Management System for Routing Patients Reguiring Medical Evacuation to Inpatient Facilities in the Megalopolis Due to Emergency and Urgent Indications

Significance. The issues of improving emergency and specialized medical care remain highly relevant in the Russian Federation, which is confirmed by the adoption of the Federal Project «Improvement of Emergency Medical care» within the framework of the National Project «Long and Active Life». A stably high level of lethality at the pre-hospital stage is largely associated with the time factor of receiving emergency care in a critical patient condition, which in turn depends on the prompt adoption of management decisions on the organization of optimal routing of patients during evacuation to inpatient medical organizations The regulation of patient routing processes becomes particularly relevant in the case of special situations, including mass crisis situations with massive influx of patients or victims. A spatial heterogeneity of the Russian population health, peculiarities of the socio-economic development of the regions, that form the resource base of the healthcare system in general and emergency care in particular, regional heterogeneity of settlement and population density, and differences in transport accessibility are factors of the «external environment» or risk factors, that are not dependable upon the emergency medical service. Nevertheless, these risk factors largely determine the accessibility and quality of emergency care in managing the routing organization during evacuation of patients to inpatient medical organizations. The purpose of the study is to analyze the organization of routing and evacuation of patients to inpatient medical organizations in a megalopolis and evaluate the role of innovative technologies in improving operational management decisions. Material and methods. The basis of the study was the A.S. Puchkov Ambulance and Emergency Care Station, Moscow. The Station performance was analyzed according to the data of the Federal statistical observation form No. 30 «Information about a medical organization» for 2014-2023. Results. The Station is entrusted with the functions of centralized routing in the course of medical evacuation. For the period 2018-2023, the frequency of evacuations of patients to inpatient medical organizations has a multidirectional character - against the background of a decrease in the number of persons delivered by ambulance crews to hospital organizations from 1339226 in 2018 to 882334 in 2023, there is an increase in this indicator in the period 2020-2022, i.e. during the Covid-19 pandemic with a subsequent decrease in 2023. In 2024, 1582 patients with circulatory arrest during continuous resuscitation measures were delivered to specialized medical institutions with spontaneous circulation restored. As part of the centralized management of routing during medical evacuation of patients to specialized hospitals, the Station has introduced modern medical and organizational technologies based on integrated management of innovative processes, including information systems and resources to handle calls and manage ambulance crews (Integrated automated control system and Automated navigation and dispatch system management), making it possible, under the “risk” conditions, to take prompt decisions on selecting the most optimal schemes and options for routing and reducing the hospital delivery time. In order to solve multidimensional problems of patient routing and evacuation, the Station has developed and implemented the target module «patient influx control» as a subsystem in the automated management system «Hospital». Implementing the developed module, coupled with establishing a separate post of a senior doctor in the medical evacuation department, made it possible to reach a 97-98% index of patient routing. Conclusion. The feasibility and effectiveness of introducing innovative technologies into the organization of the most important stage of emergency medical care delivery in critical cases, threatening the life of the patient —routing patients to inpatient medical facilities during medical evacuation—has been proven. The development of key innovative processes at all stages of emergency medical care organization can be highlighted: information systems and resources that ensure the reception of calls and management of ambulance crews. From the position of centralized regulation of the processes of routing and evacuation of patients to specialized medical organizations, an important role is played by the development and implementation of an automated navigation and dispatch management system. Keywords: emergency medical care; patient routing; medical evacuation; innovative information technologies