Problem of secondary surgical care of patients with concomitant arm injuries is regarded in modern surgery as solvable, thanks to use of microsurgery methods.
But many complications caused by a large number of mistakes at the stage of primary care, call for new organization and management technologies in form of a tactical algorithm scheme, which would let reduce their quantity considerably, or in some cases completely avoid them.
The aim of our study was to develop a model of secondary medical care for patients with concomitant arm injuries, and implement it into clinical practice of a multi-specialty hospital.
A conceptually new algorithm scheme of secondary care for patients with concomitant arm injuries was developed and introduced at the department of microsurgery and hand injuries of the Research Institute of Traumatology and Orthopedics, Astana (headed by professor N.D. Batpenov) during the period from 2001 till 2008.
Our study bases on a multi factoral analysis of qualified medical aid provided to 84 patients with concomitant arm injuries, treated at the department of microsurgery and hand injuries of the Research Institute of Traumatology and Orthopedics, Astana, during this time.
The conducted analysis revealed the most typical mistakes, made by the primary care. The main mistake was late diagnostics of acute limb ischemia provoked by a concomitant injury. Revascularization, followed by reperfusion syndrome, considerably complicated further actions of secondary care providers.
Basing on the obtained data, we have developed and introduced a new algorithm scheme of qualified medical aid to patients with concomitant arm injuries, at all stages of medical evacuation. According to this scheme, all tactical and diagnostic steps should follow each other in a clear order; at each stage, the information of the previous one is to be considered.
Newly implemented organization and management algorithm scheme resulted in better surgical results at patients with the above mentioned injuries; the number of mistakes and complications in primary care reduced twofold.
We suppose, that managerial problems of aid to patients with concomitant arm injuries could be solved, if diagnostic and tactical approaches would be clearly scheduled for primary care providers, by means of new organization and management technologies, implemented into clinical practice in form of the algorithm scheme.
The work is submitted to Scientific Conference "The Problems of International Integration of Educational Standards", England (London) - France (Paris), April 20-28, 2009. Came to the Editor´s Office on 14.01.2009.