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Bartenschlager CC, Brunner JO, Kubiciel M, Heller AR. Evaluation of score-based tertiary triage policies during the COVID-19 pandemic: simulation study with real-world intensive care data. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01162-8. [PMID: 39093430 DOI: 10.1007/s00063-024-01162-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/20/2024] [Accepted: 06/11/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the "best for the most" patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of a tertiary triage of patients arises. METHODS We provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in a COVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPS II), are compared based on the resulting mortality in the ICU and inferential statistics. RESULTS Our study shows that score-based tertiary triage policies outperform non-score-based tertiary triage policies including compliance with the German Triage Act. Based on our simulation model, a SAPS II score-based tertiary triage policy reduces mortality in the ICU by up to 18 percentage points. The longer the queue of critical care patients waiting for ICU treatment and the larger the maximum number of patients subject to tertiary triage, the greater the effect on the reduction of mortality in the ICU. CONCLUSION A SAPS II score-based tertiary triage policy was superior in our simulation model. Random allocation or "first come, first served" policies yield the lowest survival rates, as will adherence to the new German Triage Act. An interdisciplinary discussion including an ethical and legal perspective is important for the social interpretation of our data-driven results.
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Affiliation(s)
- Christina C Bartenschlager
- Applied Data Science in Healthcare, Nürnberg School of Health, Ohm University of Applied Sciences Nuremberg, 90489, Nürnberg, Germany.
- Anaesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Jens O Brunner
- Decision Science in Healthcare, Department of Technology, Management, and Economics, Technical University of Denmark, Akademivej, Kongens Lyngby, 2800, Denmark
| | - Michael Kubiciel
- Chair of German, European and International Criminal, Medical and Economic Law, University of Augsburg, Universitätsstraße 24, 86159, Augsburg, Germany
| | - Axel R Heller
- Anaesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Volberg C, Schönfeld PN, Krönig L, Hertl M, Gschnell M. Palliativversorgung in der Dermatoonkologie – Aktuelle Praxis in deutschen zertifizierten Hautkrebszentren und dermatoonkologischen Schwerpunktpraxen. J Dtsch Dermatol Ges 2024; 22:1106-1114. [PMID: 39105230 DOI: 10.1111/ddg.15439_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/26/2024] [Indexed: 08/07/2024]
Abstract
ZusammenfassungHintergründeDermatoonkologische Patienten werden häufig in zertifizierten Hautkrebszentren oder dermatoonkologischen Schwerpunktpraxen betreut. Insbesondere in höheren Tumorstadien entwickeln Patienten krankheitsbedingt oder als Nebenwirkung der Therapien Symptome, die behandlungsbedürftig sind. Bei fortschreitender Erkrankung bedarf es trotz deutlich verbesserter Prognose seit Einführung der zielgerichteten und Immuntherapien einer vorausschauenden Vorsorgeplanung. Unklar ist, wie die Palliativversorgung von Hautkrebspatienten in der Dermatoonkologie aktuell organisiert wird.Patienten und MethodikIn einer deutschlandweiten Befragung wurden alle zertifizierten Hautkrebszentren und dermatoonkologischen Schwerpunktpraxen angeschrieben und um Teilnahme an der anonymisierten Befragung gebeten.ErgebnisseInsgesamt gingen 45 Antworten (42%) ein. Der Großteil (98%) der Befragten screent Patienten regelhaft auf belastende Symptome und alle Zentren haben auch eine Anbindung an eine palliativmedizinische Versorgungsstruktur. Es wurde angegeben, dass lediglich 5% der ärztlichen Mitarbeiter die Zusatzqualifikation „Palliativmedizin“ führen. Bei 68% der teilnehmenden Institutionen wird den Patienten die Möglichkeit einer Vorsorgeplanung angeboten. Für 89% ist Palliativmedizin relevant für die tägliche Arbeit, und 82% wünschen sich hierzu mehr Fortbildungsmöglichkeiten.SchlussfolgerungenMit der Erhebung kann dargestellt werden, dass die palliativmedizinische Versorgung einen wichtigen Stellenwert in der dermatoonkologischen Arbeit hat. Da jedoch nur ein geringer Anteil der Mitarbeitenden eine Weiterbildung in Palliativmedizin besitzt, wäre es für die umfassende Versorgung wünschenswert, wenn dieser Anteil größer würde.
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Affiliation(s)
- Christian Volberg
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg
- AG Ethik in der Medizin, Dekanat Humanmedizin, Philipps-Universität Marburg
| | - Philip Niklas Schönfeld
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg, Philipps-Universität Marburg
| | - Lisa Krönig
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg, Philipps-Universität Marburg
| | - Michael Hertl
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg, Philipps-Universität Marburg
| | - Martin Gschnell
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg, Philipps-Universität Marburg
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Volberg C, Schönfeld PN, Krönig L, Hertl M, Gschnell M. Palliative care in dermatooncology - Current practice in German dermatooncological centers and specialist offices. J Dtsch Dermatol Ges 2024; 22:1106-1113. [PMID: 38965657 DOI: 10.1111/ddg.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Dermato-oncology patients are often treated in certified skin cancer centers or dermato-oncological specialist offices. Especially in higher tumor stages, patients develop symptoms, either disease-related or due to therapy-related side effects, requiring treatment. Despite a markedly improved prognosis since the introduction of targeted therapies and immunotherapies, advance care planning is required in progressive disease. It is unclear how palliative care of skin cancer patients is currently organized in dermato-oncology. PATIENTS AND METHODS In a nationwide survey, all certified skin cancer centers and dermato-oncological specialist offices in Germany were contacted and asked to participate in this anonymized survey. RESULTS Overall, 45 responses (42%) were received. The majority (98%) of the respondents screen the patients on a regular basis for distressing symptoms, and all centers are connected to palliative medical care providers. Only 5% of the medical staff members have the additional qualification "palliative medicine". In 68% of the participating institutions, the opportunity for care planning is offered to patients. For 89%, palliative care is relevant for everyday work, and 82% desire more research opportunities on this topic. CONCLUSIONS This survey has shown that palliative care plays a major role in dermato-oncological work. Given that only a small proportion of the staff have received specialized training in palliative care, however, an increase of this proportion would be desirable for comprehensive care.
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Affiliation(s)
- Christian Volberg
- Department of Anesthesia and Critical Care, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Research Group Medical Ethics, Department of Human Medicine, Philipps University Marburg, Marburg, Germany
| | - Philip Niklas Schönfeld
- Department of Dermatology and Allergology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Lisa Krönig
- Department of Dermatology and Allergology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Martin Gschnell
- Department of Dermatology and Allergology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
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Schallenburger M, Schwartz J, Icks A, In der Schmitten J, Batzler YN, Meier S, Mendez-Delgado M, Tenge T, Neukirchen M. Triggers of intensive care patients with palliative care needs from nurses' perspective: a mixed methods study. Crit Care 2024; 28:181. [PMID: 38807236 PMCID: PMC11134896 DOI: 10.1186/s13054-024-04969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE Triggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses. METHODS For the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the "content-structuring content analysis" according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey. RESULTS In the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%. CONCLUSION Intensive care nurses see various triggers, with interprofessional collaboration and the patient's prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.
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Affiliation(s)
- Manuela Schallenburger
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Center of Integrated Oncology Aachen, Bonn, Cologne (CIO ABCD), Heinrich-Heine-University, Düsseldorf, Germany.
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Center of Integrated Oncology Aachen, Bonn, Cologne (CIO ABCD), Heinrich-Heine-University, Düsseldorf, Germany
| | - Jürgen In der Schmitten
- Institute of Family Medicine/General Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Yann-Nicolas Batzler
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stefan Meier
- Department of Anaesthesiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Miguel Mendez-Delgado
- Department of Anaesthesiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Theresa Tenge
- Department of Anaesthesiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martin Neukirchen
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Anaesthesiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Center of Integrated Oncology Aachen, Bonn, Cologne (CIO ABCD), Heinrich-Heine-University, Düsseldorf, Germany
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Riessen R, Kochanek M, Specketer B, Wengenmayer T, Kluge S. [The center for intensive care medicine: a model for interdisciplinary and interprofessional collaboration]. Med Klin Intensivmed Notfmed 2024; 119:260-267. [PMID: 38485765 DOI: 10.1007/s00063-024-01128-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/09/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND The Federal Joint Committee has established requirements for centers for intensive care medicine which, in cooperation with other clinics, are to take on special tasks for intensive care medicine in a region. High demands are placed on these centers, which it may not be possible to meet without restructuring the existing intensive care structures. OBJECTIVE In this study, an organizational model for a center for intensive care medicine based on broad interdisciplinary and interprofessional cooperation is presented for discussion. METHODS AND RESULTS The organizational model contains proposals for integration of the centers for intensive care medicine into the clinic structure, the management team, the staff composition, the areas of clinical activity, and the further tasks of research, teaching, and education and training. CONCLUSION Establishment of the centers for intensive care medicine provides new and forward-looking impetus for the further development of intensive care medicine in Germany. However, for the new organizational model to be implemented effectively, the necessary restructuring measures must be adequately refinanced and supported by hospital management and medical faculties. In addition, a sustained willingness for interdisciplinary and interprofessional cooperation is required on the part of all those involved, and employees in this model must be offered attractive long-term positions in intensive care medicine.
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Affiliation(s)
- Reimer Riessen
- Internistische Intensivstation, Abteilung für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - Matthias Kochanek
- Klinik I für Innere Medizin (Hämatologie und Onkologie), Schwerpunkt Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Birte Specketer
- Internistische Intensivstation, Abteilung für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - Tobias Wengenmayer
- Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Jöbges S, Seidlein AH, Knochel K, Michalsen A, Duttge G, Supady A, Dutzmann J, Meier S, Barndt I, Neitzke G, Nauck F, Rogge A, Janssens U. [Time-limited trials (TLT) in the intensive care unit : Recommendations from the ethics section of the DIVI and the ethics section of the DGIIN]. Med Klin Intensivmed Notfmed 2024; 119:291-295. [PMID: 38345649 PMCID: PMC11059002 DOI: 10.1007/s00063-024-01112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 04/30/2024]
Abstract
The rise in intensive care treatment procedures is accompanied by an increase in the complexity of decisions regarding the selection, administration and duration of treatment measures. Whether a treatment goal is desirable in an individual case and the treatment plan required to achieve it is acceptable for the patient depends on the patient's preferences, values and life plans. There is often uncertainty as to whether a patient-centered treatment goal can be achieved. The use of a time-limited treatment trial (TLT) as a binding agreement between the intensive care unit (ICU) team and the patient or their legal representative on a treatment concept over a defined period of time in the ICU can be helpful to reduce uncertainties and to ensure the continuation of intensive care measures in the patients' best interest.
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Affiliation(s)
- Susanne Jöbges
- Klinik für Anästhesiologie und Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Anna-Henrikje Seidlein
- Institut für Ethik und Geschichte der Medizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Kathrin Knochel
- Institut für Geschichte und Ethik der Medizin, Technische Universität München, München, Deutschland
| | - Andrej Michalsen
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz, Deutschland
| | - Gunnar Duttge
- Institut für Kriminalwissenschaften, Abteilung für strafrechtliches Medizin- und Biorecht, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - Alexander Supady
- Interdisziplinäre Medizinische Intensivtherapie, Universitätsklinikum Freiburg, Freiburg i.Br, Deutschland
| | - Jochen Dutzmann
- Klinik für Innere Medizin III, Universitätsmedizin Halle (Saale), Halle (Saale), Deutschland
| | - Stefan Meier
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Iris Barndt
- Klinik für Kardiologie und internistische Intensivmedizin, Universitätsklinikum Johannes Wesling, Minden, Deutschland
| | - Gerald Neitzke
- Institut für Ethik, Geschichte und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Friedemann Nauck
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Annette Rogge
- Fachbereich Neurologie, Paracelsus Nordseeklinik Helgoland, Helgoland, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Eschweiler, Deutschland
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Jöbges S, Dutzmann J, Barndt I, Burchardi H, Duttge G, Grautoff S, Gretenkort P, Hartog C, Knochel K, Nauck F, Neitzke G, Meier S, Michalsen A, Rogge A, Salomon F, Seidlein AH, Schumacher R, Riegel R, Stopfkuchen H, Janssens U. Ethisch begründet entscheiden in der Intensivmedizin. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:52-57. [PMID: 38190826 DOI: 10.1055/a-2211-9608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
The process recommendations of the Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) for ethically based decision-making in intensive care medicine are intended to create the framework for a structured procedure for seriously ill patients in intensive care. The processes require appropriate structures, e.g., for effective communication within the treatment team, with patients and relatives, legal representatives, as well as the availability of palliative medical expertise, ethical advisory committees and integrated psychosocial and spiritual care services. If the necessary competences and structures are not available in a facility, they can be consulted externally or by telemedicine if necessary. The present recommendations are based on an expert consensus and are not the result of a systematic review or a meta-analysis.
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Neukirchen M, Metaxa V, Schaefer MS. Palliative care in intensive care. Intensive Care Med 2023; 49:1538-1540. [PMID: 38010381 PMCID: PMC10709230 DOI: 10.1007/s00134-023-07260-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Martin Neukirchen
- Interdisciplinary Centre for Palliative Care, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany.
- Department of Anesthesiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Maximilian S Schaefer
- Department of Anesthesiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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9
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Berlin P, Göggelmann L, Herzog S, Pedrosa Carrasco AJ, Hauck J, Timmesfeld N, Kruse J, Rief W, Riera Knorrenschild J, von Blanckenburg P, Seifart C. Cancer advance care planning: development of a screening tool. BMJ Support Palliat Care 2023:spcare-2022-003965. [PMID: 37979957 DOI: 10.1136/spcare-2022-003965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 09/05/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Advance care discussions are a useful communication tools for medical preferences and beneficial for shared decision-making processes in hospital settings. The present study developed the first screening tool for need for advance care planning (ACP). METHODS In phase 1 (n=92), items were evaluated using feasibility analysis and item reduction. In phase 2 (n=201), reduced screening items were analysed for predictive value of need for ACP. Statistical analysis included receiver-operating characteristics analysis (area under the curve>0.80), optimal cut-off based on sensitivity and specificity, interpretation of OR and construct validity using correlation with death anxiety, communication avoidance within families and trust based on the relationship with the treating physician. RESULTS Participants in both phases were approximately 60 years old with non-curative prognosis. After item reduction, predictive values of four possible items with good item difficulty and discrimination were compared for mild, moderate and great levels of death anxiety. A two-item combination of I am burdened by thoughts of an unfavourable course of the disease and I am burdened by the feeling of being ill-prepared for the end of life showed best prediction of death anxiety and communication avoidance. Clinical cut-off at sum-score ≥6 was of high sensitivity (95%) and specificity (81%). Previous use of social support and readiness for ACP was related to higher chance of interest in ACP. CONCLUSION Screening for need of ACP is possible with two objective items and one subjective item. Positive screening therefore indicates when to offer ACP discussions and provides routine estimation of ACP need in clinical practice.
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Affiliation(s)
- Pia Berlin
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Lena Göggelmann
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Svenja Herzog
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Anna J Pedrosa Carrasco
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Johannes Hauck
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Johannes Kruse
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Giessen and Marburg, Giessen, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Haematology, Oncology and Immunology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Carola Seifart
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
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10
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Beutel G, Liebregts T, Böll B. [With a tumor diagnosis in the intensive care unit]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:946-954. [PMID: 37728738 DOI: 10.1007/s00108-023-01583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/21/2023]
Abstract
Tumor patients nowadays show significantly improved survival rates due to advancements in modern intensive care medicine, particularly in the case of organ failure. The previous reluctance towards implementing intensive medical care measures in patients with a tumorous disease is no longer justified. For successful intensive care treatment, the timing and the mode of admission along with the specific intensive care measures and underlying organ dysfunction(s) are crucial factors for the prognosis. To ensure appropriate treatment in clinical practice and to balance between overly restrictive admission criteria and overtreatment, a triage system could be beneficial. This would consider the prognosis of the underlying malignant disease, the performance status of the patient, available treatment options and a dynamic assessment of the course of the intensive medical care. Long-term results of tumor patients show that around 80% of tumor patients who have been in the intensive care unit present physical and mental health similar to those who were never admitted. Even the majority of patients who needed ongoing cancer treatment due to tumor stage did not show any differences in treatment intensity and their remission status after 6 months. A successful intensive care medicine, the individualized definition of aims, as well as adjustment of the treatment goals, require close collaboration between hematologists, oncologists, and intensive care physicians.
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Affiliation(s)
- Gernot Beutel
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Tobias Liebregts
- Klinik für Hämatologie und Stammzelltransplantation, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Boris Böll
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie (CIO), Internistische Intensivmedizin/Hämatologie-Onkologie, Uniklinik Köln, Köln, Deutschland
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11
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Tenge T, Neukirchen M. [Advance care instruments for emergency rescue services : What is the current situation in Germany?]. DIE ANAESTHESIOLOGIE 2023; 72:748-752. [PMID: 37563316 DOI: 10.1007/s00101-023-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/12/2023]
Abstract
In addition to advance care instruments, such as advance directives and healthcare powers of attorney, adapted directives for emergency situations might be beneficial. These could avoid problems occurring with advance directives (e.g., lack of availability in acute emergencies, insufficient applicability to specific situations) when patients are no longer capable of making decisions but prompt decisions are required. Patients at the end of life are particularly relevant in this context, as they can refuse invasive procedures. Emergency advance directives should provide legally certain, quickly accessible and easily interpretable information about patient wishes regarding procedures such as resuscitation, intubation, and hospital admission. This narrative review provides a compact overview in the form of a needs and current status survey on emergency advance directives in Germany, presenting clinical and research projects. Overall, the current situation is one of inconsistent and insufficient implementation, with a concurrent increase in the proportion of palliative care patients in emergency services.An acute need for action to strengthen the cooperation between palliative medicine, emergency medicine and rescue services emerges. Training on palliative knowledge and care of patients at the end of life is also useful for prehospital care.
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Affiliation(s)
- Theresa Tenge
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
| | - Martin Neukirchen
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Heppner HJ, Hag H. [Advanced care planing and end of life decisions - the geriatricians' view]. Dtsch Med Wochenschr 2023; 148:1360-1365. [PMID: 37820646 DOI: 10.1055/a-1825-5874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Medical progress and the increasing desire for self-determination, even in the most difficult life situations, as well as the associated increasing possibilities of influencing life and dying lead to possibilities but also obligations for individual treatment design. Especially at the end of life, the desire for provision is great and many decisions need to be made in advance or by proxy. In daily dealings with sick or seriously ill people at the end of their lives, it is very helpful if appropriate advance directives have been made and the patient's wishes can be implemented simply and clearly. With the possibility of advance planning for the end of life (Advance Care Planning (ACP)), there is a precautionary and planning concept that will hopefully be used more and more in the future.
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13
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Duttge G, Chabiera PJ. [Selected legal aspects regarding limiting treatment at the end of life : Patient advance directive, proxy and indications]. Med Klin Intensivmed Notfmed 2023; 118:598-608. [PMID: 37755458 DOI: 10.1007/s00063-023-01065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
Respect for the patient's right to self-determination and the professional medical assessment of the (continued) existence of a therapeutic prospect of success of the respective curative intervention ("indication") are the two central reference parameters of every medical therapeutic decision. This is particularly true in cases of a progressive, irreversible, fatal course of the disease. However, the assessment of the presumed will of the patient or the meaningfulness of curative (intensive care) prolongation of life frequently causes difficulties. The law cannot eliminate these doubts in each individual case; it does, however, provide a framework so that factually and ethically justified therapy decisions can be made in each case. In this function, this legal framework-no matter how much it must first be concretized in the respective decision case-demands strict observance. This also includes the most recent change in the law that went into effect on 1 January 2023, through the introduction of a statutory right of (emergency) representation for spouses.
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Affiliation(s)
- Gunnar Duttge
- Zentrum für Medizinrecht, Universität Göttingen, Platz der Göttinger Sieben 6, 37073, Göttingen, Deutschland.
- Institut für Kriminalwissenschaften, Georg-August-Universität, Platz der Göttinger Sieben 6, 37073, Göttingen, Deutschland.
| | - Peter Jan Chabiera
- Universitätsklinikum, Institut für Rechtsmedizin, Goethe-Universität Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Deutschland
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14
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Lustig K, Elsner F, Krumm N, Klasen M, Rolke R, Peuckmann-Post V. [Transition from intensive care to palliative care : A retrospective analysis of 102 consultation requests]. DIE ANAESTHESIOLOGIE 2023; 72:627-634. [PMID: 37548677 PMCID: PMC10457234 DOI: 10.1007/s00101-023-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The transition of patients from the intensive care unit (ICU) to the palliative care (PC) ward often implies changes including establishing a palliative concept. Adaptation of therapeutic goals can be challenging for medical staff, patients and relatives; however, descriptions of these transition trajectories are rare. OBJECTIVE The aim of this retrospective study was to characterize the consultation requests of the ICU to the PC consultation team as well as the patients by a description of trajectories and interventions. METHODS Retrospective analysis of all patients receiving intensive care at RWTH Aachen University Hospital in 2019 for whom a PC consultation was requested. The patient population transferred from the ICU to the PC ward was compared with the non-transferred population. In each case, the primary consultation was evaluated regarding the following factors: question, vigilance, length of time from consultation request to its performance, and primary focus of the question. The question focus was categorized into "symptom control", "counselling" and "transfer" (tick options). In addition, a free text field was available for further notes. Exploration of diagnoses was complemented by accessing the electronic health records. RESULTS A total of 102 consultation requests from the ICU to the PC ward were evaluated. The morbidity of patients was high, and most patients had at least one of the following diagnoses: pulmonary (62%), cardiovascular (61%), and/or neurological disease (55%). Of the patients 32 (31%) were transferred to the PC ward, among whom weakness (94%), fatigue (77%), anxiety (55%), pain (53%), and dyspnea (48%) were the most frequently noted symptoms. Of the transferred patients 5 (16%) could be discharged to home, nursing home, hospice or other. In total, 35 (34%) of all patients who were seen by palliative care specialists on ICUs in 2019 could be discharged alive. The most frequent reasons for nonadmission were lack of capacity of the PC ward (33%), dying while being on the waiting list (20%), and refusal by the patient (20%). Of the patients, 7 (26%) died within 48 h after they had been transferred to the PC ward. Performed consultation services "symptom control" (χ2 = 10.17; p < 0.05) and "counselling" (χ2 = 12.82; p < 0.001), which were requested by the intensive care physicians, showed a significant linkage with the respective intervention performed by the palliative care team. On the other hand, no statistically significant difference was found for requested and performed "transfer" of patients from ICUs to PC ward. Comparing the transferred versus non-transferred patient population, a significantly more frequent transfer of patients with malignant tumors (p = 0.00) was observed. CONCLUSION The need for palliative care support in the ICUs exceeded the admission capacity of the PC ward. Future studies should further examine palliative care models in intensive care medicine.
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Affiliation(s)
- Kathrin Lustig
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Frank Elsner
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Norbert Krumm
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Martin Klasen
- AIXTRA, Kompetenzzentrum für Training und Patientensicherheit, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
- Klinik für Anästhesiologie, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Vera Peuckmann-Post
- Klinik für Anästhesiologie, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
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15
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Heller AR, Bartenschlager C, Brunner JO, Marckmann G. [German "Triage Act"-Regulation with fatal consequences]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01286-0. [PMID: 37233790 DOI: 10.1007/s00101-023-01286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/27/2023]
Abstract
With the coming into force of § 5c of the Infection Protection Act (IfSG), the so-called Triage Act, on 14 December 2022, a protracted discussion has come to a provisional conclusion, the result of which physicians and social associations but also lawyers and ethicists are equally dissatisfied. The explicit exclusion of the discontinuation of treatment that has already begun in favor of new patients with better chances of success (so-called tertiary or ex-post triage) prevents allocation decisions with the aim of enabling as many patients as possible to beneficially participate in medical care under crisis conditions. The result of the new regulation is de facto a first come first served allocation, which is associated with the highest mortality even among individuals with limitations or disabilities and was rejected by a large margin as unfair in a population survey. Mandating allocation decisions based on the likelihood of success but which are not permitted to be consistently implemented and prohibiting, for example the use of age and frailty as prioritization criteria, although both factors most strongly determine the short-term probability of survival according to evident data, shows the contradictory and dogmatic nature of the regulation. The only remaining possibility is the consistent termination of treatment that is no longer indicated or desired by the patient, regardless of the current resource situation; however, if a different decision is made in a crisis situation than in a situation without a lack of resources, this practice would not be justified and would be punishable. Accordingly, the highest efforts must be set on legally compliant documentation, especially in the stage of decompensated crisis care in a region. The goal of enabling as many patients as possible to beneficially participate in medical care under crisis conditions is in any case thwarted by the new German Triage Act.
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Affiliation(s)
- A R Heller
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - C Bartenschlager
- Health Care Operations/Health Information Management, Wirtschaftswissenschaftliche und Medizinische Fakultät, Universität Augsburg, Augsburg, Deutschland
| | - J O Brunner
- Zentrum für Interdisziplinäre Gesundheitsforschung, Universität Augsburg, Augsburg, Deutschland
| | - G Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
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Younsi A, Unterberg A, Marzi I, Steudel WI, Uhl E, Lemcke J, Berg F, Woschek M, Friedrich M, Clusmann H, Hamou HA, Mauer UM, Scheer M, Meixensberger J, Lindner D, Schmieder K, Gierthmuehlen M, Hoefer C, Nienaber U, Maegele M. Development and first results of a national databank on care and treatment outcome after traumatic brain injury. Eur J Trauma Emerg Surg 2023; 49:1171-1181. [PMID: 37022377 DOI: 10.1007/s00068-023-02260-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/12/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE In absence of comprehensive data collection on traumatic brain injury (TBI), the German Society for Neurosurgery (DGNC) and the German Society for Trauma Surgery (DGU) developed a TBI databank for German-speaking countries. METHODS From 2016 to 2020, the TBI databank DGNC/DGU was implemented as a module of the TraumaRegister (TR) DGU and tested in a 15-month pilot phase. Since its official launch in 2021, patients from the TR-DGU (intermediate or intensive care unit admission via shock room) with TBI (AIS head ≥ 1) can be enrolled. A data set of > 300 clinical, imaging, and laboratory variables, harmonized with other international TBI data collection structures is documented, and the treatment outcome is evaluated after 6- and 12 months. RESULTS For this analysis, 318 patients in the TBI databank could be included (median age 58 years; 71% men). Falls were the most common cause of injury (55%), and antithrombotic medication was frequent (28%). Severe or moderate TBI were only present in 55% of patients, while 45% suffered a mild injury. Nevertheless, intracranial pathologies were present in 95% of brain imaging with traumatic subarachnoid hemorrhages (76%) being the most common. Intracranial surgeries were performed in 42% of cases. In-hospital mortality after TBI was 21% and surviving patients could be discharged after a median hospital stay of 11 days. At the 6-and 12 months follow-up, a favorable outcome was achieved by 70% and 90% of the participating TBI patients, respectively. Compared to a European cohort of 2138 TBI patients treated in the ICU between 2014 and 2017, patients in the TBI databank were already older, frailer, fell more commonly at home. CONCLUSION Within five years, the TBI databank DGNC/DGU of the TR-DGU could be established and is since then prospectively enrolling TBI patients in German-speaking countries. With its large and harmonized data set and a 12-month follow-up, the TBI databank is a unique project in Europe, already allowing comparisons to other data collection structures and indicating a demographic change towards older and frailer TBI patients in Germany.
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Affiliation(s)
- Alexander Younsi
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, INF 400, 69120, Heidelberg, Germany.
| | - Andreas Unterberg
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Ingo Marzi
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum, Johann Wolfgang-Goethe-Universität, Frankfurt am Main, Germany
| | | | - Eberhard Uhl
- Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg Standort Gießen, Giessen, Germany
| | - Johannes Lemcke
- Klinik für Neurochirurgie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Germany
| | - Florian Berg
- Klinik für Neurochirurgie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Germany
| | - Mathias Woschek
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum, Johann Wolfgang-Goethe-Universität, Frankfurt am Main, Germany
| | - Michaela Friedrich
- Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg Standort Gießen, Giessen, Germany
| | - Hans Clusmann
- Klinik für Neurochirurgie, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Uwe Max Mauer
- Neurochirurgische Klinik, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Magnus Scheer
- Neurochirurgische Klinik, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Jürgen Meixensberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dirk Lindner
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Kirsten Schmieder
- Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Ruhr - Universität Bochum, In Der Schornau 23-35, 44892, Bochum, Germany
| | - Mortimer Gierthmuehlen
- Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Ruhr - Universität Bochum, In Der Schornau 23-35, 44892, Bochum, Germany
| | - Christine Hoefer
- Akademie der Unfallchirurgie GmbH, Emil-Riedel-Straße 5, 80538, Munich, Germany
| | - Ulrike Nienaber
- Akademie der Unfallchirurgie GmbH, Emil-Riedel-Straße 5, 80538, Munich, Germany
| | - Marc Maegele
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Klinikum Köln-Merheim, Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Campus Köln-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany
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Coping with COVID-19: the role of hospital care structures and capacity expansion in five countries. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:186-203. [PMID: 36625420 DOI: 10.1017/s1744133122000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This contribution examines the responses of five health systems in the first wave of the COVID-19 pandemic: Denmark, Germany, Israel, Spain and Sweden. The aim is to understand to what extent this crisis response of these countries was resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Main findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralised hospital care structures, more sophisticated concepts for providing specialised services and stronger integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralised governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen health care system resilience in pandemic situations and beyond.
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18
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Michalsen A, Dutzmann J. [65/m-Multiple organ failure from sepsis due to four quadrant peritonitis : Preparation course anesthesiological intensive care medicine: case 21]. DIE ANAESTHESIOLOGIE 2022; 71:111-114. [PMID: 35925169 DOI: 10.1007/s00101-022-01139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Andrej Michalsen
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Mainaustr. 35, 78464, Konstanz, Deutschland.
| | - Jochen Dutzmann
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
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19
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Michels G, Dutzmann J, Duttge G, Rogge A, Jöbges S, Grautoff S, Meier S, Janssens U, Michalsen A. [Ad hoc ethical decision-making in clinical acute and emergency medicine : Position paper of the Ethics Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed 2022; 117:85-90. [PMID: 34989820 DOI: 10.1007/s00063-021-00897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Decisions with considerable medical and ethical implications are made in emergency departments every day. Despite time pressure and high workloads, they have to be arrived at in an expert manner in all dimensions. For immediate ethical decisions, structuring the decision-making process in the form of standard procedures can be helpful, provided that they are trained and practiced in an interdisciplinary and interprofessional manner. The support for ad hoc ethical decisions presented here recommends an "ethical team time out" for the evaluation of treatment choices, in a framework where the patient's will and medical indication are examined and completed in a structured manner. Further experts (ideally, an ad hoc clinical ethics consultation) should be consulted if the treatment measure is of questionable medical benefit and/or of questionable patient consent.
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Affiliation(s)
- Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
| | - Jochen Dutzmann
- Universitätsklinik und Poliklinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Gunnar Duttge
- Zentrum für Medizinrecht, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - Annette Rogge
- Institut für Experimentelle Medizin, Medizinethik, Christian-Albrechts-Universität zu Kiel (CAU), Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Susanne Jöbges
- Medizinethik, Institut für Biomedizinische Ethik und Medizingeschichte (IBME), Zürich, Schweiz.,Klinik für Anästhesiologie, operative Intensivmedizin und postoperative Schmerztherapie, Klinikum Dortmund, Dortmund, Deutschland
| | - Steffen Grautoff
- Sicherheit und Ordnung, Gefahrenabwehr, Kreis Herford, Herford, Deutschland.,Zentrale Notaufnahme, Klinikum Herford, Herford, Deutschland
| | - Stefan Meier
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital Eschweiler, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland
| | - Andrej Michalsen
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz, Deutschland
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