1993

1994

1995

1996

1997

1998

1999

Nursing

• Significant change in nursing practice has been demonstrated in the operating room. A new laparoscopy suite was opened and OR nursing staff received special training for work in this area. Reduced length of stay and a low rate of infection are two positive outcomes attributed to the establishment of the unit. Nursing staff have taken on new roles in patient education, both pre- and post-operatively.
• Vladivostok Municipal Clinical Hospital #2 has developed and maintained a model center for continuing education of nurses. Through the Nursing Resource Center new and experienced nurses are offered courses on a variety of clinical and management topics. Since opening in 1997, 150 newly hired and 300 experienced nurses have been trained. Four 3-day courses on various topics are conducted each month.
• The nursing organizational structure at Municipal Clinical Hospital #2 has been modified to support more effective management. A new Chief Nurse was appointed for Municipal Clinical Hospital #2 and a group of key senior nurses has formed a committee, which has incorporated more participatory decision-making practices. Staff turnover has decreased and recruitment of nurses has improved as compared with other hospitals in the city.
• Over the course of the partnership, US partners conducted a series of skills-based nursing education workshops on a variety of topics including holistic health assessment, pulmonary assessment and airway management, assessment and monitoring of cardiac/neurological status, Basic Life Support (BLS) training, nursing care in the US, Continuous Quality Improvement (CQI), and change management.
• The NIS partners developed forms to record nursing notes in a variety of departments including a nursing flowchart in the ICU.
• The nursing staff has demonstrated increased knowledge related to the needs of critically ill patients, operating room practices, and infection control. The ICU has introduced cardiac monitors and other new technology.
• With the assistance of the Richmond partners, the staff at Vladivostok City Hospital #2 developed, implemented, and evaluated standards of patient care that support quality nursing care and improve patient outcomes. They have incorporated these standards into continuing education programs for nursing staff.
• The nursing staff has continued to expand their scope of practice and are involved in establishing a professional organization for the region.
• The Nursing Learning Resource Center is providing education to both hospital staff and health care professionals throughout the area. In 1999, there were four 1-day workshops on nosocomial infections and occupational health; 200 nurses from the regional hospitals attended.
• As a result of the improvements in nursing practice, particularly in the Operating Room and Intensive Care Unit, the retention rate for nurses at Vladivostok City Hospital #2 has improved dramatically.

Hospital Administration and Finance

• US partners assessed financial management methods of Municipal Clinical Hospital #2 and introduced new methods for financial reporting and cost accounting to hospital administrators.
• Administrative and management guidelines were set forth in "Working Standards for the MCH #2". A new employee orientation program was implemented and employee job descriptions were developed.
• Improved management of patient cases and costs has resulted in a reduction of inpatient beds from 1,030 in 1992 to 979 in 1997. Municipal Clinical Hospital #2 implemented a new financial system, which utilizes a "step-down" cost allocation method. A new cost calculation strategy was implemented and is used for charge or product pricing decisions. Data gathered from the cost accounting system provides the basis for a performance-based reimbursement system that considers volume and quality in an overall attempt to improve patient care, reduce cost, and increase reimbursement. In addition, a new budgeting system was implemented with detailed cost projections for each medical service provided.
• Partners set up a Chart of Accounts for use with the automated financial accounting system and reviewed materials management, supply distribution, and charging methods. They also provided support to the programming staff in the use of the newly implemented automated financial applications and installed word processing and spreadsheet programs on the EMS Center's computers.
• Municipal Clinical Hospital #2 created a patient billing department to process claims to the Territorial Mandatory Health Insurance Fund, insurance companies, and self-paying patients. A code-setting registry was established that maintains case records of service performed according to diagnostic group, severity, co-morbidity, and quality factors.
• Municipal Clinical Hospital #2 employees received training in computer networking and programming and have begun an ambitious project to implement a hospital computer network.
• Laproscopic surgical procedures have also contributed to the decreased length of stay, by 10 days for specific conditions. In gastroenterological patients, length of stay has been reduced by 5 days, with no noted post-operative complications.
• Newly introduced arthroscopic procedures have decreased length of stay from 14 to 7.5 days in trauma care.

Infection Control

• A significant reduction in post-surgical complications was noted. The number dropped from 112 cases in 1995 to 103 cases in 1996 and to only 32 cases in 1997.
• An overall decline in nosocomial infections has resulted in shorter hospital stays and decreases in the use of medications has allowed for the provision of ambulatory care for a greater number of patients.
• Improvements in infection control practices observed during an assessment visit in 1998 included: use of bleach in surface cleaning; disposable paper towels for hand drying in the ICU; segregation of sharps from other patient waste and use of special containers for sharps; changes in the processing of dressing materials and instruments, replacing them with individual surgical kits; implementation of unified criteria for conducting infection surveys, leading to greater accuracy; use of a closed urinary drainage system; and triaging of patients at admission, where actively infectious patients are placed in a special unit.
• A series of continuing education courses for hospital personnel were offered in the following topics: Occupational Diseases for Healthcare Workers, Antibacterial Agent Update, Hazardous Infections, HIV and Parenteral Hepatitis Prevention.
• Physician and nursing certification programs were established in infection control.
• Partners instituted the WHONET program, a database system to establish a system of antimicrobial susceptibility monitoring and introduce current methods of quality control for microbiological tests and antimicrobial resistance testing.
• Municipal Clinical Hospital #2 established an expert committee to review and analyze nosocomial infection rates.
• US partners worked with Vladivostok City Hospital #2 to recognize and identify ward- and unit-specific infection control issues and to establish priorities in infection control policies. The partners educated the staff about new infection control policies, established measurement tools and indicators to evaluate the effectiveness/appropriateness of these policies and interventions, and began basic Continuous Quality Improvement processes.
• The infection control program at City Hospital #2 has been able to develop and implement processes to significantly reduce the number of surgical wound infections and occupational injuries.
• Through collaborative efforts with the Nursing Resource Center, the infection control program has also positively impacted other hospitals and health care professionals in the region.

Emergency Medical Services

• 9,440 physicians, nurses, feldshers, medical students and paramedics have been trained in pre-hopital and/or in-hospital emergency medical care since October 1994. In addition to health professionals, the partners have extended training in basic EMS to 470 policemen and fire fighters. They have also begun an outreach program to teach first aid and CPR to secondary school students - 1,195 thus far. A videotape of the students was developed as they participated in a mock earthquake/disaster drill. The partners use this training video as a model educational tool for other EMS Training Centers and to attract medical students.
• The NIS partners established a demonstration site for the establishment of model EMS services in the town of Partizansk, a rural area of Primorksiy Krai. A special team of paramedics was trained in Vladivostok and a computer database for the dispatcher's services was established. The Richmond Ambulance Authority donated equipment. The Partizansk paramedic team has proven to be a success. They exceeded expectations because they initiated care in the home and were often able to avoid hospital admissions. This has prevented overcrowding and saved funding for more serious condition. The team responded to 1,075 calls during its first six months of operation. In 2000 the team responded to 4,015 calls--an average 11 calls per day. In 2000, they conducted 3 CPRs, 10 intubations, and 71 lung ventilations.