International Patient Department

• Develop a modern health facility that meets Western standards and serves as a resource for Russians, expatriate Americans, and visiting foreigners.

Diagnostic and Interventional Cardiology

• Expand use of angioplasty & coronary artery bypass grafts.
• Provide educational sources for angioplasty, stents and other procedures. In 1999 the partnership received additional funding to focus on the following objective:
• Develop practice guidelines and treatment protocols for invasive cardiology and cardiovascular surgery.

Nursing

• Provide models and training for continuing education, clinical competency and accountability. In 1999 the partnership received additional funding to focus on the following objective:
• Establish a Nursing Resource Center, to enhance education for student and graduate nurses.

Ambulatory Care

• Increase outpatient services to serve a broader patient base.

Healthcare Administration

• Improve administrative practices, budget and financial management and further develop ancillary services including dietary and food services and laboratory.
• Develop quality parameters to shorten patient length of stay and increase bed availability.

Intravenous Therapy Practices

• Improve dialysis techniques and clinical practice in infusion therapy.
• Establish working relationships between Premier business partners in Moscow and the Medical Center to facilitate acquisition of IV supplies.

• On August 18, the partners celebrated the signing of the Memorandum of Understanding between Premier, Inc. and the Medical Center of the General Management Department of the President of the Russian Federation.

• In the second quarter of 1994 Central Clinical Hospital hosted a clinical conference on invasive cardiology attended by 125 participants, including representatives of all NIS partner institutions.

• On March 29 and 30, a two-day conference was held on western-style nursing and standards of care. The role of the nurse was discussed, as well as physical assessment activities and vascular access and monitoring. The role of the nurse in patient/family education was also addressed.
• An intensive training program for physicians and nurses culminated in the renovation of the International Patient Department at Central Clinical Hospital and a grand opening on April 2. The General Director, Deputy Chief of the Mission, and US Embassy participated in the ribbon-cutting ceremony. Working with McHugh Construction, Shayman Salk Arenson & Sussholz, and Premier Inc., the foreign patient department of Corpus No. 1 was renovated, reducing bed capacity from 44 to 37 and creating 15 private rooms and 11 semiprivate accommodations. The construction was completed in less than 6 weeks.
• On November 4, Central Clinical Hospital presented an in-house conference on Quality Indicators for over 35 people from other partnership hospitals.
• The NIS partner sponsored a domestic conference on quality indicators in early November 1996. Representatives of AIHA's partnership programs were invited.

• The US partners hosted six cardiologists and cardiovascular surgeons for a four-week training program, followed by sponsorship of an intensive two-day conference in Moscow. Over 100 nurse-physician teams from all AIHA partnerships attended the program.
• A conference entitled "Clinical Case Management: Hip and Knee Replacements and Coronary Artery Bypass Grafts" was jointly presented by the Medical Center of the General Management Department of the President of the Russian Federation at Central Clinical Hospital on April 8 and 9. NIS nurse-physician teams from each of the partnerships were invited to attend, and over 75 Moscow-area surgeon and surgical nurses participated. The two-day workshop included an advanced discussion on the most frequent knee injuries requiring surgery, which include torn cartilage, torn ligaments, torn shift to thigh ligaments and broken knee caps.
• Six nurse leaders, a physician, dietary aide, and housekeeper from Central Clinical Hospital attended a customer-training program on April 3 in Moscow. The one-day session provided the participants the chance to build their workplace skills and focus on ways to work with others more effectively. They shared their knowledge with colleagues at a train-the-trainer program on June 9-11.

• As of September, the value of US partner donations to the projects was nearly $3,000,000. Donations included TVs, VCRs, furnishings and equipment, custom hospital headwalls, crash carts, pharmaceuticals, and other hospital supplies.

• Premier, Inc. provided the equipment and supplies for the NRC. A nurse educator from Premier's affiliated hospital, The Cleveland Clinic Foundation, provided two weeks of training on the use of new clinical equipment and the use of mannequins. The Opening of the Nursing Resource Center was held at Volinskaya Hospital on September 8, 1999.
  

International Patient Department

• An International Patient Department was established at Central Clinical Hospital. The unit features western amenities, utility areas, a procedure room, and two state-of-the-art-nursing stations. The partners produced a marketing videotape and brochure to publicize the new facility. One of the first foreign patients was the Ambassador to Denmark who was hospitalized for an emergency appendectomy.
• Rehabilitation protocols were developed and implemented.
• Average length of hospital stay was reduced by 3 days.
• A US-licensed clinical nurse educator staffed the IPD for 3 years. In addition, over 75 nurses have been trained in principles of western-style patient care to work in the IPD. Of those, 37 attended training programs in Rochester and Chicago, focusing on the expectations of foreign patients and ambulatory care.
• Interpretation services were expanded.
• Numbers of international patients increased from 19 in 1996 to 27 in 1997, and in 1998 the IPD was operating at over 70% occupancy with expatriate US and foreign patients.
• IPD meets international standards, as indicated by patient questionnaires and daily feedback.

Diagnostic and Interventional Cardiology

• A cardiovascular surgery unit was enhanced. Physicians are now performing coronary artery bypass surgery. Physicians trained in the US now complete 3 to 5 balloon angioplasties and 2 to 3 coronary artery bypass surgeries weekly. In 1997, 100 coronary artery disease treatment (revascularization) procedures were performed.

Nursing

• A cadre of teaching faculty was established at the School of Nursing.
• The nursing curriculum was standardized and translated.
• In 1995, a new position of Clinical Nurse Educator was introduced at Central Clinical Hospital and an US-trained, licensed educator was employed full time at Central Clinical Hospital, Moscow for three years.
• A commission with participation of nurses on ongoing quality improvement in patient care has been formed and is active.
• The Head of the International Patient Department assigned her deputy director the responsibility for monitoring the execution and quality of nursing care.
• The quality of the nurses' work is consistent with established protocols with the active participation of the clinical nurse instructor.
• Job descriptions for floor and procedure nurses have been reviewed and adapted to the work environment.
• Nurses now actively participate in pre- and postoperative care of the patient population, basing their performance on retraining courses they have taken.
• The NRC opened in September 1999 has served as an educational site for nurses from the partnership program. Since its opening, a total of 721 nurses have participated in NLRC- based training programs.

Ambulatory Care

• Service enhancements were made at Polyclinic No. 1 and at the Pediatric Polyclinic.
• The outpatient registration area was relocated to facilitate visits by foreigners.
• Quality parameters to shorten patient length of stay and increase bed availability were developed.
• Laparoscopic surgeries were introduced in the gynecology department as outpatient procedures.

Health Care Administration

• Admission and management protocols were developed and implemented at partner hospitals.
• A Policy and Procedures Committee was established.
• Teams comprising physicians, nurses and junior medical personnel to care for patients were formed.
• Protocols for admitting and taking care of international patients were introduced.
• New job descriptions for the IPD were developed and implemented and training in human resources management was provided for the Medical Center's director of human resources.
• A Customer Service Training Program was implemented, and the training manual was translated into Russian and shared with other AIHA partnerships.
• An advertising and marketing program was developed through the Moscow Times and the Moscow Business Guide at an annual cost of $6500. A full-time marketing coordinator was employed on-site at Central Clinical Hospital to direct the marketing campaign, renegotiate contracts, and establish relationships with foreign embassies and international firms.
• The partnership also implemented reforms in the management of its library and resources. An Information Coordinator position was established and the partnership created its own web-site.
• Food and nutrition services were improved by modernizing services to meet Western standards. Premier's business partners - Ross Laboratories, Kraft Foods, ServiceMaster, and McDonalds Corporation - facilitated the nutrition and food service educational program.
• In the third quarter of 1995 the Medical Center became a member of the Maryland Hospital Association's quality indicator program.
• In early 1995 Central Clinical Hospital expanded its Quality Indicator Program, based upon the Maryland Hospital Association's model, to include eight indicators in fifteen clinical departments.
• Central Clinical Hospital received a grant from Abt Associates to submit an abstract on their work in quality indicators for presentation at the "13th International Conference on Quality in Health Care in Jerusalem, Israel May 26-30, 1996. The conference was conducted in collaboration with the Israel Society for Quality in Health Care, the Israel Medical Association, the Israel Association for Medical Information and the Palestine Council of Health.
• The Medical Center translated the quality indicator manual into Russian and made it available through AIHA's website.
• Four additional hospitals were enrolled in the MHA Quality Indicator project, including St. Petersburg's Sokolov Medical Center. Data is collected by a statistician at each site and summarized by the chief statistician. The partners are collaborating on the development of a Quality Indicators manuscript for a professional journal.

Intravenous Therapy Practices

• Practical training on infusion therapy was provided to nurses and training in central venous catheter placement and catheter confirmation was provided to 30 physicians and nurses.
• Mannequins for simulated I.V. practice were donated to the Medical Center for use at Central Clinical Hospital and the Polyclinic.
• Standards of Practice were introduced at Medical Center sites.

Other

• Intensive training in high-risk obstetrics was provided and practice guidelines for high-risk obstetrics were developed. In addition, Russian physicians and midwives were introduced to a multi-cultural program for foreign obstetrical patients.
• Additional US training was provided in neurology, emergency medicine, trauma, surgery, anesthesiology, pathology, endoprosthetics, high-risk obstetrics, and cardiology. Other programs have addressed biomedical engineering, materials management, sterile processing, ambulatory surgery, and facilities management.
• American Association of Blood Banks (AABB) standards were introduced at Central Clinical Hospital, and the director of the Medical Center's post-graduate institute studied blood banking at George Washington Medical Center, Washington, DC.