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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] [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,*Zentrale Notaufnahme/Beobachtungsstation Notaufnahme Universitätsklinikum Leipzig AöR Liebigstraße 20, 04103 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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Lindner T, Campione A, Möckel M, Henschke C, Dahmen J, Slagman A. [Direct admission of patients to doctors' offices by prehospital emergency services-an effective method to relieve emergency departments? : Analysis of routine pre- and in-hospital emergency data]. Med Klin Intensivmed Notfmed 2022; 117:447-456. [PMID: 34468771 PMCID: PMC8408819 DOI: 10.1007/s00063-021-00860-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/17/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the 2018 advisory opinion concerning the realignment of healthcare, it is advocated that in order to relieve pressure on emergency departments (ED) prehospital medical emergency services should be given the option to directly transport suitable patients to doctors' offices. OBJECTIVES To determine the prevalence of patients treated by prehospital emergency services that have the potential to be directly allocated to a primary care provider. MATERIALS AND METHODS Preclinical and clinical data of adult patients who in a 2-month period were transported to the ED of a university hospital by an ambulance were evaluated. To determine a safe and meaningful transport directly to a doctor's office, a stepwise assessment was carried out: patients were categorized on the basis of the prehospital assessment of urgency as "urgent" (contact to doctor necessary within a maximum time of 30 min) and "less urgent" (contact to doctor not necessary within 30 min, maximum 120 min). "Less urgent" patients were further divided and those treated as outpatients were identified. This group was further restricted to cases whose administrative reception in the ED was documented Monday-Friday between 8 am and 7 pm. In addition, these cases were further differentiated with regard to medical content and compared with the triage results in the ED (Manchester Triage, MTS). RESULTS In all, 1260 patients were brought to the ED by ambulance within the study period (total number of patients treated in this time period n = 11,506); 894 cases had a documented prehospital level of urgency and could therefore be included. Of these n = 477 (53.4%) were categorized as "less urgent"; 317 (66.5%) of these "less urgent" cases were treated as outpatients in the ED, and n = 114 (23.9%) in a time frame potentially suitable for direct transport to doctors' offices, which is 1% of all patients treated in the ED in the time period examined. However, 70 of the cases suitable for doctors' office (63.6% of n = 110 with documented MTS) were rated more urgent in the ED. With regards to prehospital complaints and documented diagnosis we assume employment of a relevant amount of resources in the treatment of these cases. CONCLUSIONS EDs could be relieved from every tenth patient brought in by prehospital emergency services (1% of all patients treated) during normal offices hours by direct allocation to doctors' offices. Regarding patient's safety this process however has to be seen critically as > 60% of these cases were potentially undertriaged. Necessary resources for diagnostics and treatment have to be available in the doctors' offices and known to prehospital emergency services. Primary assignment of patients to doctors' offices by prehospital emergency can only relieve urban EDs to a negligible extent, is potentially dangerous and linked to a tremendous logistic effort.
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Affiliation(s)
- Tobias Lindner
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Alessandro Campione
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Cornelia Henschke
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Janosch Dahmen
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
| | - Anna Slagman
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland
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Bernhard M, Kumle B, Dodt C, Gräff I, Michael M, Michels G, Gröning I, Pin M. [Care of critically ill nontrauma patients in the resuscitation room]. Notf Rett Med 2022; 25:1-14. [PMID: 35431645 PMCID: PMC9006203 DOI: 10.1007/s10049-022-00997-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Bernhard Kumle
- Klinik für Akut- und Notfallmedizin, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Deutschland
| | - Christoph Dodt
- Klinik für Akut- und Notfallmedizin, München Klinik Bogenhausen, München, Deutschland
| | - Ingo Gräff
- Abteilung Klinische Akut- und Notfallmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Mark Michael
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St. Antonius Hospital Eschweiler, Eschweiler, Deutschland
| | - Ingmar Gröning
- Klinik für Notfallmedizin, Krankenhaus Maria-Hilf, Krefeld, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme und Akutstation, Florence-Nightingale-Krankenhaus der Kaiserwerther Diakonie Düsseldorf, Düsseldorf, Deutschland
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Michael M, Kumle B, Pin M, Kümpers P, Gröning I, Bernhard M. [Nontraumatic resuscitation room management of critically ill patients]. Med Klin Intensivmed Notfmed 2021; 116:405-414. [PMID: 33599782 PMCID: PMC7891119 DOI: 10.1007/s00063-021-00789-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 12/03/2022]
Abstract
Critically ill patients are often initially treated by out-of-hospital emergency medicine services. A major challenge-especially at the interface between out-of-hospital and in-hospital care-is to continue patient care without wasting time, while maintaining a high level. These include the stabilization of vital functions (e.g., airway management, noninvasive/invasive ventilation, circulatory stabilization) and implementation of a suitable diagnostic and therapeutic strategy (e.g., laboratory examinations, sonography, radiological imaging). In recent years, therefore, interest and research has focused on the topic of "nontraumatic resuscitation room care". The first monocentric data recently became available and work is ongoing to develop nontraumatic resuscitation room management for optimal care of critically ill patients in the emergency department. Based on initial studies, experiences and expert opinions, this paper describes a structured approach to nontraumatic resuscitation room management.
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Affiliation(s)
- M Michael
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - B Kumle
- Klinik für Akut- und Notfallmedizin, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Deutschland
| | - M Pin
- Zentrale Notaufnahme, Florence-Nightingale-Krankenhaus, Düsseldorf, Deutschland
| | - P Kümpers
- Medizinische Klinik D (Allg. Innere Medizin und Notaufnahme sowie Nieren- und Hochdruckkrankheiten und Rheumatologie), Universitätsklinikum Münster, Münster, Deutschland
| | - I Gröning
- Klinik für Akut- und Notfallmedizin, Krankenhaus Maria Hilf, Krefeld, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
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Özkan T, Lindner T, Möckel M. [The conservative emergency room - care of acutely critically ill non-trauma patients]. Dtsch Med Wochenschr 2021; 146:647-656. [PMID: 33957686 DOI: 10.1055/a-1226-8117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Treatment of critically ill non-trauma patients is challenging, due to the broad spectrum of underlying diseases in this clinical setting. It has been shown that outcome in these patients is poor due to high age, comorbidities and severeness of acute disease. In most cases it is crucial to establish diagnosis and start specific treatment immediately to improve patients' outcome. In contrast to the management of severely injured patients, general guidelines for the initial diagnostic and therapeutic approaches in these patients have been lacking until now. As a consequence, little is known about both: patients' characteristics and outcome. This article provides an overview of the current information available on this group of patients.All critically ill patients should first be managed in the resuscitation room, as it is necessary to provide the optimal infrastructure, including material and personal resources, to maintain high quality care. For non-trauma patients, indication can be defined using the ABCDE approach. Expertise in emergency ultrasound as a key diagnostic tool, profound knowledge of intensive care treatment and of diagnostic and therapeutic approaches according to current specific guidelines are required. These requirements can be implemented by assembling nursery and medical staff trained in emergency care, supported by accredited continued professional development and regular simulation trainings.The best transition from preclinical to in-hospital care is achieved through detailed preparation and the use of standardized handover tools. Subsequent patient management can be organized using the primary and secondary survey. These aim to detect and treat life threatening pathologies first and, within a second step, to expand the diagnosis and therapy according to the individual case. Special focus should be put on communication, using crew resource management training, and on the provision on an open and constructive approach to making mistakes.
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Lichtenstein T, Chang DH, Sokolowski M, Hokamp NG, Berninger M, Simons R, Hellmich M, Maintz D, Henning T. Diagnostic value of abdominal follow-up sonography in polytrauma patients: A retrospective study. Medicine (Baltimore) 2020; 99:e22412. [PMID: 33080675 PMCID: PMC7571869 DOI: 10.1097/md.0000000000022412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In many German trauma centres, it is routine to perform abdominal follow-up sonography (AFS) 6 h after admission for patients with multiple trauma, even if the clinical course is uneventful and multi-slice computed tomography (MSCT) reveals no abdominal pathology. However, this approach is not recommended in the German Guidelines for trauma, and recent studies have questioned the value of AFS to these patients. The present study aimed to evaluate the revised German Guidelines for trauma with respect to the omission of AFS.We included patients with multiple injuries with no clinical signs of abdominal trauma and with normal abdominal MSCT. We collected clinical data of 370 consecutive patients who underwent AFS (Group A) and another 370 consecutive patients who did not undergo AFS (Group B).No abdominal injury was missed by the omission of AFS, and thus, no patient suffered from its omission or benefitted from the use of AFS. In our study population, the negative predictive value of normal MSCT results combined with no clinical signs of abdominal trauma was 100% (95% confidence interval: 99.5%-100.0%).This single-centre study conducted in a large German trauma centre demonstrates AFS to have no utility in the diagnosis of abdominal injury. Moreover, omission of AFS for conscious patients without clinical signs of abdominal trauma and with negative abdominal MSCT does not appear to have negative consequences in terms of missed abdominal injury.Therefore, AFS can be safely omitted in the majority of cases of polytrauma, which simplifies the imaging workup tremendously.
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Affiliation(s)
- Thorsten Lichtenstein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - De-Hua Chang
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
- Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg
| | - M. Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - N. Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - M.T. Berninger
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee
| | - R.M. Simons
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne
| | - M. Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne
| | - D. Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
| | - T.D. Henning
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne
- Department of Neuroradiology, Brüderkrankenhaus Trier, Trier, Germany
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Bogner-Flatz V, Hinzmann D, Kanz KG, Bernhard M. Der Schockraum als Nahtstelle zwischen Präklinik und Klinik. DER NOTARZT 2020. [DOI: 10.1055/a-0991-5425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie ständige Vorhaltung und Verfügbarkeit eines Schockraums zur Versorgung von kritisch kranken und schwer verletzten Patienten ist eine wesentliche und für die transsektorale Notfallversorgung wichtige klinische Ressource. In diesem Artikel sollen die derzeitigen Entwicklungen der Schockraumbereitstellung in Deutschland aufgezeigt werden.
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Kumle B, Merz S, Mittmann A, Pin M, Brokmann JC, Gröning I, Biermann H, Michael M, Böhm L, Wolters S, Bernhard M. Nichttraumatologisches Schockraummanagement. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0613-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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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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11
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[Development of ground-based physician-staffed emergency missions in the city of Leipzig from 2003 to 2013]. Anaesthesist 2017; 67:177-187. [PMID: 29230501 DOI: 10.1007/s00101-017-0393-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/10/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The annual number of physician-based emergency missions reported is continuously increasing. Data from large cities concerning this development over long periods is sparse. MATERIAL AND METHODS In this retrospective study the charts of all ground-based physician-staffed emergency missions in the city of Leipzig for the first quarters of 2003 and 2013 were analyzed. Patient characteristics, injury and illness severities, mission location, hospital admission rate, as well as emergency interventions were collated. The emergency mission rate was calculated as rescue missions per 1000 inhabitants per year. RESULTS The number of physician-staffed emergency missions increased by approximately 24% between 2003 and 2013 (6030 vs. 7470, respectively). The emergency mission rate was 48 vs. 58 in the 2 study periods. The median patient age increased from 66 to 70 years. The number of geriatric patients (age ≥ 85 years: n = 650 (11%) vs. n = 1161 (16%), p < 0.01) also increased. The corresponding number of emergency missions in nursing homes showed a fourfold (n = 175, 3% vs. n = 750, 10%, p < 0.01). The percentage of hospital admissions also increased (n = 3049, 51% vs. n = 4738, 66%, p < 0.01). A change in patient distribution to level I hospitals was noticed (n = 1742, 29% vs. n = 3436, 46%, p < 0.01). CONCLUSION The findings suggest that the necessity for the high number of physician-staffed emergency missions should be verified, especially in the context of strained emergency healthcare resources. The basis of an optimized use of resources could be a better inclusion of alternative, especially ambulant, healthcare structures and the implementation of a structured emergency call questionnaire accompanied by a more efficient disposition of the operating resources, not least in view of the economic aspects. Taking the concentrated patient allocation to level 1 hospitals into consideration, there is a need for optimized patient distribution strategies to minimize the overload of individual institutions and thereby improve the general quality of care at the interface between preclinical and clinical emergency medicine.
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Brokmann JC, Rossaint R, Müller M, Fitzner C, Villa L, Beckers SK, Bergrath S. Blood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out-of-hospital care. J Clin Hypertens (Greenwich) 2017; 19:704-712. [PMID: 28560799 DOI: 10.1111/jch.13026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/07/2017] [Accepted: 01/22/2017] [Indexed: 12/25/2022]
Abstract
Prehospital hypertensive emergencies and urgencies are common, but evidence is lacking. Telemedically supported hypertensive emergencies and urgencies were prospectively collected (April 2014-March 2015) and compared retrospectively with a historical control group of on-scene physician care in the emergency medical service of Aachen, Germany. Blood pressure management and guideline adherence were evaluated. Telemedical (n=159) vs conventional (n=172) cases: blood pressure reductions of 35±24 mm Hg vs 44±23 mm Hg revealed a group effect adjusted for baseline differences (P=.0006). Blood pressure management in categories: no reduction 6 vs 0 (P=.0121); reduction ≤25% (recommended range) 113 vs 110 patients (P=.2356); reduction >25% to 30% 13 vs 29 (0.020); reduction >30% 12 vs 16 patients (P=.5608). The telemedical approach led to less pronounced blood pressure reductions and a tendency to improved guideline adherence. Telemedically guided antihypertensive care may be an alternative to conventional care especially for potentially underserved areas.
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Affiliation(s)
- Jörg C Brokmann
- Emergency Department, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Müller
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christina Fitzner
- Department of Medical Statistics, University Hospital RWTH Aachen, Aachen, Germany
| | - Luigi Villa
- Emergency Department, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefan K Beckers
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.,Emergency Medical Service, Fire Department Aachen, Aachen, Germany
| | - Sebastian Bergrath
- Emergency Department, University Hospital RWTH Aachen, Aachen, Germany.,Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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Zimmermann M, Brokmann JC, Gräff I, Kumle B, Wilke P, Gries A. [Emergency departments--2016 update]. Anaesthesist 2017; 65:243-9. [PMID: 26952123 DOI: 10.1007/s00101-016-0142-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute medical care in hospital emergency departments has experienced rapid development in recent years and gained increasing importance not only from a professional medical point of view but also from an economic and health policy perspective. The present article therefore provides an update on the situation of emergency departments in Germany. Care in emergency departments is provided with an increasing tendency to patients of all ages presenting with varying primary symptoms, complaints, illnesses and injury patterns. In the process, patients reach the emergency department by various routes and structural provision. Cross-sectional communication and cooperation, prioritization and organization of emergency management and especially medical staff qualifications increasingly play a decisive role in this process. The range of necessary knowledge and skills far exceeds the scope of prehospital medical emergency care and the working environment differs substantially. In addition to existing structural and economic problems, the latest developments, as well as future proposals for the design of in-hospital emergency medical care in interdisciplinary emergency departments are described.
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Affiliation(s)
- M Zimmermann
- Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
| | - J C Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - I Gräff
- Notfallzentrum, Universitätsklinikum Bonn, Bonn, Deutschland
| | - B Kumle
- Zentrale Notaufnahme, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Deutschland
| | - P Wilke
- Zentrale Notaufnahme, Klinikum Frankfurt/Oder, Frankfurt/Oder, Deutschland
| | - A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Eidenbenz D, Taffé P, Hugli O, Albrecht E, Pasquier M. A two-year retrospective review of the determinants of pre-hospital analgesia administration by alpine helicopter emergency medical physicians to patients with isolated limb injury. Anaesthesia 2016; 71:779-87. [PMID: 27091515 DOI: 10.1111/anae.13462] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/28/2022]
Abstract
Up to 75% of pre-hospital trauma patients experience moderate to severe pain but this is often poorly recognised and treated with insufficient analgesia. Using multi-level logistic regression analysis, we aimed to identify the determinants of pre-hospital analgesia administration and choice of analgesic agent in a single helicopter-based emergency medical service, where available analgesic drugs were fentanyl and ketamine. Of the 1156 patients rescued for isolated limb injury, 657 (57%) received analgesia. Mean (SD) initial pain scores (as measured by a numeric rating scale) were 2.8 (1.8), 3.3 (1.6) and 7.4 (2.0) for patients who did not receive, declined, and received analgesia, respectively (p < 0.001). Fentanyl as a single agent, ketamine in combination with fentanyl and ketamine as a single agent were used in 533 (84%), 94 (14%) and 10 (2%) patients, respectively. A high initial on-scene pain score and a presumptive diagnosis of fracture were the main determinants of analgesia administration. Fentanyl was preferred for paediatric patients and ketamine was preferentially administered for severe pain by physicians who had more medical experience or had trained in anaesthesia.
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Affiliation(s)
- D Eidenbenz
- Medical School of the University of Lausanne, Lausanne, Switzerland
| | - P Taffé
- Institute for Social and Preventive Medicine (IUMSP), Lausanne, Switzerland
| | - O Hugli
- Emergency Service, Lausanne, Switzerland
| | - E Albrecht
- Anaesthesiology Service, Lausanne, Switzerland
| | - M Pasquier
- Emergency Service, Lausanne University Hospital, Lausanne, Switzerland
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