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Jansen G, Scholz SS, Rehberg SW, Wnent J, Gräsner JT, Seewald S. Indications and measures of medical emergency teams: a retrospective evaluation of in-hospital emergency operations of the German Resuscitation Register. Minerva Anestesiol 2023; 89:56-65. [PMID: 36282223 DOI: 10.23736/s0375-9393.22.16665-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study examines characteristics and interventions of medical emergency teams (MET) in in-hospital emergency care. METHODS Analysis of all in-hospital emergencies in patients ≥18 years at 62 hospitals with established MET from the database of the German Resuscitation Registry between 2014-2019. The evaluation covered indications for activation using the ABCDE-scheme, time intervals of arrival and patient care as well as the performed invasive/medical interventions. RESULTS Out of 62 hospitals 14,166 in-hospital emergencies (male: 8033 [56.7%]; mean age: 64±18 years) were included. Causes of activation were circulation (5760 [40.7%]), disability (4076 [28.8%]), breathing (3649 [25.8%]) and airway-problems (1589 [11.2%]). Average arrival time at the emergency scene was 4±3 minutes, supply time of MET was 24±23 minutes. Endotracheal intubation was required in 1757 (12.4%) and difficult intubation occurred in 201 (11.4%) patients with the necessity for cricothyroidotomy in eight cases (3.9%). Invasive blood-pressure-measurement was indicated in 1074 (7.6%) patients. Catecholamines were required for hemodynamic stabilization in 2421 (17.1%) patients (norepinephrine: 1520 [10.7%], epinephrine: 430 [3.0%], dobutamine: 26 [0.2%]). CONCLUSIONS Current in-hospital emergency care requires special skills in invasive hemodynamic and airway interventions. Recommendations from professional societies are necessary to optimize equipment (e.g. videolaryngoscopy, invasive blood pressure management), training, care algorithms and staff composition against the background of an increasing shortage of resources in the healthcare system.
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Affiliation(s)
- Gerrit Jansen
- Department of Anesthesiology, Operative Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bielefeld Municipal Hospital, Bielefeld, Germany - .,University Hospital OWL, Campus Klinukum Bielefeld, University of Bielefeld, Bielefeld, Germany - .,Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany -
| | - Sean S Scholz
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, University of Bielefeld, Bielefeld, Germany
| | - Sebastian W Rehberg
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, University of Bielefeld, Bielefeld, Germany
| | - Jan Wnent
- Department of Anesthesiology and Intensive Care Medicine, Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan-Thorsten Gräsner
- Department of Anesthesiology and Intensive Care Medicine, Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Stephan Seewald
- Department of Anesthesiology and Intensive Care Medicine, Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
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Schwarzkopf D, Rüddel H, Brinkmann A, Fleischmann-Struzek C, Friedrich ME, Glas M, Gogoll C, Gründling M, Meybohm P, Pletz MW, Schreiber T, Thomas-Rüddel DO, Reinhart K. The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis. Front Med (Lausanne) 2022; 9:882340. [PMID: 35573007 PMCID: PMC9094049 DOI: 10.3389/fmed.2022.882340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative, which aimed to decrease sepsis-related hospital mortality. Methods The German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality management and staff education. This study evaluates the effects of participating in the GQNS during the intervention period (April 2016-June 2018) in comparison to a retrospective baseline (January 2014-March 2016). The primary outcome was all-cause risk-adjusted hospital mortality among cases with sepsis. Sepsis was identified by International Classification of Diseases (ICD) codes in claims data. A controlled time series analysis was conducted to analyze changes from the baseline to the intervention period comparing GQNS hospitals with the population of all German hospitals assessed via the national diagnosis-related groups (DRGs)-statistics. Tests were conducted using piecewise hierarchical models. Implementation processes and barriers were assessed by surveys of local leaders of quality improvement teams. Results Seventy-four hospitals participated, of which 17 were university hospitals and 18 were tertiary care facilities. Observed mortality was 43.5% during baseline period and 42.7% during intervention period. Interrupted time-series analyses did not show effects on course or level of risk-adjusted mortality of cases with sepsis compared to the national DRG-statistics after the beginning of the intervention period (p = 0.632 and p = 0.512, respectively). There was no significant mortality decrease in the subgroups of patients with septic shock or ventilation >24 h or predefined subgroups of hospitals. A standardized survey among 49 local quality improvement leaders in autumn of 2018 revealed that most hospitals did not succeed in implementing a continuous quality management program or relevant measures to improve early recognition and treatment of sepsis. Barriers perceived most commonly were lack of time (77.6%), staff shortage (59.2%), and lack of participation of relevant departments (38.8%). Conclusion As long as hospital-wide sepsis quality improvement efforts will not become a high priority for the hospital leadership by assuring adequate resources and involvement of all pertinent stakeholders, voluntary initiatives to improve the quality of sepsis care will remain prone to failure.
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Affiliation(s)
- Daniel Schwarzkopf
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Hendrik Rüddel
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Alexander Brinkmann
- Department of Anesthesiology and Intensive Care Medicine, General Hospital of Heidenheim, Heidenheim, Germany
| | - Carolin Fleischmann-Struzek
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | | | - Michael Glas
- Department for Infectious Diseases and Infection Control, KH Labor GmbH, AMEOS Group, Bernburg, Germany
| | - Christian Gogoll
- Outpatient Services, Evangelische Lungenklinik Berlin-Buch, Berlin, Germany
| | - Matthias Gründling
- Department of Anesthesiology, University Hospital of Greifswald, Greifswald, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Torsten Schreiber
- Department of Anesthesia and Intensive Care, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - Konrad Reinhart
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Jansen G, Kappelhoff N, Borgstedt R, Rehberg S, Seewald S, Scholz SS. [In-hospital emergency care in the Federal Republic of Germany. A site survey of hospitals in the German Resuscitation Registry]. Anaesthesist 2021; 71:502-509. [PMID: 34889966 DOI: 10.1007/s00101-021-01075-7] [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: 09/02/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In contrast to prehospital care there is a lack of specifications for the organization and equipment of medical emergency teams for in-hospital emergency care. OBJECTIVE Evaluation of the organization, team composition, training, equipment and tasks of medical emergency teams in the Federal Republic of Germany. MATERIAL AND METHODS Evaluation of a web-based survey of all hospitals participating in the German Resuscitation Register between February and March2020. The participants were asked about team composition; emergency equipment; type, content and scope of special training or further training as well as other additional tasks in the everyday clinical routine when participating in the medical emergency team. Hospitals with ≤ or >600 beds were compared. RESULTS A total of 21 (>600 beds: 10, 48%; ≤600 beds: 11, 52%) hospitals participated in the survey. Team composition requirements were present at 76% (n = 16; ≤600 beds: 8, 72% vs. >600 beds: 8, 80%), training requirements for medical emergency teams at 38% (n = 16; ≤600 beds: 4, 36% vs. >600 beds: 4, 40%) of hospitals, with a focus on cardiac life support (n = 6, 28%; ≤600 beds: 3, 27% vs. >600 beds: 3, 30%) and airway management (n = 4, 19%; ≤600 beds: 3, 27% vs. >600 beds: 1, 10%). A 12-lead electrocardiogram (n = 7, 33%; ≤600 beds: 1, 9% vs. >600 beds: 6, 60%; p = 0.02), video laryngoscope (n = 7, 33%; ≤600 beds: 2, 18% vs. >600 beds: 5, 50%), ventilator without (n = 7, 33%; ≤600 beds: 2, 18% vs. >600 beds: 5, 50%) or with the possibility of non-invasive ventilation was part of the standard equipment in n = 4, 19% (≤600 beds: 1, 9% vs. >600 beds: 3, 30%). A total of 85% (n = 18; ≤600 beds: 10, 100% vs. >600 beds 8, 72%), had additional tasks in the daily clinical routine. While clinics with >600 beds staffed medical emergency teams 100% of the time from the intensive care units, in clinics ≤600 beds medical emergency teams were deployed significantly more often in the emergency department (n = 5, 45%) and in the normal wards (n = 5, 45%, p = 0.03). CONCLUSION Training and equipment of medical emergency teams in the Federal Republic of Germany is heterogeneous. They should at least meet the standards commonly used in prehospital emergency medicine and include the availability of a portable 12-lead electrocardiogram, a ventilator with the possibility of noninvasive ventilation and a video laryngoscope. Regardless of the size of the hospital, continuous availability of all members of the medical emergency teams should be ensured.
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Affiliation(s)
- G Jansen
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - N Kappelhoff
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - R Borgstedt
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - S Rehberg
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - S Seewald
- Deutsches Reanimationsregister, Kiel, Deutschland
| | - S S Scholz
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
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Gräsner JT, Wnent J. Im Krankenhaus immer auf der „sicheren Seite“? Anaesthesist 2020; 69:699-701. [DOI: 10.1007/s00101-020-00796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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