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Waydhas C, Brod T, Deininger M, Dubb R, Hoffmann F, van den Hooven T, Janssens U, Kaltwasser A, Markewitz A, Pelz S, Walcher F, Zergiebel D. Interprofessionelle Handlungsfelder der Pflegefachpersonen in der Klinischen Akut- und Notfallmedizin. Dtsch Med Wochenschr 2024; 149:904-911. [PMID: 38848750 PMCID: PMC11251751 DOI: 10.1055/a-2328-5953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Affiliation(s)
- Christian Waydhas
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen
| | - Torben Brod
- Zentrale Notaufnahme, Medizinische Hochschule Hannover
| | - Matthias Deininger
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum der RWTH Aachen
| | - Rolf Dubb
- Fachbereichsleitung Weiterbildung, Kreiskliniken Reutlingen GmbH
| | - Florian Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, Campus Innenstadt, München
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen,
| | - Arnold Kaltwasser
- Fachbereichsleitung Weiterbildung für Intensivpflege und Anästhesie, Kreiskliniken Reutlingen GmbH
| | | | - Sabrina Pelz
- Advanced Practice Nurse, Fachgesundheits- und Krankenpflegerin für Intensivpflege und Anästhesie, Intensivstation, Universitätsklinikum Tübingen
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Universitätsmedizin Magdeburg
| | - Dominik Zergiebel
- Aus-, Fort- und Weiterbildung Pflege & OP, Bildungsinstitut für Pflege und Gesundheit (BiPG), Universitätsklinikum Münster
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Brokmann JC, Bergrath S, Unterkofler J. [Structure and Organization of an Emergency Department]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:456-465. [PMID: 35896384 DOI: 10.1055/a-1545-2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The more diverse the German hospital landscape, the more important it is to define tasks and processes in order to ensure a uniform standard of care at the highest level for the population. With the introduction of additional training in clinical acute and emergency medicine and specifications for inpatient emergency care, important foundations for the necessary structure of emergency rooms have been given.
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Otto R, Blaschke S, Schirrmeister W, Drynda S, Walcher F, Greiner F. Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry). Intern Emerg Med 2022; 17:1199-1209. [PMID: 34989969 PMCID: PMC9135863 DOI: 10.1007/s11739-021-02919-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/18/2021] [Indexed: 11/21/2022]
Abstract
Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min-3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients' age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.
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Affiliation(s)
- Ronny Otto
- Department of Trauma Surgery, Otto Von Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Sabine Blaschke
- Emergency Department, University Medicine Göttingen, Göttingen, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto Von Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Susanne Drynda
- Department of Trauma Surgery, Otto Von Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto Von Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Felix Greiner
- Department of Trauma Surgery, Otto Von Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
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Ignatyev Y, Habicht J, Schwarz J, Neumann A, Schmitt J, Pfennig A, Geraedts M, Heinze M. [Biometric properties of QUALIFY: a tool for assessing quality indicators]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 170:7-13. [PMID: 35450830 DOI: 10.1016/j.zefq.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Accurate health care evaluation using quality indicators (QIs) is of vital clinical importance for a quality-oriented health care system. The QUALIFY tool is the current research standard for assessing QIs of health care; however, its biometric properties in psychiatry have not yet been evaluated empirically. Our aim was to evaluate the internal consistency and structure of QUALIFY. METHODS This study applies a literature-based post-hoc analytical design to a sample of 289 QIs of mental health care. First, the indicators were assessed on the basis of nineteen ordinal QUALIFY criteria as a single measuring tool. Second, using Cronbach's alpha the internal consistency of the measuring tool was evaluated and the structure of QUALIFY using an explorative principal component analysis was tested. RESULTS AND DISCUSSION The tool showed an acceptable internal consistency (Cronbach's α=0.75), with three criteria (consideration of potential risks/side effects when using the indicator, implementation barriers taken into account, and the ability to influence the indicator) being inconsistent with the full scale. If these three criteria were not taken into account, the tool had a good internal consistency (Cronbach's α=0.81). The QUALIFY structural matrix comprises three components, one of which reflected six from eight original quality criteria of the scientific category. The other two components represent the semiotic structure of the QIs. CONCLUSION QUALIFY is an internally inconsistent instrument, which may be useful to assess mental health care QIs. The information about the structure of QUALIFY can be applied for the purposes of research planning as well as the interpretation and development of QIs.
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Affiliation(s)
- Yuriy Ignatyev
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland; Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland.
| | - Juri Habicht
- Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland
| | - Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Anne Neumann
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Jochen Schmitt
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie der Philipps-Universität Marburg, Marburg, Deutschland
| | - Martin Heinze
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, 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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Manych M. Dokumentationsstandard statt Datenflickenteppich – das AKTIN-Notaufnahmeregister. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:135-137. [PMID: 35354205 DOI: 10.1055/a-1287-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Greiner F, Erdmann B, Thiemann VS, Baacke M, Grashey R, Habbinga K, Kombeiz A, Majeed RW, Otto R, Wedler K, Brammen D, Walcher F. Der AKTIN-Monatsbericht: Plädoyer für ein standardisiertes Reporting in der Notaufnahme. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00910-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Zusammenfassung
Hintergrund
Vor dem Hintergrund der steigenden Inanspruchnahme und aktuellen Veränderungen in der Notfallversorgung ist eine standardisierte Erfassung relevanter Kennzahlen in Notaufnahmen zwingend erforderlich.
Ziel der Arbeit
Es werden die Konsentierung von Inhalten und technische Umsetzung eines automatisierten Reportings für Notaufnahmen des AKTIN-Notaufnahmeregisters beschrieben. Ziel war ein aussagefähiger Monatsbericht zur Prozesssteuerung und Qualitätssicherung.
Material und Methoden
Datengrundlage ist der Datensatz Notaufnahme V2015.1 der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin e. V. (DIVI). Die Konsentierung der Inhalte erfolgte auf Basis von externen Referenzen und fachlicher Expertise; die technische Entwicklung erfolgte anhand eines Testdatensatzes. Mit der Software R und Apache Formatting Objects Processor (FOP) wird der finale Bericht im PDF-Format automatisiert erstellt.
Ergebnisse
Der Bericht enthält unter anderem Angaben zu Fallzahlen, Demografie der Patienten, Vorstellungsgründen, Ersteinschätzung, Verbleib und ausgewählten Prozesszeiten in Form von Tabellen und Grafiken. Er wird monatsweise automatisch oder auf Anforderung aus den Routinedaten generiert. Fehlende Werte und Ausreißer werden zur Abschätzung der Datenqualität separat ausgewiesen.
Diskussion
Beim AKTIN-Monatsbericht handelt es sich um ein Instrument, welches das Versorgungsgeschehen aufbereitet und visualisiert. Die konsentierten Kennzahlen sind praxistauglich und bilden auch die Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung ab. Die Nutzung von Interoperabilitätsstandards erlaubt eine automatische Erfassung im Alltag, gewährleistet eine Unabhängigkeit von einzelnen IT-Systemen und kann als Grundlage für ein klinikübergreifendes Benchmarking dienen.
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[Development of a new module for the TraumaRegister DGU ® : Better collation of the sequelae of severe injuries during pregnancy]. Unfallchirurg 2020; 123:954-960. [PMID: 33048210 DOI: 10.1007/s00113-020-00890-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Life-threatening injuries during pregnancy are a rare occurrence. The TraumaRegister DGU® (TR-DGU) has been recording whether seriously injured women were pregnant since 2016. This information is not sufficient to enable a differentiated assessment of the quality of care because parameters, such as gestational age, state of pregnancy at discharge and survival of the child are missing. The TraumaRegister working group of the committee on emergency medicine, intensive care and severe trauma management (section NIS) of the German Trauma Society (DGU) therefore came to the conclusion that the fetal outcome or the intactness of the pregnancy after acute treatment is an important measure of the quality of care of pregnant women. They commissioned a task force to work out a suitable data set for a better analysis of such cases. This article presents the so-called fetus module in detail. METHODS The data set was developed in an interdisciplinary process together with accredited experts from the German Society for Gynecology and Obstetrics (DGGG), the German Society for Perinatal Medicine (DGPM) and the Society for Neonatology and Pediatric Intensive Care Medicine (GNPI). RESULTS The fetus module comprises 20 parameters describing the pregnancy, the condition of the mother and child on admission and discharge. CONCLUSION The fetus module will provide important data to make the process and outcome quality of care of severely injured pregnant women measurable and to develop prognostic instruments with which predictions about high-risk constellations for the outcome of mother and child can be made.
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Drynda S, Schindler W, Slagman A, Pollmanns J, Horenkamp-Sonntag D, Schirrmeister W, Otto R, Bienzeisler J, Greiner F, Drösler S, Lefering R, Hitzek J, Möckel M, Röhrig R, Swart E, Walcher F. Evaluation of outcome relevance of quality indicators in the emergency department (ENQuIRE): study protocol for a prospective multicentre cohort study. BMJ Open 2020; 10:e038776. [PMID: 32948571 PMCID: PMC7500312 DOI: 10.1136/bmjopen-2020-038776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Quality of emergency department (ED) care affects patient outcomes substantially. Quality indicators (QIs) for ED care are a major challenge due to the heterogeneity of patient populations, health care structures and processes in Germany. Although a number of quality measures are already in use, there is a paucity of data on the importance of these QIs on medium-term and long-term outcomes. The evaluation of outcome relevance of quality indicators in the emergency department study (ENQuIRE) aims to identify and investigate the relevance of QIs in the ED on patient outcomes in a 12-month follow-up. METHODS AND ANALYSIS The study is a prospective non-interventional multicentre cohort study conducted in 15 EDs throughout Germany. Included are all patients in 2019, who were ≥18 years of age, insured at the Techniker Krankenkasse (statutory health insurance (SHI)) and gave their written informed consent to the study.The primary objective of the study is to assess the effect of selected quality measures on patient outcome. The data collected for this purpose comprise medical records from the ED treatment, discharge (claims) data from hospitalised patients, a patient questionnaire to be answered 6-8 weeks after emergency admission, and outcome measures in a 12-month follow-up obtained as claims data from the SHI.Descriptive and analytical statistics will be applied to provide summaries about the characteristics of QIs and associations between quality measures and patient outcomes. ETHICS AND DISSEMINATION Approval of the leading ethics committee at the Medical Faculty of the University of Magdeburg (reference number 163/18 from 19 November 2018) has been obtained and adapted by responsible local ethics committees.The findings of this work will be disseminated by publication of peer-reviewed manuscripts and presentations as conference contributions (abstracts, poster or oral presentations).Moreover, results will be discussed with clinical experts and medical associations before being proposed for implementation into the quality management of EDs. TRIAL REGISTRATION NUMBER German Clinical Trials Registry (DRKS00015203); Pre-results.
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Affiliation(s)
- Susanne Drynda
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Wencke Schindler
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Magdeburg, Germany
| | - Anna Slagman
- Emergency and Acute Medicine, Charité, Berlin, Germany
| | - Johannes Pollmanns
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | | | | | - Ronny Otto
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Jonas Bienzeisler
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Felix Greiner
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Saskia Drösler
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Köln, Germany
| | | | - Martin Möckel
- Emergency and Acute Medicine, Charité, Berlin, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
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Brokmann JC, Pin M, Bernhard M, Walcher F, Gries A. [Restructuring of inpatient emergency treatment : What will change?]. Anaesthesist 2020; 68:261-269. [PMID: 31025042 DOI: 10.1007/s00101-019-0588-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The resolution on the restructuring of inpatient emergency treatment was passed by the Federal Joint Committee (G-BA) on 19 April 2018 based on the Hospital Structure Act and became binding with the publication in the Bundesanzeiger on 18 May 2018. The resolution describes the future structural and qualitative prerequisites for participation of hospitals in the provision of emergency treatment in three levels: basic emergency treatment, extended emergency treatment and comprehensive emergency treatment. Furthermore, a level of nonparticipation is also planned. In addition, there are special modules, e.g. for the treatment of children and auxiliary modules for specifically equipped hospitals with highly specialized patient treatment (e.g. stroke unit). A transition regulation period of 3-5 years provides hospitals with the possibility to adjust to the new minimum requirements. The German Hospital Federation (DKG) and the National Association of Statutory Health Insurance Funds (GKV-SV) will negotiate the assessment of surcharges and deductions subsequent to the resolution.
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Affiliation(s)
- J C Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - M Pin
- Zentrale Notaufnahme, Florence Nightingale Krankenhaus, Düsseldorf, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - F Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Dormann H, Eder PA, Gimpel H, Meindl O, Rashid A, Regal C. Assessing healthcare service quality using routinely collected data: Linking information systems in emergency care. J Med Syst 2020; 44:113. [PMID: 32385607 PMCID: PMC7210224 DOI: 10.1007/s10916-020-01572-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/31/2020] [Indexed: 11/29/2022]
Abstract
Emergency departments need to continuously calculate quality indicators in order to perform structural improvements, improvements in the daily routine, and ad-hoc improvements in everyday life. However, many different actors across multiple disciplines collaborate to provide emergency care. Hence, patient-related data is stored in several information systems, which in turn makes the calculation of quality indicators more difficult. To address this issue, we aim to link and use routinely collected data of the different actors within the emergency care continuum. In order to assess the feasibility of linking and using routinely collected data for quality indicators and whether this approach adds value to the assessment of emergency care quality, we conducted a single case study in a German academic teaching hospital. We analyzed the available data of the existing information systems in the emergency continuum and linked and pre-processed the data. Based on this, we then calculated four quality indicators (Left Without Been Seen, Unplanned Reattendance, Diagnostic Efficiency, and Overload Closure). Lessons learned from the calculation and results of the discussions with staff members that had multiple years of work experience in the emergency department provide a better understanding of the quality of the emergency department, the related challenges during the calculation, and the added value of linking routinely collected data.
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Affiliation(s)
- Harald Dormann
- Department of Emergency Medicine, Klinikum Fürth, Fürth, Germany
| | | | - Henner Gimpel
- Project Group Business & Information Systems Engineering of Fraunhofer FIT, Augsburg, Germany.,FIM Research Center, University of Augsburg, Augsburg, Germany
| | - Oliver Meindl
- FIM Research Center, University of Augsburg, Augsburg, Germany.
| | | | - Christian Regal
- Project Group Business & Information Systems Engineering of Fraunhofer FIT, Augsburg, Germany.,FIM Research Center, University of Augsburg, Augsburg, Germany
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12
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Diagnosen einer Zentralen Notaufnahme als Qualitätsindikator. Notf Rett Med 2020. [DOI: 10.1007/s10049-019-0611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bieler D, Hörster A, Lefering R, Franke A, Waydhas C, Huber-Wagner S, Baacke M, Paffrath T, Wnent J, Volland R, Jakisch B, Walcher F, Kulla M. Evaluation of new quality indicators for the TraumaRegister DGU ® using the systematic QUALIFY methodology. Eur J Trauma Emerg Surg 2018; 46:449-460. [PMID: 30552453 DOI: 10.1007/s00068-018-1055-z] [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] [Received: 05/03/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The TraumaRegister DGU® (TR-DGU) of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU) enables the participating hospitals to perform quality management. For that purpose, nine so-called audit filters have existed, since its foundation, which, inter alia, is listed in the Annual Report. The objective of this study effort is a revision of these quality indicators with the aim of developing pertinent new and reliable quality indicators for the management of severely injured patients. MATERIALS AND METHODS Apart from indicators already used at national and international levels, a systematic review of the literature revealed further potential key figures for quality of the management of severely injured patients. The latter were evaluated by an interdisciplinary and interprofessional group of experts using a standardized QUALIFY process to assess their suitability as a quality indicator. RESULTS By means of the review of the literature, 39 potential indicators could be identified. 9 and 14 indicators, respectively, were identified in existing trauma registries (TR-DGU and TARN), 17 in the ATLS® training concept, and 57 in the S3 guideline on the treatment of polytrauma/severe injuries. The exclusion of duplicates and the limitation to indicators that can be collected using the TR-DGU Version 2015 data set resulted in a total of 43 indicators to be reviewed. For each of the 43 indicators, 13 quality criteria were assessed. A consensus was achieved in 305 out of 559 individual assessments. With 13 quality criteria assessed and 43 indicators correspond this to a relative consensus value of 54.6%. None of the indicators achieved a consensus in all 13 quality criteria assessed. The following 13 indicators achieved a consensus in at least 9 quality criteria: time between hospital admission and WBCT, mortality, administration of tranexamic acid to bleeding patients, use of CCT with GCS <14, time until first emergency surgical intervention (7-item list in the TR-DGU), time until surgical intervention for penetrating trauma, application of pelvic sling belt (prehospital), capnometry (etCO2) in intubated patients, time until CCT with GCS < 15, time until surgery for hemorrhagic shock, time until craniotomy for severe TBI, prehospital airway management in unconscious patients (GCS < 9), and complete basic diagnostics available. Two indicators achieved a consensus in 11 criteria and thus represent the maximum consensus achieved within the group of experts. Four indicators only achieved a consensus in three quality criteria. 17 indicators had a mean value for the 3 relevance criteria of ≥ 3.5 and were, therefore, assessed by the group of experts as being highly relevant. CONCLUSION Not all the key figures published for the management of severely injured patients are suitable for use as quality indicators. It remains to be seen whether the quality indicators identified by experts using the QUALIFY process will meet the requirements in practice. Prior to the implementation of the assessed quality indicators in standardized quality assurance programs, a scientific evaluation based on national data will be required.
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Affiliation(s)
- Dan Bieler
- Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, Armed Forces Central Hospital Koblenz, Ruebenacher Strasse 170, 56072, Coblenz, Germany.
| | - Anna Hörster
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Ostmerheimer Str. 200 House 38, 51109, Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Ostmerheimer Str. 200 House 38, 51109, Cologne, Germany
| | - Axel Franke
- Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, Armed Forces Central Hospital Koblenz, Ruebenacher Strasse 170, 56072, Coblenz, Germany
| | - Christian Waydhas
- Department of Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, 44789, Bochum, Germany.,Medical Faculty of the University Duisburg-Essen, Bürkle-de-la-Camp Platz 1, Hufelandstr. 55, 45137, Essen, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Klinikum rechts, Isar Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Markus Baacke
- Department of Trauma and Reconstructive Surgery/Emergency Department, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292, Trier, Germany
| | - Thomas Paffrath
- Department of Trauma and Orthopaedic Surgery, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Haus 808, 24105, Kiel, Germany
| | - Ruth Volland
- AUC, Academy for Trauma Surgery GmbH, Wilhelm-Hale-Straße 46b, 80639, Munich, Germany
| | - Barbara Jakisch
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 808, 24105, Kiel, Germany
| | - Felix Walcher
- Department of Trauma Surgery, University Magdeburg A.ö.R, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Martin Kulla
- Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Armed Forces Hospital Ulm, HEMS "Christoph 22", Oberer Eselsberg 40, 89081, Ulm, Germany
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Entwicklung der innerklinischen Notfallmedizin in Deutschland. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wedler K, Mersmann J, Schuster S, Stadelmeyer U, Stork G, Schwarz C, Machner M, Krebs A, Petri B, Fuchs A, Scharf J, Friesdorf M, Swistun H, Glien P, Weiß C, Dietz-Wittstock M, Dormann P, Schilling T, Walcher F. Positionspapier zur Stärkung und Weiterentwicklung der Notfallpflege in deutschen Notaufnahmen. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0333-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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