group on quality patient care organization "Hospitals for Europe" has reported that in 2000, one in ten European hospitals’ patients suffered from preventable harm or adverse effects of treatment. In 2004, the 57th World Health Assembly considered a proposal for building an international alliance to improve the situation in the field of patient safety as a global initiative.
The resolution of the problem of patient safety requires a comprehensive approach that includes an evaluation of all vital activities. Now it is proved that the quality of life of patients has an independent predictive value and does not have more accurate criteria for determining the status of the patient during treatment than indicators of general somatic status.
Medical care should be safe, effective, timely, qualified, and patient-centered. Consequently, the widespread introduction of measures aimed at improving safety of patients is of particular scientific and practical interest. Implementation of a comprehensive system of treatment for ensuring patient safety in hospitals can improve clinical effectiveness and cost-effectiveness of the diagnostic and treatment process.
Parameters reflecting the underlying negative indicators of diagnostic and treatment process may increase the effectiveness of monitoring the safety of hospitalized patients. Integrated safety criterion allows measuring the level of patient safety, plan further improvement of diagnostic and treatment process in order to assess overall trends in patient safety and of its comparative quantitative analysis in different parts of a multi-hospital setting.
Elimination of any possible defects in organization of the hospital and work of medical personnel, complications of medical interventions and complications associated with the behavior of the patient and staff can also improve patient safety. Intensification of treatment and diagnostic process when implementing an integrated system of patient safety in hospital is not accompanied by a significant increase in workload for staff but, on the contrary, increases the number of staff which is fully satisfied with their employment.
The main factors distracting the safety of patients in hospital include medical interventions, psychological conflicts and dissatisfaction of patients with the quality of medical care. At the heart of preventive measures to ensure the safety of patients are the introduction of evidence of medical practice, industrial technology management with quality of care, and informing and training patients.
Monitoring of patients around the hospital showed that for the evaluation of patient safety, integrated criterion of security can be used founded on the basis of inverse negative indices, ranked in order of their clinical significance: in-hospital mortality, non-fatal adverse outcomes, complications of medical interventions, intra-hospital infections, dissatisfied patients, the presence of psychological conflicts and medical personnel interested in the elimination of organizational defects.
Economic efficiency evaluation consists of saving funds allocated to facility of obligatory medical insurance (savings rate) by reducing the average length of treatment and increase of clinical effectiveness. Cost-effectiveness of a comprehensive system to ensure patient safety in the hospital is to reduce the actual average cost of treatment per patient. To achieve some significant reduction in the cost of the diagnostic and treatment process, increase in the frequency of positive outcomes, decrease in the average duration of treatment, and some significant changes are necessary.
Reducing the negative effects of the organization of medical and diagnostic process is accompanied by increased access to quality patient care due to the increase in the number of patients with stable bed turnover, the number of days of bed occupancy in a year, shorter hospital stay, the increasing number of tools and laboratory studies per patient per year (Institute of Medicine, 2012).
Implementation of an integrated system for patient safety leads to the intensification of labor and reduced employee turnover. Increase of the overall satisfaction of medical staff of the quality of diagnostic and treatment process, the number of associates, innovations, personal activity of health workers in the management of quality also increases the proportion of staff trained specialization and improvement of their qualification.
Implementation of a comprehensive system to ensure patient safety in a multidisciplinary hospital reduces the frequency of psychological conflict between the medical staff and the patient or his/her relatives, which helps to reduce cases of unjustified increase in terms of hospital treatment and non-patients on therapeutic and diagnostic procedures (Youngberg & Hatlie, 2004).
During the intensive care treatment, advanced monitoring is needed for ensuring patience safety: monitoring of cardiovascular, respiratory and nervous systems, liver, kidney, gastrointestinal tract, blood, homeostasis as well as energy, water, electrolyte and acid-base balance. Equally important is the intensive surveillance of the ongoing treatment interventions and their outcomes. The important role plays external and internal monitoring of microbiological status and the use of prognostic criteria.
Clinical monitoring (observation of clinical signs and symptoms and quality data) is no less important than the quantitative indicators obtained by using sophisticated equipment. Monitoring provides a timely evaluation of the circulatory function of the heart, vascular tone, blood volume and the overall adequacy of the blood supply of vital organs (Tingle & Bark, 2011).