On improving the functional diagnostic service in healthcare institutions of the Russian Federation. On declaring illegal the order to introduce labor standards Recommended staffing standards for the functional diagnostics room

On declaring illegal the order to introduce labor standards

In case No. 2-

Accepted Khorolsky District Court (Primorsky Territory)

1. Khorolsky District Court of Primorsky Krai composed of:
2. Presiding judge Ivashinnikova E.A.
3. under secretary Gurova N.Yu.
4. having considered in open court the application of Irina Vyacheslavovna Kobzeva to recognize as illegal the order to introduce labor standards of the Chief Physician of the Khorol Central District Hospital,

5. Installed:

6. The applicant asks the court to satisfy the claim on the following grounds:
7. May 28, 2010 in the office functional diagnostics(FD) The MUZ KhCRH conducted a timing study, based on the results of which the Order of the MUZ KhCRH No. 293 dated June 3, 2010 “On the introduction of labor standards for employees of the functional diagnostics room” was issued. She, Kobzeva I.V., a doctor at the functional diagnostics office, does not agree with this order, since labor standards are too high. The activities of medical staff in departments (offices) of functional diagnostics are regulated by the current Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993 “On improving the functional diagnostic service in healthcare institutions of the Russian Federation.”
8. The timing of research in the FD office of the MUZ KhCRH dated May 28, 2010 is considered to have been carried out illegally, since according to clause 2.1 of the Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993, the Department was ordered to carry out adjustments, development and approval of calculated time standards medical care Ministry of Health of Russia. And the heads of healthcare institutions, in accordance with clause 4 of the order of the same name, must establish the number of department staff in accordance with the volume of work based on the estimated time standards for functional studies(Appendix 7).
9. The timing of research in the office of the FD MUZ KhCRH dated May 28, 2010 was carried out formally: within 1 hour, once, without taking into account standard technological operations, etc., and not all functional methods; Medical staff are not familiar with the research timing report. The timing commission did not include members of the trade union or a specialist in functional diagnostics and labor protection.
10. In paragraph 3 of the note in Appendix 7 “Calculated time standards for functional studies carried out in functional diagnostic rooms of medical institutions” of the order of the same name it is stated that the heads of institutions, in agreement with the trade union committee, set time standards only when introducing new equipment or new methods of functional research , using Appendix 8 “Instructions for the use of estimated time standards for functional studies” and Appendix 9 “Instructions for the development of estimated time standards when introducing new equipment or new research methods” to the order of the Ministry of Health of the Russian Federation dated November 30, 1993.
11. . There have been no changes in the nature or working conditions in the functional diagnostics room over the past 10 years. There was no introduction of new diagnostic methods, modernization of the activities of the functional diagnostics room through the acquisition and use of new equipment, or multi-complex systems. Equipment that failed due to breakdowns and aging was replaced with similar models. All studies carried out in the FD office are calculated in accordance with Order No. 283 of the Ministry of Health of the Russian Federation (Appendix 7).
12. Considers the introduction of labor standards for employees of the functional diagnostics room to be a violation of workers’ rights, according to Table 1 of the Order of the Ministry of Health of the Kharkov Central Regional Hospital No. 293 dated June 3, 2010 “On the introduction of labor standards for employees of the functional diagnostics room,” which overstates the current standard of the Order of the Ministry of Health of the Russian Federation. Asks to recognize the indicated order of the chief physician of the MUZ KhTsRB No. 293 dated June 3, 2010 as illegal and to oblige the corresponding executive eliminate these violations.
13. At the court hearing, applicant Kobzeva I.V. requests that her application be granted on the grounds set out therein. She explained to the court that in comparison with the standards established by Order of the Ministry of Health of the Russian Federation No. 283, the labor standards established by the order of the chief physician of the Ministry of Health of the Kharkov Central Regional Hospital No. 293 dated June 3, 2010, are significantly higher. For example, the Order of the Ministry of Health of the Russian Federation established the time standard for a doctor to conduct an ECG - 1.7 conventional unit of time, according to the order, 1 conventional unit corresponds to 10 minutes, that is, conducting an ECG By order of the Ministry of Health of the Russian Federation, 17 minutes are allotted, and by order of the Ministry of Health of the Kharkov Central Regional Hospital No. 293, 6 minutes are allotted for conducting an ECG, and in order to fulfill her load norm for the day, she needs to conduct large quantity research, the workload has increased by about 40 percent, which violates her work standards. Claims that there has been no introduction of new diagnostic methods or modernization of the activities of the functional diagnostics room through the acquisition and use of new equipment over the past 10 years. Replacement of equipment that failed due to breakdowns and aging was carried out with similar models; technological process research has not changed. Believes that the defendant’s representative did not provide the court with evidence that the equipment received for Lately to the FD office, is technologically new. Regarding the order of the chief physician of the MUZ KhTsRB, dated June 28, 2010, provided to the court by the representative of the defendant, she explained that she was not familiarized with this order; it contains load standards for nurses, and order No. 333, according to its name, amends the order of the Ministry of Health of the KhCRH No. 293, and does not cancel it. In this connection, she insists on satisfying her claims.
14. Representative of the Khorol Central District Hospital Pavlov A.A. I do not agree with the statement and explained to the court that the position of the chief physician of the Municipal Healthcare Institution KhCRH I.Yu. Klimenko, who adopted the contested order, regarding the claims is set out in the explanation provided to the court. Believes that the order of the chief physician of the Municipal Health Center of the Kharkov Central Regional Hospital was adopted in accordance with her powers as an employer in accordance with the Charter of the Municipal Health Institution of the Kharkov Central Regional Hospital; In accordance with this, the employer has the right to revise labor standards, and this order was adopted lawfully. Compared to the standards established by Order of the Ministry of Health of the Russian Federation No. 283, the labor standards established by the order of the chief physician of the MUZ KhTsRB No. 293 dated June 3, 2010, increased slightly, so the labor standard per day increased from 30 to 33, but he considers this insignificant, since how the equipment recently supplied to the PD office is technologically newer and allows for a larger number of studies to be performed on it. This was done to improve accessibility medical services. Believes that order of the Ministry of Health of the Russian Federation No. 283 dated November 30, 1993. cannot be used because it is outdated and contradicts. In addition, according to an additional explanation to the court of the chief physician of the MHRC Klimenko I.Yu. by order of the chief physician of the MUZ KhCRH No. 333 dated June 28, 2010. changes were made to the order of the chief physician of the MUZ KhCRH No. 293 dated June 3, 2010, in fact, this order cancels the effect of order No. 293, since tables No. 1 and No. 2 in it are set out in a new edition, which establish new labor standards only for nurses, and the plaintiff is a doctor, and her labor standards have remained unchanged, and there are no violations of her labor rights. In this connection, he requests that the plaintiff’s claims be rejected.
15. According to the written explanation of the chief physician of the Khorolskaya Central District Hospital, provided to the court, Klimenko I.Yu. explained that labor standards for employees of the functional diagnostics room are established by Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993 “On improving the functional diagnostic service in healthcare institutions of the Russian Federation.” Order No. 293 of 06/03/2010 “On the introduction of labor standards for employees of the functional diagnostics room” (hereinafter referred to as Order No. 293) was issued on the basis of an act of timing measurement of actual time spent in the functional diagnostics room dated May 28, 2010. This order was issued to increase the availability of medical care, in accordance with the requirements of paragraph 2.2. Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993, Labor Code of the Russian Federation. In accordance with the Labor Code of the Russian Federation, “Labor standards - production standards, time standards, headcount standards and other standards - are established in accordance with the achieved level of technology, technology, organization of production and labor. Labor standards may be revised as new equipment, technology, and organizational or other measures are improved or introduced to ensure an increase in labor productivity, as well as in the case of the use of physically and morally outdated equipment.” The procedure for introducing new labor standards in an organization is regulated by the Labor Code of the Russian Federation, according to which “Local regulations providing for the introduction, replacement and revision of labor standards are adopted by the employer taking into account the opinion of representative body workers. The Khorol Central District Hospital has a trade union committee, Order No. 293 has been agreed upon with the trade union committee. It should be noted that from 1993 to June 3, 2010. labor standards in the functional diagnostics room did not change; by Order No. 293, time standards for carrying out ECG research reduced slightly. Thus, according to the standards approved by Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993 “On improving the functional diagnostic service in healthcare institutions of the Russian Federation,” the number of ECG studies performed per day is 30; according to the standards established by Order No. 293, the number of research data is 33. Naturally, over 17 years, medical technology has made significant progress, and therefore labor standards have been slightly changed. List of modern patients admitted to the functional diagnostics office in the period from 2006 to 2009 medical equipment attached to the explanation. Earlier, 06/18/2010, Kobzeva I.V. filed a statement addressed to the chief physician of the Municipal Health Center of the Central Regional Hospital about disagreement with the introduction of new labor standards; this statement was answered on June 23, 2010, in which the need for a slight reduction in time standards was clearly explained.
16. After hearing the parties and examining the case materials, the court comes to the following conclusion:
17. Based on the Code of Civil Procedure of the Russian Federation, each party must prove the circumstances to which it refers as the basis for its claims and objections, unless otherwise provided by federal law.
18. According to Labor Code Russian Federation, labor standards - production standards, time standards, headcount standards and other standards - are established in accordance with the achieved level of technology, technology, organization of production and labor. Labor standards may be revised as new equipment, technology, and organizational or other measures are improved or introduced to ensure an increase in labor productivity, as well as in the case of the use of physically and morally outdated equipment.
19. In accordance with the Labor Code of the Russian Federation, standard labor standards are developed and approved in the manner established by the federal executive body authorized by the Government of the Russian Federation.
20. According to the Labor Code of the Russian Federation, local regulations providing for the introduction, replacement and revision of labor standards are adopted by the employer taking into account the opinion of the representative body of employees. Employees must be notified of the introduction of new labor standards no later than two months in advance.
21. Clause 2.2 of the Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993 “On improving the functional diagnostic service in healthcare institutions of the Russian Federation” ordered the Department of Medical Care to the Population of the Ministry of Health of Russia, together with other interested departments, to ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.
22. Clause 4.1 of the Order of the Ministry of Health of the Russian Federation No. 283 dated November 30, 1993. It is recommended that heads of healthcare institutions set the number of personnel in departments, departments, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).
23. The court found that labor standards for employees of the functional diagnostics room, according to Table 1 of the Order of the chief physician of the MUZ KhCRH No. 293 dated 06/03/2010 “On the introduction of labor standards for employees of the functional diagnostics room,” are overstated, since these labor standards exceed the standards established in Appendix No. 7 “Calculated time standards for functional studies carried out in functional diagnostic rooms of medical institutions” of Order of the Ministry of Health of the Russian Federation No. 283.
24. In paragraph 3 of the note to the specified Appendix 7 of the Order of the Ministry of Health of the Russian Federation No. 283, it is determined that time standards are established by the head of the institution in agreement with the trade union committee on the basis of objective data on the cost of working time when introducing new equipment or new types of functional research. However, the defendant did not provide evidence of the introduction of new equipment or new types of functional studies in the functional diagnostics room. The defendant explains that Order No. 293 was issued on the basis of a report on the timing of actual time spent in the functional diagnostics room dated May 28, 2010. In the timekeeping report dated May 28, 2010. Also, nothing is stipulated that new equipment or new types of functional research have been introduced in the functional diagnostics room. Thus, the court comes to the conclusion that the grounds provided for labor legislation, the head of the institution did not have time to establish new standards.
25. In accordance with clause 4 of the Labor Code of the Russian Federation, the norms of local regulations that worsen the situation of workers in comparison with established labor legislation and other regulations legal acts, containing labor law norms, collective agreements, agreements, as well as local regulations adopted without observing the procedure for taking into account the opinions of the representative body of workers established by Article 372 of this Code, are not subject to application. In such cases, labor legislation and other regulatory legal acts containing labor law norms, collective agreements, and agreements are applied.
26. Considering that the norms of the order of the chief physician of the MUZ KhTsRB No. 293 dated June 3, 2010 “On the introduction of labor standards for employees of the functional diagnostics office” worsen the situation of workers in comparison with established labor legislation and other regulatory legal acts containing labor law norms (Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993), order of the Ministry of Health of the KhTsRB No. 293 of June 3, 2010 is not subject to application and cannot be recognized by the court as legal.
27. Adoption of Order No. 333 of June 28, 2010 by the Chief Physician of the Ministry of Health of the Kharkov Central Regional Hospital. “On amendments to the order of the chief physician No. 293 dated 06/03/2010.” the court cannot consider it as canceling order No. 293 or declaring it illegal, since order No. 333 does not contain such wording, therefore its publication does not preclude consideration of the applicant’s claims about the legality of order No. 293, which violates the rights of the plaintiff.
28. Arguments of the representative of the defendant that Order of the Ministry of Health of the Russian Federation No. 283 of November 30, 1993. is not subject to application, since it is outdated and contradicts, the court cannot take into account, since this Order of the Ministry of Health of the Russian Federation No. 283 is valid, it has not been canceled due to the adoption, and the court does not see any contradictions between the norms of Order No. 283 and
29. Declare illegal the order of the chief physician of the Khorol Central District Hospital No. 293 dated 06/03/2010 “On the introduction of labor standards for employees of the functional diagnostics office” and oblige the specified official to eliminate these violations.
30. The decision can be appealed in cassation to the Primorsky Regional Court within 10 days from the date of its announcement by filing a complaint through the Khorolsky District Court.
31. Judge

This instruction is intended for heads of departments and doctors of departments of functional diagnostics for use in rational use calculated time standards approved by order of the Ministry of Health of the Russian Federation dated November 30, 1993 No. 283 (Appendix 7).

The main purpose of the calculated time standards for functional studies is to use them when:

Resolving issues of improving the organization of activities of functional diagnostics rooms (departments);

Labor planning and organization medical personnel these units;

Analysis of labor costs of medical staff;

Formation of staffing standards for medical staff of relevant medical institutions.

1. Use of estimated time standards for functional studies for planning and organizing the work of medical personnel in functional diagnostics offices (departments).

Specific gravity The work of medical staff to directly carry out functional studies (main and auxiliary activities, work with documentation) for doctors and nurses is 84.0% of the working time. This time is included in the estimated time standards. Time for other necessary work and personal required time not taken into account in the standards.

For doctors, this is a joint planned discussion with their attending physicians of clinical and instrumental data, participation in medical conferences, reviews, and rounds; supervising the work of nurses, mastering techniques, equipment, monitoring their work, working with archives and documentation, administrative and economic work.

For nurses - preparatory work at the beginning of the working day (preparing the workplace, group calling patients from departments, etc.), issuing reports, putting the workplace in order at the end of the shift, receiving necessary materials(medicines, special paper, tools), equipment care.

When determining the estimated workload standards for doctors and nursing staff, it is recommended to be guided by the methodology for rationing the work of medical personnel (M., 1987, approved by the USSR Ministry of Health). In this case, the ratio of the above-mentioned working time costs is taken as a basis.

To take into account the work of staff in functional diagnostics rooms (departments), the possibility of comparing their workload, etc., the calculated time standards and the determined workload standards for doctors and nursing staff are reduced to a common unit of measurement - conventional units. 1 conventional unit is 10 minutes of working time. Thus, the shift load rate is 33 conventional units.

In accordance with the clarifications of the Ministry of Labor of the Russian Federation dated December 29, 1992 No. 5, approved by Decree No. 65 dated December 29, 1992, the transfer of days off coinciding with holidays, is carried out at enterprises, institutions and organizations that apply various work and rest regimes, in which work is not carried out on holidays.

The standard working time for certain periods of time is calculated according to the estimated schedule of a five-day work week with two days off, Saturday and Sunday, based on the following "duration of daily work (shift):

At 40 hours working week- 8 hours, on pre-holiday days - 7 hours;

If the working week is less than 40 hours - the number of hours obtained by dividing the established working week by five days, the day before holidays in this case, working hours are not reduced (Article 47 of the Labor Code of the Russian Federation). For example, in 1993, with a five-day work week with two days off, taking into account additional days holidays on January 4, May 3, 4 and 10, June 14 and November 8 due to the coincidence of holidays on January 2, May 1, 2 and 9, June 12 and November 7 with Saturday and Sunday days off - 252 working days and 113 days off , incl. 4 pre-holiday days (January 6, April 30, June 11 and December 31).

Based on this, the annual workload of the doctor and nurse in the office (department) of functional diagnostics will be 8316 conventional units in 1993. units or on average - 8300 conventional units. units (252 days x 33 conventional units = 8316 conventional units).

When planning the activities of a functional diagnostics unit, it is important to distribute the workload between medical and paramedical personnel, taking into account the different time costs for performing the same types of studies. For example, it is incorrect to combine within a single team or one schedule a doctor analyzing electrocardiograms and a nurse recording an ECG on a multi-channel device in the office (department), because it takes a doctor more time to decipher 1 ECG than it takes a nurse to record an ECG and prepare data for its analysis. Depending on the local conditions, the need for various types of electrocardiographic studies, the number of doctors and nurses, it is necessary to select a variant of their work schedule in which the sum of the products (according to the relevant research methods and techniques) of the number of planned studies per work shift by the estimated time standard established for this study, would be approximately the same. Failure to comply with this condition will result in the fact that part of the research performed by the nurse will not be completed that day by the doctor's analysis.

You can, for example, assign a nurse to record part of the ECG at home (in outpatient settings) or in the ward (in inpatient conditions), to equalize the shift costs of working time for doctors and nurses.

The same approach should be used when scheduling physicians and nurses when scheduling other studies, including those that do not require same-day conclusions. These conditions must also be observed when developing weekly and monthly schedules.

Thus, employee work schedules and execution schedules various types research must take into account the benchmark performance indicators of the unit, the needs of the medical institution in the structure and number of functional research methods, various throughput during the work of medical and nursing staff, depending on the type of diagnostic techniques.

2. Use of estimated time standards for functional studies to account for and analyze the activities of the functional diagnostics office (department).

Actual or planned annual volume of functional research activity, expressed in conventional units, is determined by the formula:
T = t 1 x n 1 +t 2 x n 2 + t i x n i, (1)
where T is the actual or planned annual volume of activity for conducting functional research, expressed in conventional units;

t 1, t 2, t i - time in arbitrary units in accordance with the approved estimated time standards for research (main and additional);

n 1, n 2, n i - actual or planned number of studies during the year using individual diagnostic methods.
A comparison of the actual annual volume of activity with the planned one allows for an integral assessment of the unit’s activities, to get an idea of ​​the labor productivity of its personnel and the efficiency of the unit as a whole.

Carrying out research on a larger scale throughout the year can be achieved by intensifying the work of medical staff, or by increasing the amount of time used for core activities by significantly reducing the share of other necessary types of labor. If this is not the result of the use of automation tools for research and calculation of physiological parameters, methods for more rational organization of the work of doctors and nurses, then such intensification of work inevitably leads to a decrease in the quality, information content and reliability of conclusions. Failure to fulfill the plan for the volume of activity may be the result of improper planning, a consequence of defects in the organization of work and in the management of the department. Therefore, both failure to fulfill the plan and its excessive overfulfillment should be equally carefully analyzed by both the head of the office (department) and the management of the medical institution in order to identify their causes and take appropriate measures. Deviations of the actual volume of activity from the annual planned volume within +20% ... -10% can be considered acceptable.

Along with general indicators After completing the work, the structure of the research conducted and the number of studies on individual diagnostic methods are traditionally analyzed to assess the balance and adequacy of the structure, the sufficiency of the number of studies, and the actual need for them.
The average time spent on one study is determined by:
C = Ф/n, a.u., (2)
where C is the average time spent on one study;

F - total actual time spent (on basic and additional diagnostic procedures) in total for all studies performed according to a certain diagnostic technique(in arbitrary units);

n is the number of studies performed using the same diagnostic technique.
The correspondence of the average time spent on research to the calculated time standards (in%) for a certain method is determined by the formula:
K = (C/t)x100. (3)
It is acceptable, along with those stated, to use other traditional and unconventional ways analysis with calculation and use of other indicators.

Heads of institutions and chief specialists also need to monitor the rational use of medical personnel and, when determining staffing levels, be guided by the results of an annual or multi-year analysis of the actual or planned volume of activity of the department.

Head of the Department of Medical Assistance to the Population

HELL. Tsaregorodtsev
Head of the Department of Maternal and Child Health Protection

DI. Zelinskaya

Appendix 9

to the order of the Ministry of Health of Russia dated November 30, 1993 No. 283
INSTRUCTIONS FOR DEVELOPING ESTIMATED TIME STANDARDS WHEN IMPLEMENTING NEW EQUIPMENT OR NEW TYPES OF RESEARCH
When introducing new diagnostic methods and technical means their implementation, which is based on different research methodology and technology, new content of medical staff’s work, and the absence of estimated time standards approved by the Russian Ministry of Health, they can be developed locally and agreed upon with the trade union committee in those institutions where new methods are being introduced.

The development of new calculation standards includes taking time measurements of the actual time spent on individual elements of labor, processing this data (according to the methodology outlined below), and calculating the time spent on the study as a whole.

Before timing, a list of technological operations (main and additional) for each method is compiled. For these purposes, it is recommended to use the methodology applied in compiling a universal list of labor elements for technological operations. In this case, it is possible to use the “List..” itself, adapting each technological operation to the technology of a specific new diagnostic method.
A universal list of labor elements for technological operations, recommended when developing estimated time standards.

Note: If a labor operation is to be performed by a doctor and a nurse, then it is carried out simultaneously.

Timing is carried out using sheets of timing measurements, which consistently set out the names of technological operations and the time of their implementation.

Processing the results of timing measurements includes calculating the average time spent, determining the actual and expert repeatability coefficient for each technological operation and the estimated time to complete the study under study.

The average time spent on an individual technological operation is defined as the average arithmetic quantity by all measurements.

The actual repeatability factor of technological operations in each study is calculated using the formula:
K = n/N, (4)
where K is the actual repeatability coefficient of the technological operation;

n is the number of timed studies using a specific research method in which this technological operation took place;

N- total number the same timed studies.
The expert coefficient of repeatability of a technological operation is determined by the most qualified functional diagnostics doctor who knows this technique, based on the existing experience in using the method and professional understanding of the proper repeatability of the technological operation.

The estimated time for each technological operation is determined by multiplying the average actual time spent on a given timing operation by the export coefficient of its repeatability.

The estimated time to complete the study as a whole is determined separately for the doctor and the nurse as the sum of the estimated time to complete all technological operations for this method. It, after approval by the order of the head of the medical institution, is the estimated time limit for performing this type of research in this institution.

To ensure the reliability of local time standards and their correspondence to the true time spent, not dependent on random causes, the number of studies subjected to time measurements should be as large as possible, but not less than 20-25.

It is possible to develop local time standards only when the staff of the office (department) have mastered the methods sufficiently well, when they have developed a certain automatism and professional stereotypes in performing diagnostic and analytical manipulations. Before this, research is carried out in the order of mastering new methods, within the time spent on other types of activities.

Estimated time standards for functional studies are determined taking into account the necessary relationship between the optimal labor productivity of medical staff and the high quality and completeness of functional diagnostic studies.

This instruction is intended for heads of departments and doctors of departments of functional diagnostics to use it for the purpose of rational application of calculated time standards approved by Order of the Ministry of Health of the Russian Federation dated November 30, 1993 No. 283 (Appendix 7).

The main purpose of the calculated time standards for functional studies is to use them when:

Resolving issues of improving the organization of activities of functional diagnostics rooms (departments);

Planning and organizing the work of medical personnel of these units;

Analysis of labor costs of medical staff;

Formation of staffing standards for medical staff of relevant medical institutions.

1. Use of estimated time standards for functional studies for planning and organizing the work of medical personnel in functional diagnostics offices (departments).

The share of medical staff's work on direct functional research (main and auxiliary activities, work with documentation) for doctors and nurses is 84.0% of working time. This time is included in the estimated time standards. Time for other necessary work and personal necessary time is not taken into account in the standards.

For doctors, this is a joint planned discussion with their attending physicians of clinical and instrumental data, participation in medical conferences, reviews, and rounds; supervising the work of nurses, mastering techniques, equipment, monitoring their work, working with archives and documentation, administrative and economic work.

For nurses, preparatory work at the beginning of the working day (preparing the workplace, group calling patients from departments, etc.), issuing reports, putting the workplace in order at the end of the shift, obtaining the necessary materials (medicines, special paper, tools) , equipment care.

When determining the estimated workload standards for doctors and nursing staff, it is recommended to be guided by the methodology for rationing the work of medical personnel (M., 1987, approved by the USSR Ministry of Health). In this case, the ratio of the above-mentioned working time costs is taken as a basis.

To take into account the work of staff in functional diagnostics rooms (departments), the possibility of comparing their workload, etc., the calculated time standards and the determined workload standards for doctors and nursing staff are reduced to a common unit of measurement - conventional units. 1 conventional unit is 10 minutes of working time. Thus, the shift load rate is 33 conventional units.

In accordance with the clarifications of the Ministry of Labor of the Russian Federation dated December 29, 1992 No. 5, approved by Decree No. 65 dated December 29, 1992, the transfer of days off coinciding with holidays is carried out at enterprises, institutions and organizations that apply different work and rest regimes, with which work is not carried out on holidays.

The standard working time for certain periods of time is calculated according to the estimated schedule of a five-day work week with two days off, Saturday and Sunday, based on the following "duration of daily work (shift):

With a 40-hour work week - 8 hours, on holidays - 7 hours;

If the duration of the working week is less than 40 hours - the number of hours obtained by dividing the established duration of the working week by five days, on the eve of holidays, in this case, no reduction in working hours is made (Article 47 of the Labor Code of the Russian Federation). For example, in 1993, with a five-day work week with two days off, taking into account additional days of rest on January 4, May 3, 4 and 10, June 14 and November 8 due to the coincidence of holidays on January 2, May 1, 2 and 9, 12 June and November 7 with Saturdays and Sundays off - 252 working days and 113 days off, incl. 4 pre-holiday days (January 6, April 30, June 11 and December 31).

Based on this, the annual workload of the doctor and nurse in the office (department) of functional diagnostics will be 8316 conventional units in 1993. units or on average - 8300 conventional units. units (252 days x 33 conventional units = 8316 conventional units).

When planning the activities of a functional diagnostics unit, it is important to distribute the workload between medical and paramedical personnel, taking into account the different time costs for performing the same types of studies. For example, it is incorrect to combine within a single team or one schedule a doctor analyzing electrocardiograms and a nurse recording an ECG on a multi-channel device in the office (department), because it takes a doctor more time to decipher 1 ECG than it takes a nurse to record an ECG and prepare data for its analysis. Depending on local conditions, the need for various types of electrocardiographic studies, the number of doctors and nurses, it is necessary to select a variant of their work schedule in which the sum of the products (according to the relevant research methods and techniques) of the number of planned studies per work shift by the estimated time standard established for this study, would be approximately the same. Failure to comply with this condition will result in the fact that part of the research performed by the nurse will not be completed that day by the doctor's analysis.

You can, for example, entrust a nurse with recording part of the ECG at home (in an outpatient setting) or in the ward (in an inpatient setting), to equalize the shift costs of working time for a doctor and a nurse.

The same approach should be used when scheduling physicians and nurses when scheduling other studies, including those that do not require same-day conclusions. These conditions must also be observed when developing weekly and monthly schedules.

Thus, the work schedules of employees and the schedule for performing various types of research must take into account the benchmark indicators of the unit’s activities, the needs of the medical institution in the structure and number of functional research methods, the different throughput during the work of medical and nursing staff, depending on the type of diagnostic techniques.

^ 2. Use of estimated time standards for functional studies to account for and analyze the activities of the functional diagnostics office (department).

The actual or planned annual volume of activity for conducting functional research, expressed in conventional units, is determined by the formula:

T = t 1 x n 1 +t 2 x n 2 + t i x n i, (1)

where T is the actual or planned annual volume of activity for conducting functional research, expressed in conventional units;

T 1 , t 2 , t i - time in conventional units in accordance with the approved estimated time standards for research (main and additional);

N 1, n 2, n i - the actual or planned number of studies during the year using individual diagnostic methods.

A comparison of the actual annual volume of activity with the planned one allows for an integral assessment of the unit’s activities, to get an idea of ​​the labor productivity of its personnel and the efficiency of the unit as a whole.

Carrying out research on a larger scale throughout the year can be achieved by intensifying the work of medical staff, or by increasing the amount of time used for core activities by significantly reducing the share of other necessary types of labor. If this is not the result of the use of automation tools for research and calculation of physiological parameters, methods for more rational organization of the work of doctors and nurses, then such intensification of work inevitably leads to a decrease in the quality, information content and reliability of conclusions. Failure to fulfill the plan for the volume of activity may be the result of improper planning, a consequence of defects in the organization of work and in the management of the department. Therefore, both failure to fulfill the plan and its excessive overfulfillment should be equally carefully analyzed by both the head of the office (department) and the management of the medical institution in order to identify their causes and take appropriate measures. Deviations of the actual volume of activity from the annual planned volume within +20% ... -10% can be considered acceptable.

Along with the general indicators of the work performed, the structure of the studies conducted and the number of studies on individual diagnostic methods are traditionally analyzed to assess the balance and adequacy of the structure, the sufficiency of the number of studies, and the actual need for them.

The average time spent on one study is determined by:

C = Ф/n, a.u., (2)

where C is the average time spent on one study;

F - total actual time spent (on basic and additional diagnostic procedures) in total for all studies performed using a certain diagnostic technique (in arbitrary units);

N is the number of studies performed using the same diagnostic technique.

The correspondence of the average time spent on research to the calculated time standards (in%) for a certain method is determined by the formula:

K = (C/t)x100. (3)

It is acceptable, along with the above, to use other traditional and non-traditional methods of analysis with the calculation and use of other indicators.

Heads of institutions and chief specialists also need to monitor the rational use of medical personnel and, when determining staffing levels, be guided by the results of an annual or multi-year analysis of the actual or planned volume of activity of the department.

^ Head of the Department of Medical Assistance to the Population

HELL. Tsaregorodtsev

Head of the Department of Maternal and Child Health Protection

DI. Zelinskaya

Appendix 9

To the order of the Ministry of Health of Russia dated November 30, 1993 No. 283

^ INSTRUCTIONS FOR DEVELOPING ESTIMATED TIME STANDARDS WHEN IMPLEMENTING NEW EQUIPMENT OR NEW TYPES OF RESEARCH

When introducing new diagnostic methods and technical means for their implementation, which are based on different research methodology and technology, new content of medical personnel’s work, the absence of estimated time standards approved by the Ministry of Health of Russia, they can be developed on the spot and agreed upon with the trade union committee in those institutions where they are being introduced new techniques.

The development of new calculation standards includes taking time measurements of the actual time spent on individual elements of labor, processing this data (according to the methodology outlined below), and calculating the time spent on the study as a whole.

Before timing, a list of technological operations (main and additional) for each method is compiled. For these purposes, it is recommended to use the methodology applied in compiling a universal list of labor elements for technological operations. In this case, it is possible to use the “List..” itself, adapting each technological operation to the technology of a specific new diagnostic method.

^ A universal list of labor elements for technological operations, recommended when developing estimated time standards.

Note: If a labor operation is to be performed by a doctor and a nurse, then it is carried out simultaneously.

Timing is carried out using sheets of timing measurements, which consistently set out the names of technological operations and the time of their implementation.

Processing the results of timing measurements includes calculating the average time spent, determining the actual and expert repeatability coefficient for each technological operation and the estimated time to complete the study under study.

The average time spent on an individual technological operation is determined as the arithmetic average of all measurements.

The actual repeatability factor of technological operations in each study is calculated using the formula:

K = n/N, (4)

where K is the actual repeatability coefficient of the technological operation;

N is the number of timed studies using a specific research method in which this technological operation took place;

N is the total number of the same timed studies.

The expert coefficient of repeatability of a technological operation is determined by the most qualified functional diagnostics doctor who knows this technique, based on the existing experience in using the method and professional understanding of the proper repeatability of the technological operation.

The estimated time for each technological operation is determined by multiplying the average actual time spent on a given timing operation by the export coefficient of its repeatability.

The estimated time to complete the study as a whole is determined separately for the doctor and the nurse as the sum of the estimated time to complete all technological operations using this method. It, after approval by the order of the head of the medical institution, is the estimated time limit for performing this type of research in this institution.

To ensure the reliability of local time standards and their correspondence to the true time spent, not dependent on random causes, the number of studies subjected to time measurements should be as large as possible, but not less than 20-25.

It is possible to develop local time standards only when the staff of the office (department) have mastered the methods sufficiently well, when they have developed a certain automatism and professional stereotypes in performing diagnostic and analytical manipulations. Before this, research is carried out in the order of mastering new methods, within the time spent on other types of activities.

^ An example of determining the estimated time limit for conducting an initial ECG for a nurse (when recording on a manual 5-channel electrocardiograph).

Appendix 10

To the order of the Ministry of Health of Russia dated November 30, 1993 No. 283

^ QUALIFICATION REQUIREMENTS FOR A SPECIALIST IN FUNCTIONAL DIAGNOSTICS

In accordance with the requirements of the specialty, a functional diagnostics doctor must know and be able to:

1. General knowledge:

Fundamentals of healthcare legislation and policy documents defining the activities of healthcare bodies and institutions;

General issues of organizing therapeutic, cardiological, pulmonological, neurological services in the Russian Federation, organizing functional diagnostics services in medical institutions;

Classification and metrological characteristics of equipment for functional studies, nomenclature of the main instruments used in functional diagnostics, the use of electronic computer technology in functional diagnostic studies;

Clinical physiology of blood circulation and respiration and, depending on the profile of the institution, other sections of clinical physiology;

Etiology, pathogenesis and clinic of major diseases in the relevant field of functional diagnostic research (cardiology, angiology, pulmonology, neurology and other areas depending on the profile of the institution).

2. General skills:

Identify general and specific signs of the disease;

Determine what functional methods of examining the patient are necessary to clarify the diagnosis;

Determine indications for additional consultations with specialists or for hospitalization, as well as indications and contraindications for the choice of treatment method and tactics;

Prepare medical documentation approved by in the prescribed manner.

3. Special knowledge and skills:

A functional diagnostics doctor must know the principles of the equipment on which he works, the rules of its operation, the method of recording curves and functional diagnostic parameters using this equipment, and write a conclusion on them;

Depending on the qualification category A functional diagnostics doctor must be proficient in all of the specified research methods for one of the following systems:

^ Second qualification category

of cardio-vascular system:

Electrocardiography (ECG), including examination in additional leads and functional tests;

Phonocardiography (PCG);

Rheovasography (RVG);

Determination of central hemodynamic parameters.

respiratory systems:

Electronic pneumotachometry with registration of the flow-volume loop;

Spirography in a closed system (for the study of residual lung volume and lateral position test).

nervous system:

- Echoencephalography;

Rheoencephalography;

Routine electroencephalography with functional tests;

Determination of SRV by motor and sensory fibers of peripheral vessels.

^ First qualification category

of cardio-vascular system:

- Electrocardiography (ECG), including studies in additional leads and functional tests;

Phonocardiography (PCG);

Rheovasography (RVG);

Determination of central hemodynamic parameters;

Sphygmography (SFG);

Bicycle ergometry (VEM);

Holter monitoring.

respiratory systems:

- Electronic pneumotachometry with registration of the flow-volume loop;

Spirography in a closed system (to conduct a study of residual lung volume and a lateral position test);

Study of the structure of the total lung capacity;

Indirect photooximetry;

Lung rheography;

Study of exhaled air gases (O 2 CO 2 N 2,).

nervous system:

- Echoencephalography;

Rheoencephalography;

Routine electrocephalography with functional tests;

Neuromuscular transmission testing;

Determination of SRV by motor and sensory fibers of peripheral vessels;

Standard needle electromyography;

Thermal imaging;

Doppler vasography of the brain.

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ORDER of the Ministry of Health of the Russian Federation dated 30-11-93 283 ON IMPROVING FUNCTIONAL DIAGNOSTICS SERVICES IN HEALTHCARE INSTITUTIONS... Relevant in 2018

Order

In the context of health care reform and the transition to medical insurance of citizens, the task of developing and introducing into practice new medical technologies, including diagnostic systems and complexes that allow increasing the efficiency of the treatment and diagnostic process and reducing economic and labor losses.

In this regard, the role and importance of functional research methods, which are widely used for the purpose of early detection pathologies, differential diagnosis various diseases and monitoring the effectiveness of therapeutic and health measures.

In 1993, in the treatment and preventive institutions of the republic there were 10.7 thousand departments of functional diagnostics, in which about 60 million studies are carried out annually.

The development of domestic diagnostic equipment necessary for the technical equipment of healthcare institutions at all levels has not received systematic development. In medical and preventive institutions, metrological support of measuring instruments is carried out at an extremely low level.

It is necessary to take effective measures to strengthen the interaction of functional diagnostics with other diagnostic services and the introduction of diagnostic algorithms.

In order to improve the organization of the functional diagnostics service and improve the quality of its work, the rapid introduction of new diagnostic methods, as well as improving personnel training and technical re-equipment of units with modern equipment

I affirm:

1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and republics within the Russian Federation, regional (territorial), city departments, health departments (Appendix 1).

2. Regulations on the department, unit, functional diagnostics room (Appendix 2).

3. Regulations on the head of the department, division, functional diagnostics room (Appendix 3).

4. Regulations on the doctor of the department, department, functional diagnostics office (Appendix 4).

5. Regulations on the head nurse of the department, department of functional diagnostics (Appendix 5).

6. Regulations on the nurse of the department, functional diagnostics room (Appendix 6).

7. The estimated workload for a doctor and nurse in the department (office) of functional diagnostics for a 6.5-hour working day is 33 conventional units.

8. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical and preventive institutions (Appendix 7).

9. Instructions for the use of estimated time standards for functional studies (Appendix 8).

10. Instructions for the development of estimated time standards when introducing new equipment or new types of research (Appendix 9).

11. Qualification requirements see a doctor - a specialist in functional diagnostics (Appendix 10).

12. Qualification requirements for a functional diagnostic nurse (Appendix 11).

15. Journal of registration of studies performed in the department (office) of functional diagnostics - form N 157/u-93 (Appendix 14).

16. Instructions for filling out a log of studies performed in the department (office) of functional diagnostics (Appendix 15).

17. Addition to the list of forms of primary medical documentation(Appendix 16).

I order:

1. To the ministers of health of the republics within the Russian Federation, heads of government bodies and health care institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:

1.1. Organize the work of departments, departments, functional diagnostic rooms in accordance with this order.

1.2. During 1993-1994. organize on the basis of medical and preventive institutions and clinics of medical and scientific - research institutes departments of functional diagnostics including rooms for instrumental research functions of blood circulation, respiration, digestion, nervous and endocrine systems, as well as other types of functional diagnostics, taking into account the profile of institutions and local conditions; organize their work in accordance with the Regulations on the department, unit, functional diagnostics room and its personnel (Appendices 2 - 6).

1.3. Approve the position of the chief freelance specialist of the health authority in functional diagnostics, organize its activities in accordance with the Regulations on the chief freelance specialist in functional diagnostics (Appendix 1).

1.4. Ensure regular training of doctors of the medical network on topical issues functional diagnostics.

1.5. Together with territorial VET "Medtechnika" to ensure the organization of high-quality and timely service of diagnostic equipment and metrological support of measuring instruments.

2. The Department of Medical Assistance to the Population of the Ministry of Health of Russia (Tsaregorodtsev A.D.) together with other interested departments:

2.1. Ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.

2.2. Carry out in 1994-1995. seminars for specialists in various directions functional diagnostics.

3. Management educational institutions(Volodin N.N.) add learning programs training of specialists in functional diagnostics in medical and pharmaceutical universities, as well as in medical faculties of universities, taking into account the implementation in practical work modern equipment and new research methods.

4. Heads of healthcare institutions:

4.1. It is recommended to establish the number of personnel in departments, divisions, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).

4.2. Develop standardized and unified schemes diagnostic examination patients with various diseases taking into account the stages and continuity in the examination carried out in medical and preventive institutions of various levels.

5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of specialists and doctors of various profiles on functional diagnostics in accordance with the approved standard programs.

6. State Central Scientific medical library Ministry of Health of Russia (Loginov B.R.) to create reference information and methodological centers to provide specialist doctors and cadets necessary information about modern effective methods functional diagnostics.

7. Management scientific research Ministry of Health of Russia (Samko N.N.):

7.1. Develop and approve in the prescribed manner a long-term program related to the creation various types devices for functional studies that meet modern technical and medical requirements for equipping medical and preventive institutions at various levels.

7.2. Ensure regular distribution to health authorities with the right to replicate in the required number of orders of the Ministry of Health of the Russian Federation on permission to use new devices and devices and on the exclusion of obsolete equipment from the range.

8. All-Russian Scientific Research and Testing Institute medical equipment(Leonov B.I.):

8.1. Together with the chief metrologists of administrative and territorial health authorities, organize work on certification of measurement methods and functional diagnostics.

8.2. Ensure, on a self-financing basis, the provision of information on health care authorities and institutions at the request of consumer characteristics serially produced domestic medical equipment, addresses and details of organizations and manufacturing companies.

8.3. Organize permanent and traveling exhibitions of medical equipment for functional diagnostics.

9. Heads and chief metrologists of territorial health authorities, heads of health care institutions, ensure timely Maintenance medical equipment products and verification of measuring instruments.

10. Consider as invalid for institutions of the Russian Ministry of Health the order of the USSR Ministry of Health dated August 12, 1988 N 642 “On estimated time standards for functional studies”, the order of the USSR Ministry of Health dated July 7, 1989 “On the addition to the order of the USSR Ministry of Health dated August 12, 1988 year N 642."

"Regulations on the electrocardiology room", approved by the Main Directorate of Medical Treatment - preventative care Ministry of Health of the USSR dated April 21, 1954.

11. Entrust control over the execution of the order to First Deputy Minister A.M. Moskvichev.

Minister of Health
Russian Federation
E.A.NECHAEV

Appendix 1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and republics within the Russian Federation, regional (territorial), city departments, health departments Appendix 2. Regulations on the department, division, office of functional diagnostics Appendix 3. Regulations on the head of the department, department, office of functional diagnostics Appendix 4. Regulations on the doctor of functional diagnostics of the department, department, office of functional diagnostics Appendix 5. Regulations on the head nurse of the department, department of functional diagnostics Appendix 6. Regulations on the nurse of the department, department, office of functional diagnostics Appendix 7. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical institutions Appendix 8. Instructions for the use of estimated time standards for functional studies Appendix 9. Instructions for the development of estimated time standards when introducing new equipment or new types of research Appendix 10. Qualification requirements to a doctor-specialist in functional diagnostics Appendix 11. Qualification requirements for a nurse in the office (department) of functional diagnostics Appendix 12. Recommended approximate list of the minimum set of methods and techniques for functional studies for medical institutions Appendix 13. Methods for calculating prices for diagnostic studies for departments departments, functional diagnostics rooms Appendix 14. Form N 157/u-93 "Registration log of studies performed in the functional diagnostics department (office)" Appendix 15. Instructions for filling out the "Registration log of studies performed in the functional diagnostics department (office)" ( form N 157/у-93) Appendix 16. Addition to the list of forms of primary medical documentation

Order of the Ministry of Health of the Russian Federation of November 30, 1993 N 283
"On improving the functional diagnostic service
in healthcare institutions of the Russian Federation"

In the context of health care reform and the transition to health insurance for citizens, the task of developing and introducing into practice new medical technologies, including diagnostic systems and complexes that make it possible to increase the efficiency of the diagnostic and treatment process and reduce economic and labor losses, becomes extremely urgent.

In this regard, the role and importance of functional research methods are increasing, which are widely used for the purpose of early detection of pathology, differential diagnosis of various diseases and monitoring the effectiveness of therapeutic measures.

In 1993, there were 10.7 thousand functional diagnostic departments in medical institutions of the republic, in which about 60 million studies are carried out annually.

The range of studies is constantly expanding, mainly due to highly informative methods of functional diagnostics. Their share in the total volume of instrumental research is only in diagnostic centers reaches 25-30 percent.

At the same time, in many medical institutions, especially in prehospital stage There has been a serious lag in the development of the functional diagnostic service.

As of 01/01/93 in the Russian Federation, out of 19.6 thousand outpatient clinics and inpatient institutions only about half of the institutions had departments (offices) of functional diagnostics.

In the last three years, the growth in the exchange of functional studies has practically ceased, especially in clinics serving the adult population.

There has been a steady downward trend in the rate of provision of the population with these types of research from 5.6 in 1990 to 5.0 in 1992 per 100 visits.

Compared to 1991, the number of remote diagnostic rooms decreased from 354 to 286 and the number of ECG studies performed in them decreased from 887.7 to 857.1 thousand.

The possibilities of functional diagnostics are unjustifiably reduced due to the insufficiently clear organization of its work. structural divisions, irrational use of technical means, slow introduction into practice of new forms of management and labor organization of medical personnel, highly effective diagnostic programs and algorithms.

The effectiveness of using the information received in medical institutions is insufficient due to the poor preparedness of specialists in functional diagnostics and attending physicians, and the lack of proper continuity in their work.

To a certain extent, difficulties in organizing a functional diagnostic service are associated with the lack of necessary regulatory framework, recommendations for optimizing the structure, staffing table and nomenclature of studies in departments and functional diagnostics rooms of medical institutions of various capacities. The principles of phasing with differentiation of levels and strict unification of the methods and techniques used at each stage, as well as accounting and reporting, which allow analyzing the activities of the service to the required extent, have not been worked out.

The development of domestic diagnostic equipment necessary for the technical equipment of healthcare institutions at all levels has not received systematic development. In medical institutions, metrological support of measuring instruments is carried out at an extremely low level.

It is necessary to take effective measures to strengthen the interaction of functional diagnostics with other diagnostic services and the introduction of diagnostic algorithms.

In order to improve the organization of the functional diagnostics service and improve the quality of its work, the rapid introduction of new diagnostic methods, as well as improving personnel training and technical re-equipment of departments with modern equipment, I affirm:

1. Regulations on the chief freelance specialist in functional diagnostics of the Ministry of Health of the Russian Federation and republics within the Russian Federation, regional (territorial), city departments, health departments (Appendix 1).

7. The estimated workload for a doctor and nurse in the department (office) of functional diagnostics for a 6.5-hour working day is 33 conventional units.

8. Estimated time standards for functional studies carried out in functional diagnostic rooms of medical institutions (Appendix 7).

10. Instructions for the development of estimated time standards when introducing new equipment or new types of research (Appendix 9).

15. Journal of registration of studies performed in the department (office) of functional diagnostics - form N 157/u-93 (Appendix 14).

16. Instructions for filling out a log of studies performed in the department (office) of functional diagnostics (Appendix 15).

I order:

1. To the health ministers of the republics within the Russian Federation, heads of government bodies and health care institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:

1.1. Organize the work of departments, departments, functional diagnostic rooms in accordance with this order.

1.2. During 1993-1994. organize departments of functional diagnostics on the basis of treatment and preventive institutions and clinics of medical and research institutes, including rooms for instrumental studies of the functions of blood circulation, respiration, digestion, nervous and endocrine systems, as well as other types of functional diagnostics, taking into account the profile of institutions and local conditions; organize their work in accordance with the regulations on the department, unit, functional diagnostics room and its personnel (Appendices 2-6).

1.3. Approve the position of the chief freelance specialist of the health authority in functional diagnostics, organize its activities in accordance with the regulations on the chief freelance specialist in functional diagnostics (Appendix 1).

1.4. Provide regular training to medical doctors on current issues of functional diagnostics.

1.5. Together with territorial VET "Medtechnika" to ensure the organization of high-quality and timely service of diagnostic equipment and metrological support of measuring instruments.

2. The Department of Medical Assistance to the Population of the Ministry of Health of Russia (Tsaregorodtsev A.D.) together with other interested departments:

2.1. Ensure systematic (every 2-3 years) adjustment, development and approval of calculated time standards, taking into account the improvement and development of methods and equipment used in functional diagnostics.

2.2. Carry out in 1994-1995. seminars for specialists in various areas of functional diagnostics.

3. The Department of Educational Institutions (N.N. Volodin) should supplement the training programs for specialists in functional diagnostics in medical and pharmaceutical universities, as well as in medical faculties of universities, taking into account the introduction of modern equipment and new research methods into practical work.

4. Heads of healthcare institutions:

4.1. It is recommended to establish the number of personnel in departments, divisions, and functional diagnostic rooms in accordance with the amount of work based on the estimated time standards for functional studies (Appendix 7).

4.2. To develop standardized and unified schemes for the diagnostic examination of patients for various diseases, taking into account the phasing and continuity of the examination carried out in medical institutions of various levels.

5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of specialists and doctors of various profiles on functional diagnostics in accordance with the approved standard programs.

6. The State Central Scientific Medical Library of the Ministry of Health of Russia (Loginov B.R.) to create reference information and methodological centers to provide specialist doctors and cadets with the necessary information about modern effective methods of functional diagnostics.

7. Directorate of Scientific Research of the Ministry of Health of Russia (Samko N.N.):

7.1. To develop and approve in the prescribed manner a promising program related to the creation of various types of devices for functional research that meet modern technical and medical requirements for equipping medical institutions at various levels.

7.2. Ensure regular distribution to health authorities with the right to replicate in the required number of orders of the Ministry of Health of the Russian Federation on permission to use new devices and devices and on the exclusion of obsolete equipment from the range.

8. All-Russian Research and Testing Institute of Medical Equipment (Leonov B.I.)

8.1. Together with the chief metrologists of administrative-territorial health authorities, organize work on certification of measurement methods in functional diagnostics.

8.2. To provide, on a self-supporting basis, at the request of health authorities and institutions, information on the consumer characteristics of mass-produced domestic medical equipment, addresses and details of organizations and manufacturing companies.

8.3. Organize permanent and traveling exhibitions of medical equipment for functional diagnostics.

9. Heads and chief metrologists of territorial health authorities and heads of health care institutions should ensure timely maintenance of medical equipment products and verification of measuring instruments.

10. Consider as invalid for institutions of the Russian Ministry of Health the order of the USSR Ministry of Health dated August 12, 1988 N 642 “On estimated time standards for functional studies”, the order of the USSR Ministry of Health dated July 7, 1989 “On the addition to the order of the USSR Ministry of Health dated August 12, 1988 year N 642.

“Regulations on the electrocardiology room”, approved by the Main Directorate of Treatment and Preventive Care of the USSR Ministry of Health on April 21, 1954.

11. Entrust control over the execution of the order to First Deputy Minister A.M. Moskvichev.

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