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Gries A, Marie Schrimpf A, von Dercks N. Hospital Emergency Departments—Utilization and Resource Deployment in the Hospital as a Function of the Type of Referral. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:640-646. [PMID: 35912425 PMCID: PMC9764348 DOI: 10.3238/arztebl.m2022.0276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/03/2022] [Accepted: 07/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inpatient admission rates and the resources required upon admission to the hospital were studied as a function of the type of referral to the emergency department (ED) of a university hospital. METHODS We retrospectively analyzed data concerning patients who were treated in the ED of the University of Leipzig Medical Center in 2019. The following data were recorded: process data, type of referral, hospital admission vs. discharge from the ED, and leading symptom according to classification as "trauma" or "non-trauma." For all admitted patients, the Patient Clinical Complexity Level (PCCL), length of hospital stay, and intensive care (yes/no) with or without ventilation were recorded. RESULTS Data on 34 178 patients (50.9 ± 22.2 years, 53.8% male) were analyzed; 28.8% of patients were referred because of "trauma," and the remaining 71.2% for "non trauma". The most common sources of referral were the rescue and emergency medical services (47.7%) and the patients themselves (self-referrals, 44.7%); 7.6% of the patients were referred by a resident doctor or general practitioner (physician). 62.6% were discharged from the ED after diagnosis and treatment, while 37.4% were admitted to the hospital. In comparison with self-referred patients as a baseline, the likelihood of inpatient admission was higher when the patient was referred by a physician (adjusted odds ratio [OR] 2.2), by the emergency rescue service without an emer - gency physician (OR 3.4), by an emergency physician (OR 9.3), or by the helicopter rescue service (OR 44.1). 49.1% of patients with trauma referred themselves to the ER, and 36% were referred by the emergency rescue service. Older and male patients were more likely to be admitted to the hospital, especially for non-trauma. 30.4% of the admitted patients required intensive care, and 35.5% of the patients in intensive care required ventilation. CONCLUSION Whether a patient is admitted to the hospital depends on the source of the referral and the leading symptom on arrival in the ED. One in every six self-referred patients is admitted to the hospital, particularly when the reason for presenting to the ER is non-traumatic and some of them go on to receive intensive care. The high percentage (around 95%) of self-referred trauma patients that are discharged from the ED presumably indicates that they were referred mainly for the exclusion of dangerous conditions, and/or that appropriate care options are lacking in the community setting.
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Affiliation(s)
- André Gries
- Hospital emergency department/observation unit, University of Leipzig Medical Center, Leipzig, Germany
| | - Anne Marie Schrimpf
- Independent Department of General Practice, University of Leipzig, Division of Health Services Research, University of Leipzig Medical Center, Leipzig, Germany
| | - Nikolaus von Dercks
- Medical Controlling Unit, University of Leipzig Medical Center, Leipzig, Germany
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Das (PR_E-)AUD2IT-Schema als Rückgrat für eine strukturierte Notfallversorgung und Dokumentation nichttraumatologischer kritisch kranker Schockraumpatienten. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00878-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungBei traumatologischen Schockraumpatienten ist die Versorgung seit vielen Jahren standardisiert und auf Basis von Algorithmen vereinheitlicht. Für das breite Spektrum der nichttraumatologischen Notfallpatienten fehlt eine solche einheitliche, übergeordnete Struktur bisher in der Schockraumversorgung. Zwar sind auch hier einzelne Algorithmen und Abläufe üblich und verbreitet, jedoch fehlt ein Gesamtkonzept für die gesamte Notfallversorgung, in das die bestehenden Akronyme eingebunden sind. Durch Vereinheitlichung von Untersuchungsschritten und Dokumentation in der Notfallmedizin könnten Fehler in der Behandlung von Notfallpatienten, verursacht durch Informationsverlust an den Schnittstellen, reduziert werden. Im Rahmen dieser konzeptionellen Arbeit wird daher ein standardisiertes und einfach zu erlernendes Konzept für die Behandlung in der Notfallmedizin vorgestellt. Das (PR_E-)AUD2IT-Schema beinhaltet folgende Phasen: P – Präparation, R – Ressourcen, „_“ – Pause (Team-Time-out) zur strukturierten Übergabe, E – Erstversorgung, A – Anamnese, U – Untersuchung, D2 – Differenzialdiagnosen/apparative Diagnostik, I – Interpretation und T – To-do. Um den Umgang mit zeitkritischen Notfällen nicht zu verzögern, soll dieses Konzept auch von unerfahrenen Mitarbeitern schnell und sicher angewendet werden können. Das (PR_E-)AUD2IT-Schema ist ein didaktisches Instrument zur Strukturierung und Gliederung einer Schockraumversorgung nichttraumatologisch kritisch kranker Patienten und ihrer Dokumentation.
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Stiefler S, Seibert K, Domhoff D, Wolf-Ostermann K, Peschke D. [Predictors of Admission to Nursing Home in Care-Dependent People - A Longitudinal Secondary Data Analysis]. DAS GESUNDHEITSWESEN 2021; 84:139-153. [PMID: 33822335 DOI: 10.1055/a-1276-0525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine predictors of admission to nursing home by means of secondary data analysis of German statutory health insurance claims data and care needs assessments. MATERIALS AND METHODS A retrospective longitudinal analysis was conducted covering the period 2006-2016 and using routine data. Health insurance data and care needs assessment data for people who became care dependent in 2006 and who lived in their own homes were merged. Cox regression analyses were conducted to identify predictors of admission to a nursing home. RESULTS The study population comprised 48,892 persons. Dementia, cancer of the brain, cognitive impairment, antipsychotics prescriptions, hospitalized fractures, hospital stays over ten days, and higher age had the highest hazard ratios among the predictors. CONCLUSIONS Knowledge about the predictors serves to sensitize health care professionals in the care of people in need of care. It facilitates identification of care needs in community-dwelling persons at an increased risk of admission to a nursing home.
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Affiliation(s)
- Susanne Stiefler
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Kathrin Seibert
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Dominik Domhoff
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Karin Wolf-Ostermann
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Dirk Peschke
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit Bochum, Bochum
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Faqar-Uz-Zaman SF, Filmann N, Mahkovic D, von Wagner M, Detemble C, Kippke U, Marschall U, Anantharajah L, Baumartz P, Sobotta P, Bechstein WO, Schnitzbauer AA. Study protocol for a prospective, double-blinded, observational study investigating the diagnostic accuracy of an app-based diagnostic health care application in an emergency room setting: the eRadaR trial. BMJ Open 2021; 11:e041396. [PMID: 33419909 PMCID: PMC7798704 DOI: 10.1136/bmjopen-2020-041396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Occurrence of inaccurate or delayed diagnoses is a significant concern in patient care, particularly in emergency medicine, where decision making is often constrained by high throughput and inaccurate admission diagnoses. Artificial intelligence-based diagnostic decision support system have been developed to enhance clinical performance by suggesting differential diagnoses to a given case, based on an integrated medical knowledge base and machine learning techniques. The purpose of the study is to evaluate the diagnostic accuracy of Ada, an app-based diagnostic tool and the impact on patient outcome. METHODS AND ANALYSIS The eRadaR trial is a prospective, double-blinded study with patients presenting to the emergency room (ER) with abdominal pain. At initial contact in the ER, a structured interview will be performed using the Ada-App and both, patients and attending physicians, will be blinded to the proposed diagnosis lists until trial completion. Throughout the study, clinical data relating to diagnostic findings and types of therapy will be obtained and the follow-up until day 90 will comprise occurrence of complications and overall survival of patients. The primary efficacy of the trial is defined by the percentage of correct diagnoses suggested by Ada compared with the final discharge diagnosis. Further, accuracy and timing of diagnosis will be compared with decision making of classical doctor-patient interaction. Secondary objectives are complications, length of hospital stay and overall survival. ETHICS AND DISSEMINATION Ethical approval was received by the independent ethics committee (IEC) of the Goethe-University Frankfurt on 9 April 2020 including the patient information material and informed consent form. All protocol amendments must be reported to and adapted by the IEC. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER DRKS00019098.
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Affiliation(s)
- S Fatima Faqar-Uz-Zaman
- Department for General, Visceral and Transplant Surgery, Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University, Frankfurt/Main, Frankfurt, Germany
| | - Dora Mahkovic
- Ljubljana Central Medical School, Ljubljana, Slovenia
| | | | - Charlotte Detemble
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Ulf Kippke
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | | | - Luxia Anantharajah
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Philipp Baumartz
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Paula Sobotta
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Wolf O Bechstein
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Andreas A Schnitzbauer
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
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Gries A, Seekamp A, Wrede C, Dodt C. [Training in clinical acute and emergency medicine - Supraspeciality in Germany : A concept for nationwide implementation!]. Anaesthesist 2019; 67:895-900. [PMID: 30511109 DOI: 10.1007/s00101-018-0515-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
At the 121st German Physicians Conference 2018 in Erfurt a resolution to accept the full amendment of the (draft) further training regulations (MWBO) was adopted and the State Medical Councils were requested to include them in their respective areas of responsibility. Therefore, the nationwide implementation of the supraspeciality (ZWB) for clinical acute and emergency medicine has been officially finalized. After consultation with the German Medical Council (BÄK) concerning the format, both the new MWBO 2018 and now the content of the ZWB are available as of 15 November 2018.The Physicians Conference resolution and anchoring of the new ZWB clinical acute and emergency medicine in the MWBO were preceded by a process lasting approximately 10 years. The concept of the ZWB clinical acute and emergency medicine, which was scrutinized by the Standing Committee on "medical further training" and the board of the BÄK and presented for approval, was essentially developed by representatives of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) and the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) in consultation with the BÄK. A consensus was finally reached in September 2017 in cooperation with those German specialist societies with a high proportion of emergency patients.In addition to the title, definition, and minimum requirements for applying the ZWB, the content was processed according to the European curriculum for emergency medicine. The structural prerequisites have now been approved, the Standing Committee has configured the content, and the complete MWBO 2018 has been successfully presented, such that the ZWB clinical acute and emergency medicine is expected to be implemented in the individual Federal States within the next 1-2 years.This article describes the history and development of ZWB clinical acute and emergency medicine in Germany and outlines future perspectives.
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Affiliation(s)
- A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - A Seekamp
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig Holstein, Kiel, Deutschland
| | - C Wrede
- Interdisziplinäres Notfallzentrum, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland
| | - C Dodt
- Notfallzentrum, Städtisches Klinikum München Bogenhausen, München, Deutschland
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Greiner F, Slagman A, Stallmann C, March S, Pollmanns J, Dröge P, Günster C, Rosenbusch ML, Heuer J, Drösler SE, Walcher F, Brammen D. [Routine Data from Emergency Departments: Varying Documentation Standards, Billing Modalities and Data Custodians at an Identical Unit of Care]. DAS GESUNDHEITSWESEN 2019; 82:S72-S82. [PMID: 31597189 PMCID: PMC7939518 DOI: 10.1055/a-0996-8371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hintergrund
Nicht nur im Kontext der Neuordnung der Notfallversorgung in
Deutschland besteht derzeit ein hoher Bedarf an Daten aus Notaufnahmen.
Für die Versorgungsforschung bieten sich Daten an, welche auf
gesetzlicher Grundlage generiert werden. Unterschiedliche Kostenträger
und Abrechnungsmodi stellen eigene Anforderungen an die Dokumentation dieser
Routinedaten.
Methodische Herausforderungen
Aufgrund der sektoralen Trennung gibt es
keinen Datensatz oder Datenhalter, der Auskunft über alle
Notaufnahmebehandlungen geben kann. Aus administrativer Sicht gilt die gesamte
Notaufnahmebehandlung als ambulant oder stationär, tatsächlich
wird die Entscheidung darüber erst während der Versorgung
getroffen. Für die stationäre Versorgung existiert ein
administratives Notfallkennzeichen, allerdings kein direktes Merkmal für
Notaufnahmebehandlungen. Bei Abrechnung ambulanter Fälle über
die kassenärztlichen Vereinigungen ist mindestens eine Diagnose
(ICD-10-Kode) zu erfassen, versehen mit einem Kennzeichen zur
Diagnosesicherheit. Es können mehrere ICD-10-Kodes ohne Hierarchie
angegeben werden. Bei stationär behandelten Patienten ist eine
Aufnahmediagnose und nach Behandlungsende die Hauptdiagnose und ggf.
Nebendiagose(n) an die zuständige Krankenkasse zu übermitteln.
Die gesetzliche Unfallversicherung hat eigene Dokumentationsanforderungen.
Lösungsansätze
Je nach Forschungsfrage und Studiendesign
sind unterschiedliche Vorgehensweisen erforderlich. Stammen die Daten
unmittelbar aus Notaufnahmen bzw. Kliniken ist eine Information über den
Kostenträger und den Abrechnungsmodus hilfreich. Bei Nutzung von
Krankenkassendaten muss die Identifikation von stationär behandelten
Patienten in einer Notaufnahme aktuell indirekt erfolgen. Dazu können
unter anderem die Parameter Aufnahmegrund und definierte
„eindeutige“ Notfall-Diagnosen herangezogen werden. Die
fallpauschalenbezogene Krankenhausstatistik hat eigene Limitationen,
enthält dafür aber die stationären Fälle aller
Kostenträger.
Diskussion
Die divergierenden Anforderungen an die administrative
Dokumentation verursachen einen hohen Aufwand in den Kliniken. Perspektivisch
ist eine Vereinheitlichung der Leistungserfassung und Dokumentation von
Notfallbehandlungen aller Kostenarten auch zur Generierung von validen,
vergleichbaren und repräsentativen Daten für die
Versorgungsforschung erstrebenswert. Die Einführung eines eigenen
Fachabteilungsschlüssels würde zur Identifikation von
Notaufnahmebehandlungen beitragen.
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Affiliation(s)
- Felix Greiner
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Anna Slagman
- Notfall- und Akutmedizin (CVK, CCM), Charité - Universitätsmedizin Berlin, Berlin.,Australian Institute of Tropical Health and Medicine, Cairns, James Cook University, Australia
| | - Christoph Stallmann
- Medizinische Fakultät, Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Stefanie March
- Medizinische Fakultät, Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | | | - Patrik Dröge
- Wissenschaftliches Institut der AOK (WIdO), Qualitäts- und Versorgungsforschung, Berlin
| | - Christian Günster
- Wissenschaftliches Institut der AOK (WIdO), Qualitäts- und Versorgungsforschung, Berlin
| | | | - Joachim Heuer
- Zentralinstitut für die kassenärztliche Versorgung in Deutschland, Berlin
| | | | - Felix Walcher
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Dominik Brammen
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg.,Medizinische Fakultät, Universitätsklinik für Anästhesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Magdeburg
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Graf von Stillfried D, Czihal T, Meer A. Sachstandsbericht: Strukturierte medizinische Ersteinschätzung in Deutschland (SmED). Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0627-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Zusammenfassung
Ab 01.01.2020 müssen die Kassenärztlichen Vereinigungen eine telefonische Ersteinschätzung im 24/7-Betrieb anbieten. Ziel ist die Ersteinschätzung der Dringlichkeit akuter Beschwerden und eine Vermittlung an die angemessene Versorgungsstufe. Sehr schwer kranke Patienten müssen unmittelbar der Notfallversorgung, weniger oder nicht dringliche Anliegen alternativen Versorgungsangeboten zugeführt werden. Diese anspruchsvolle Aufgabe werden Fachpersonen übernehmen, die durch geeignete Software unterstützt werden. Im Ausland existieren hierfür Vorbilder. Das Zentralinstitut für die kassenärztliche Versorgung (Zi) überträgt gemeinsam mit der Health Care Quality System GmbH (HCQS) das in Teilen der Schweiz bereits angewendete Swiss Medical Assessment System (SMASS) für eine Anwendung in Deutschland. Das System soll unter dem Namen Strukturierte medizinische Ersteinschätzung in Deutschland (SmED) im Jahr 2019 in den Arztrufzentralen unter der Nummer 116117 eingeführt werden. Auch eine Anwendung für den sogenannten „gemeinsamen Tresen“ von Bereitschaftsdienstpraxen und Krankenhausnotaufnahmen wird entwickelt. Beide Anwendungen werden in dem vom Innovationsfonds geförderten DEMAND-Projekt evaluiert. Die Entwicklung von SmED erfolgt unter Einbeziehung von Vertretern des Marburger Bundes sowie der Deutschen Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA) und Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI). Eine technische Integration mit der 112 ist in Arbeit.
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8
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Gries A, Bernhard M, Helm M, Brokmann J, Gräsner JT. [Future of emergency medicine in Germany 2.0]. Anaesthesist 2018; 66:307-317. [PMID: 28424835 DOI: 10.1007/s00101-017-0308-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In 2003 an article on the future of prehospital emergency medicine in Germany was published in the journal Der Anaesthesist. Emergency medicine in Germany, which at that time was almost exclusively defined as prehospital emergency rescue, has evolved and now in-hospital domains have increasingly moved into the focus. At that time, the primary goal was to connect prehospital management with a smooth transition to hospital admission and further care in the hospital and to further optimize the rescue chain from the actual emergency through to causative treatment. Now after 15 years, the authors have critically assessed the development postulated in 2003 and reevaluated it. Which aspects could be developed further and become firmly established, what is still open and which questions in preclinical and clinical emergency treatment of the population will occupy us in the coming 15 years? With a critical eye to the past, the present contribution aims to capture the essential and new topics and open questions and provide a fresh perspective for the future of emergency medicine. Regulation at the state level or even lower levels of government often stand in contrast to more sweeping and economically effective approaches at the federal level. Prehospital emergency medicine in Germany is on the whole well-positioned with respect to facilities and personnel; however, as far as the economic situation and the utilization of available systems are concerned, there is still substantial room for improvement.
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Affiliation(s)
- A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland.
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M Helm
- Abt X, Anästhesie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - J Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J-T Gräsner
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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9
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Hofer KD, Saurenmann RK. Parameters affecting length of stay in a pediatric emergency department: a retrospective observational study. Eur J Pediatr 2017; 176:591-598. [PMID: 28275860 DOI: 10.1007/s00431-017-2879-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED Prolonged emergency department (ED) length of stay (LOS) is used as a proxy for ED overcrowding and is associated with adverse outcomes of patients requiring therapy and reduced patient satisfaction. Our aim was to identify and quantify variables which affect ED-LOS. Patients admitted to the pediatric ED of a large regional Swiss hospital during a 1-year period were analyzed for LOS (in minutes). Predictor variables included patient-associated parameters (time of admission and discharge, ED occupancy, triage score, diagnosis, and demographic data) and external factors (weekday, time, and season). A total of 4885 visits were included in a multivariable logistic regression analysis. Median LOS was 124 min. The most important factors associated with prolonged LOS were physician referral (adjusted odds ratio [OR], 1.97; 95% confidence interval [CI], 1.47-2.62); morning admissions, especially before noon (OR, 1.92; 95% CI, 1.23-3.07); and gastrointestinal infections (OR, 1.38; 95% CI, 1.08-1.76). Upper airway infections (OR, 0.37; 95% CI, 0.27-0.49) and triage level 5 (OR, 0.18; 95% CI, 0.06-0.61) were inversely associated with ED-LOS. Together with ED occupancy, these factors did significantly contribute to log LOS in a stepwise backward multiple regression model (p < 0.001). CONCLUSION Several parameters are associated with prolonged ED-LOS. Notably, morning arrivals represent possible targets for strategies to reduce LOS. What is Known: • Prolonged length of stay (LOS) may affect care delivered to admitted patients in the emergency department (ED) and is well studied in the setting of adult patients with high acuity conditions. • Little is known about parameters which impact LOS in European pediatric EDs. What is New: • Several predictors of prolonged LOS could be identified in a European pediatric setting. • Our results indicate that prolonged LOS is associated with modifiable factors like morning and summer admission, which have the potential to be addressed by modification in staffing, infrastructure, and higher attention to faster processing.
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Affiliation(s)
- Kevin D Hofer
- Department of Child and Adolescent Medicine, Kantonsspital Winterthur, 8401, Winterthur, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistr. 3, CH-8091, Zurich, Switzerland
| | - Rotraud K Saurenmann
- Department of Child and Adolescent Medicine, Kantonsspital Winterthur, 8401, Winterthur, Switzerland.
- Faculty of Medicine, University of Zurich, Pestalozzistr. 3, CH-8091, Zurich, Switzerland.
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[Management of critically ill patients in the resuscitation room. Different than for trauma?]. Anaesthesist 2014; 63:144-53. [PMID: 24270938 DOI: 10.1007/s00101-013-2258-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The general approach to the initial resuscitation of non-trauma patients does not differ from the ABCDE approach used to evaluate severely injured patients. After initial stabilization of vital functions patients are evaluated based on the symptoms and critical care interventions are initiated as and when necessary. Adequate structural logistics and personnel organization are crucial for the treatment of non-trauma critically ill patients although there is currently a lack of clearly defined requirements. For severely injured patients there are recommendations in the S3 guidelines on treatment of multiple trauma and severely injured patients and these can be modeled according to the white paper of the German Society of Trauma Surgery (DGU). However, structured training programs similar to the advanced trauma life support (ATLS®)/European resuscitation course (ETC®) that go beyond the current scope of advanced cardiac life support training are needed. The development of an advanced critically ill life support (ACILS®) concept for non-trauma critically ill patients in the resuscitation room should be supported.
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