[Implementation of emergency classifications-Where do we stand? : Results of a nationwide survey]

[Modern OR management in tertiary care hospitals]

Institutional operating room (OR) management is an established and indispensable component of organizational structures in most hospitals, independent of the level of care. In this role, OR management needs to consider both the high fixed costs of operation areas and the increased relevancy of generated revenue. Therefore, in the day to day operations, OR management strives to ensure reliable and safe patient care amidst efficient use of resources and high patient and employee satisfaction. Given these aims, proven strategies, such as constituting processes and responsibilities by OR statutes or tracking key figures and indicators of the OR, must be continuously supplemented and improved upon by OR management. In the future, OR management can derive innovative methods from adaptable capacity management, agile forms of collaboration, integrating upstream and downstream segments into OR management general process organization, and harnessing the potentials of artificial intelligence. Innovation in the face of these and other challenges contributes to improving long-term interdisciplinary and interprofessional collaboration in the OR and with the numerous adjacent teams.

Bedarfsanalyse zur Curriculumsentwicklung für die anästhesiologische Kreißsaalversorgung – eine deutschlandweite Umfrage

Hintergrund

Die anästhesiologische Tätigkeit in der Kreißsaalumgebung impliziert die Besonderheiten der 200 %-Letalität, die beschreibt, dass Notfallsituationen Mutter und Kind betreffen können. Ein Umstand, der die Notwendigkeit einer besonderen Sorgfalt in der Mitarbeiterausbildung und -auswahl eindrücklich unterstreicht. Gleichwohl existiert derzeit keine detaillierte Beschreibung der notwendigen Kompetenzen in dieser Arbeitsumgebung. Die vorliegende Studie soll die Ausbildungssituation in der anästhesiologischen Weiterbildung beschreiben und im Hinblick auf die Notwendigkeit eines Curriculums analysieren.

Methodik

In einer multizentrischen Beobachtungsstudie wurden Ärzt:innen in Weiterbildung (AiW) und ausbildende Fachärzt:innen (FÄ) nach Methoden der Einarbeitung, Feedbackgabe, übernommenen Tätigkeiten und Bedarf eines Curriculums befragt. Teilnehmende wurden über die Mitgliedsdatenbank der DGAI angeschrieben und konnten onlinebasiert den 11 Items umfassenden Fragebogen beantworten.

Ergebnisse

Insgesamt wurden 495 Fragebogen (FÄ 329;166 AiW) abgeschlossen. Fachärzt:innen und AiW machen unterschiedliche Angaben zur Durchführung von Abschlussgesprächen (59,6 % vs. 10 %) und der Unterstützung durch ein Curriculum (76,3 % vs. 15,7 %). Unabhängig vom Weiterbildungsjahr werden von AiW Kaiserschnitte unter Supervisionsstufe „Rufweite“ durchgeführt. Die Periduralanästhesie (PDA) ist während der Einarbeitung die am seltensten durchgeführte Maßnahme. Beide Gruppen schätzen den Nutzen bzw. den Wert einer Beschreibung von Lernzielen und der Verfügbarkeit eines Curriculums als hoch ein.

Schlussfolgerung

Die Unterstützung der Einarbeitung wird von FÄ und AiW teilweise unterschiedlich beantwortet. Einzelne seltene durchgeführte Maßnahmen, wie die PDA, bedürfen künftig einer gesonderten Aufmerksamkeit. Die Beschreibung von Lernzielen und die Curriculumsentwicklung werden ausdrücklich gewünscht.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00101-022-01172-1) enthält den Fragebogen zur Arbeit.

[Frequency distribution and coordination of emergency operations in German hospitals (FACE) : Analysis in 26 hospitals depending on the level of care]

BACKGROUND

Timely emergency surgery is vital as this often has a direct impact on morbidity and mortality. The joint recommendations of the German Associations of Anesthesiologists (BDA), Surgeons (BDC), and Operating Room Management (VOp.M) for coordinative implementation have been available since 2016: N0 (surgery immediately), N1 (surgery start in the next free operating room), N2 (surgery start ≤ 6 h), N3 (surgery at the end of the elective schedule), N4/Urgent (surgery within 12-24 h). The aim of this study was to describe the situation of care in German hospitals of different sizes for the first time using routine data.

METHODS

The data were collected in 26 hospitals with different levels of care over a period of 10 days. The frequency distribution of the individual emergency categories and the duration from the notification of the operation to the start of anesthesia or surgery were examined for the hospital as a whole and for the four operating departments with a typically high ratio of emergencies: general surgery, trauma surgery, gynecology/obstetrics and urology.

RESULTS

A total of 1603 emergency surgical interventions were analyzed. The number of N0 cases was very low due to the specific entity of these emergencies, N1 made up approximately 13-15% of emergencies and categories N2-N4/Urgent comprised approximately 25-32% of emergencies each. The average duration between the notification of the operation and the start of anesthesia or surgery was (min): N0 20.7 ± 14.3 and 43.6 ± 31.8, N1 61.5 ± 48.7 and 90.1 ± 56.1, N2 187.9 ± 152.0 and 220.5 ± 153.4, N3 394.5 ± 392.3 and 428.3 ± 397.9 and N4/Urgent 494.8 ± 484.4 and 519.6 ± 486.6, respectively. The distribution of the emergency categories did not differ significantly between community hospitals compared to tertiary care hospitals, including university hospitals (p = 0.731) and also the duration between notification and start of anesthesia and operation was similar. Significant differences depending on the service level were only found for N1 until the start of anesthesia and for N3 until the start of anesthesia and of surgery. General surgery classified as N3 has a significantly shorter implementation time in community hospitals compared to tertiary care hospitals, including university hospitals, both at the start of anesthesia (mean 287.8 min versus 417.1 min; p = 0.045) and at the start of surgery (mean 316.3 min versus 459.0 min; p = 0.032). The implementation of trauma surgery emergencies classified as N1 took place, based on the start of surgery in community hospitals with an average duration of 91.2 min, statistically significantly faster than in hospitals with a maximum care of 133.0 min (p = 0.036). In urology, there were notable variations between smaller and larger hospitals in emergency interventions with the classification N4/Urgent for both periods of time, both up to the start of anesthesia (p = 0.012) and up to the start of surgery (p = 0.007). At an average of 291.8 min (start of anesthesia) or 294.4 min (start of surgery), the implementation time in hospitals with maximum care, including university hospitals, was shorter than in urological clinics of community providers (626.5 min and 645.6 min, respectively). In gynecology/obstetrics, there was no statistically significant difference between the two groups.

CONCLUSION

Cases with high urgency were surgically treated within a short time period. Overall, differences in time management of emergencies were only small between hospital types. The gradations in the temporal implementation of the individual emergency categories were due particularly to distinctions in the resources available, such as the number of operating theaters, including the run times.