1
|
Knizia NA, Hirschler J, Stegbauer C, Schwinger A, Büscher A, Englert N, Peters L, Bayarassou HA, Mallmann L, Willms G. ATME-Needs, requirements and cross-sectoral patient journeys of patients with out-of-hospital mechanical ventilation and intensive care in outpatient settings: study protocol for an observational study. BMJ Open 2024; 14:e078621. [PMID: 38448068 PMCID: PMC10916159 DOI: 10.1136/bmjopen-2023-078621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION An increasing number of tracheotomised and/or ventilated patients with high-cost out-of-hospital intensive care needs and, at the same time, a decreasing number of healthcare professionals inevitably lead to challenges in the care of this patient population. In addition, little is known about this population, their health restrictions, needs, patient journeys, care structures and processes. The project 'Needs, requirements and cross-sectoral care pathways of out-of-hospital ventilated intensive care patients' (ATME) aims to analyse these aspects and explore current care structures to inform further development of care in line with patients' needs and requirements. METHODS AND ANALYSIS Qualitative and quantitative methods will be used. In preparation of a semistandardised survey, exploratory interviews will be conducted with tracheotomised and/or ventilated patients with out-of-hospital intensive care needs (TVPOI) (n=15), nursing care providers (n=30), outpatient medical centres, as well as outpatient medical, medical technology and therapeutic care providers (n=35). Three semistandardised survey questionnaires for TVPOI (n=2,000) will be developed and conducted with nursing care facilities (n=250) and outpatient medical centres for mechanical ventilation (n=25). Content analyses will be conducted for qualitative data; survey data will be analysed descriptively. In addition, healthcare claims data will be analysed descriptively to provide information on patient journeys. Three result workshops and one consensus conference will be carried out with representatives of the relevant target groups to analyse the suitability of care structures and to develop recommendations for action to improve TVPOI. ETHICS AND DISSEMINATION The ATME study received a positive vote from the Ethics Committee of the Osnabrück University of Applied Sciences and is registered in 'Deutsches Register Klinischer Studien (DRKS)' (registration number: DRKS00030891). The study results will be presented at national conferences and in relevant peer-reviewed journals. Additionally, study results will be published by the funding institution (the Innovation Committee of the Federal Joint Committee) on their website.
Collapse
Affiliation(s)
- Nahne-Alina Knizia
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | - Josefine Hirschler
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | - Constance Stegbauer
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | | | - Andreas Büscher
- Faculty of Business Administration and Social Sciences, University of Applied Sciences, Osnabrück, Germany
| | - Nathalie Englert
- Faculty of Business Administration and Social Sciences, University of Applied Sciences, Osnabrück, Germany
| | - Lara Peters
- Faculty of Business Administration and Social Sciences, University of Applied Sciences, Osnabrück, Germany
| | - Hakim A Bayarassou
- German Interdisciplinary Society for Out-of Hospital Ventilation e. V. (DIGAB), Cologne, Germany
| | - Leonie Mallmann
- Federal Association of Private Social Service Providers, Berlin, Germany
| | - Gerald Willms
- aQua Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| |
Collapse
|
2
|
Lehmann Y, Stark S. [Supply of Medical Aids in home Mechanical Ventilation: needs-Based and Safe? - The Views of Stakeholders Related to the Care Process on the Current Status and Perspectives]. DAS GESUNDHEITSWESEN 2024; 86:200-207. [PMID: 38471513 DOI: 10.1055/a-2233-6309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The supply of medical aids is essential for patients with home mechanical ventilation. However, it is largely unclear to what extent this supply is needs-based and safe. METHODS As part of a health services research project, 20 expert interviews were conducted with a heterogeneous group of stakeholders related to ventilation-specific medical aids supply. The interviews were analysed using qualitative content analysis. RESULTS The interviewees pointed to challenges and problems regarding structural, procedural and personal aspects at all levels of medical aids supply. In particular, deficits in task performance, coordination and cooperation between the stakeholders and authorities involved became apparent. Such might result in avoidable safety risks and hinder needs-oriented supply of medical aids. CONCLUSION Further development in ventilation-associated medical aids supply is needed, with focus on evidence-based practices, a comprehensive, cross-sectoral and cross-professional design as well as systematic evaluation.
Collapse
Affiliation(s)
- Yvonne Lehmann
- Standort Nord, BBG Berliner Bildungscampus für Gesundheitsberufe, Berlin, Germany
| | - Susanne Stark
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, QUEST Center for Responsible Research, Berlin, Deutschland
| |
Collapse
|
3
|
Stark S, Lehmann Y. ["Ensuring patient safety is one of our primary responsibilities." - Results of a qualitative study on maintaining safety in ventilation-associated technical aid supply]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:53-62. [PMID: 37926622 DOI: 10.1016/j.zefq.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Maintaining safety is critical in home mechanical ventilation (HMV). It is co-determined by the availability of reliable technical aids and their correct application. Ensuring safe aid supply is part of the aid providers'́ legal mandate. However, whether and how this is achieved is largely unknown. Therefore, the tasks of technical aid providers, associated requirements and challenges with special regards to educational and safety aspects were investigated. METHODS For this purpose, episodic interviews were conducted between July and December 2020 with a purposive sample of field representatives of eleven technical aid providers. Between one and six persons participated in each of the interviews, resulting in a total sample of 25 persons (14 field representatives without management function, ten with management function, one director). Given the conditions during the COVID-19 pandemic, six interviews took place face-to-face and five as web meetings. Interviews were analysed using qualitative content analysis. RESULTS From the interviewees'́ perspective, the most important safety-related measure is the legally required and individually tailored initial instruction in a safe aid application. Additional safety-related tasks comprise counselling, e. g. for prescribing physicians and users (patients, relatives, nursing service employees), regular home visits, and the provision of a technical emergency service. Interviewees indicate that safety risks emerge primarily from a lack of skills and a high staff turnover among professional caregivers. This, they state, challenges building up and maintaining competencies among nursing staff. Other safety risks arise from healthcare fragmentation, lacking coordination, cooperation, and accountability of the professionals involved. Respondents address these challenges pragmatically by providing additional services, like ongoing caregiver training, care coordination and support roles. DISCUSSION Maintaining safety in ventilation-associated technical aid supply must be considered a crucial component of the overall HMV care processes, in which safety currently cannot be taken for granted. Field representatives of technical aid providers address the existing challenges with selective and intuitive strategies, some of which exceed their legal mandate. CONCLUSION Improving safety in home care can be supported by establishing Advanced Nursing Practice roles in nursing services. The systematic further development of roles and tasks of staff of technical aid providers should be clarified within an overarching discourse on viable approaches to cross-sectoral and interprofessional HMV care.
Collapse
Affiliation(s)
- Susanne Stark
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, QUEST Center for Responsible Research, Berlin, Deutschland; Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Deutschland.
| | - Yvonne Lehmann
- BBG Berliner Bildungscampus für Gesundheitsberufe gGmbH, Berlin, Deutschland; Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Deutschland
| |
Collapse
|
4
|
Brüll N, Nicca D, Staudacher S, Schmid-Mohler G, Zúñiga F. [Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis]. Pflege 2023; 36:269-276. [PMID: 37334888 DOI: 10.1024/1012-5302/a000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis Abstract. Background: With the progress in medical options, the need for home mechanical ventilation increases. The transition from long-term ventilation in an institution to home mechanical ventilation in an outpatient setting is a difficult phase in terms of setting up the network of care, coordination of care for those with the ventilatory insufficiency and the financing. Aim: The study describes how patients with ventilatory insufficiency and family caregivers experience the transition from an institution to an ambulatory setting with invasive or non-invasive home mechanical ventilation. Methods: A qualitative research design with a social-constructivist approach was adopted using thematic analysis according to Braun and Clarke. We included seven German-speaking patients (≥ 18 years old) with ventilatory insufficiency and home mechanical ventilation (> 6 h/day) from the German part of Switzerland, with discharge from an institution to home, and five family caregivers who care for patients with the described criteria. Results: The institution was seen as a safe place. Affected persons and their family caregivers had to create a safe environment at home. Three themes were formed inductively: To gradually build trust with each other, to become experts as family caregivers, to align their own network with the new care needs.Conclusions: The transition home succeeds in the interplay of gaining trust, building expertise, and creating sustainable networks. Professionals can use this knowledge to provide targeted support to patients with home mechanical ventilation and their family caregivers.
Collapse
Affiliation(s)
- Nicole Brüll
- Departement Muskuloskelettales System, Universitätsspital Basel, Schweiz
| | - Dunja Nicca
- Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich, Schweiz
| | - Sandra Staudacher
- Pflegewissenschaft - Nursing Science, Universität Basel, Schweiz
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Holland
| | - Gabriela Schmid-Mohler
- Zentrum Klinische Pflegewissenschaft, Universitätsspital Zürich, Schweiz
- Klinik für Pneumologie, Universitätsspital Zürich, Schweiz
| | - Franziska Zúñiga
- Pflegewissenschaft - Nursing Science, Universität Basel, Schweiz
| |
Collapse
|
5
|
von Schumann S, Ullrich C, Weis A, Wensing M, Litke N. Interprofessional weaning boards for invasively ventilated patients in intensive care units: Qualitative interview study with healthcare professionals in Germany. Res Nurs Health 2023; 46:148-158. [PMID: 36453115 DOI: 10.1002/nur.22279] [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: 06/27/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 12/05/2022]
Abstract
Numbers of mechanically ventilated patients are increasing worldwide. Weaning Boards could support weaning from the ventilator by facilitating interprofessional consultations between Weaning Centers and nonpneumological intensive care units. This study, which is linked to the project Prevention of invasive Ventilation, aimed to explore the design and implementation of future Weaning Boards. Semistructured interviews were conducted with physicians, nurses, respiratory therapists, and physiotherapists of intensive care units and Weaning Centers in Baden-Wuerttemberg, Germany. Participants were asked to share their views on (a) required characteristics of Weaning Boards and (b) the current care of weaning patients in their wards. Qualitative data analysis included inductive and deductive steps referring to the Template for Intervention Description and Replication checklist and the Consolidated Framework for Implementation Research. The 14 interviewed healthcare professionals addressed characteristics of future Weaning Boards including (a) preconditions, (b) procedure, (c) interprofessional participants, (d) type of performance, and (d) time frame. Identified determinants for successful implementation were related to (a) individual characteristics of healthcare professionals, (b) ward characteristics, and (c) healthcare system characteristics. Weaning Boards could be a useful tool to advance knowledge sharing between professionals, improve education about weaning protocols, and support patient-oriented care. The implementation of Weaning Boards can be influenced by individual characteristics of participating professionals, difficulties in the interaction between professional groups, the present workplace culture, and the current coronavirus disease 2019 (COVID-19) pandemic.
Collapse
Affiliation(s)
- Selina von Schumann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Aline Weis
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicola Litke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
6
|
Klingshirn H, Gerken L, Hofmann K, Heuschmann PU, Haas K, Schutzmeier M, Brandstetter L, Wurmb T, Kippnich M, Reuschenbach B. [Complexity of outpatient intensive care for ventilated people: Cross-mapping into the standardised NNN-taxonomy]. Pflege 2022; 36:259-268. [PMID: 36325985 DOI: 10.1024/1012-5302/a000919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Complexity of outpatient intensive care for ventilated people: Cross-mapping into the standardised NNN-taxonomy Abstract. Background: In Germany, free text is the preferred method for recording the nursing process in outpatient intensive care, although classification systems could enable a more precise description. Research question: How is nursing care for people with outpatient ventilation represented by the NNN-taxonomy and what are the recommendations for nursing practice? Methods: A qualitative "multiple case" design was applied. Using deductive content analysis (data sources: nursing documentation and secondary analysis of interviews with affected persons), several cases, both individually and across all cases were linked to the NNN-taxonomy (cross-mapping). Results: In total, the nursing documentation of 16 invasively ventilated persons with a mean age of 58.4 years (SD = 16.3) was analysed. Seven persons additionally contributed interview data. Documentation was mainly based on the "Strukturmodell" (14/16) with a moderate to high accuracy (D-Catch Score: 16.6; SD = 4.1). Cross-mapping resulted in 4016 codes: 618 nursing diagnoses, 1956 interventions and 1442 outcomes. Documentation was strongly measure-oriented, not very person-centred and with a lack of differentiation between diagnosis and intervention. Conclusions: To improve nursing practice, a person-centred attitude and the ability to differentiate between nursing diagnoses, interventions and outcomes should be promoted.
Collapse
Affiliation(s)
- Hanna Klingshirn
- Katholische Stiftungshochschule München, University of Applied Sciences, München, Deutschland
| | - Laura Gerken
- Katholische Stiftungshochschule München, University of Applied Sciences, München, Deutschland
| | - Katharina Hofmann
- Katholische Stiftungshochschule München, University of Applied Sciences, München, Deutschland
| | - Peter Ulrich Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Deutschland
- Zentrale für Klinische Studien Würzburg, Universitätsklinikum Würzburg, Deutschland
- Deutsches Zentrum für Herzinsuffizienz (DZHI), Universität Würzburg, Deutschland
| | - Kirsten Haas
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Deutschland
| | - Martha Schutzmeier
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Deutschland
| | - Lilly Brandstetter
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Deutschland
| | - Thomas Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Deutschland
| | - Maximilian Kippnich
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Deutschland
| | - Bernd Reuschenbach
- Katholische Stiftungshochschule München, University of Applied Sciences, München, Deutschland
| |
Collapse
|
7
|
Klingshirn H, Schwarz SB. [Quality of Care in Home Mechanical Ventilation]. Pneumologie 2022; 76:397-403. [PMID: 35588747 DOI: 10.1055/a-1803-2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Home mechanical ventilation has developed rapidly over the last 20 years. Today's most common positive pressure ventilation can be performed either non-invasively via face masks or invasively via endotracheal intubation or tracheal cannula. Non-invasive ventilation (NIV) in particular has gained in importance in recent years as positive evidence for a variety of indications for home mechanical ventilation has become increasingly available. In order to ensure a high quality of treatment for the steadily increasing number of patients, specific guidelines for different patient groups have been developed and regularly updated. The appropriate care structures for these partly multimorbid patient cohorts are strongly discussed, since the capacity limits of the existing care structure are reached by the rapid development in home mechanical ventilation. This development shows, that a critical evaluation of the existing care structures is necessary in order to develop a patient-centered, customized and resource-saving healthcare structure on the basis of the existing structures and taking into account the national characteristics of the German healthcare system.
Collapse
Affiliation(s)
- Hanna Klingshirn
- Katholische Stiftungshochschule München, University of Applied Sciences, München
| | - Sarah B Schwarz
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Medizinische Fakultät, Universität Witten/Herdecke
| |
Collapse
|
8
|
Hoeppchen I, Walter C, Berger S, Brandauer A, Freywald N, Kutschar P, Lex KM, Strobl A, Gnass I. Hygiene management for long-term ventilated persons in the home health care setting: a scoping review. BMC Health Serv Res 2022; 22:244. [PMID: 35197063 PMCID: PMC8864850 DOI: 10.1186/s12913-022-07643-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Evidence and recommendations for hygiene management in home mechanical ventilation (HMV) are rare. In Germany, few regionally limited studies show poor hygiene management or a lack of its implementation. This scoping review of international literature identified the evidence in hygiene management for ventilated patients in the home care setting which has to be implemented for infection prevention and control. Methods A review of international literature was conducted in CINAHL, PubMed and Web of Science. The search focused on four key domains: HMV, hygiene management, home care setting, and methicillin-resistant Staphylococcus aureus (MRSA). Data of included studies were extracted using a data charting sheet. Extracted data were assigned to the categories (1) study description, (2) setting and participants, and (3) hygiene management. Results From 1,718 reviewed articles, n = 8 studies met inclusion criteria. All included studies had a quantitative study design. The approaches were heterogeneous due to different settings, study populations and types of ventilation performed. Regarding aspects of hygiene management, most evidence was found for infectious critical activities (n = 5), quality management for hygiene (n = 4), and training and education (n = 4). This review identified research gaps concerning kitchen hygiene, relatives and visitors of HMV patients, and waste management (n = 0). Discussion Overall evidence was rather scarce. Consequently, this review could not answer all underlying research questions. No evidence was found for measures in hygiene management relating to ventilated patients’ relatives. Evidence for kitchen hygiene, waste management and interaction with relatives is available for inpatient care settings. However, this may not be transferable to outpatient care. Binding legal requirements and audits may help regulate the implementation of HMV hygiene measures. Conclusion Infection control programmes included qualified personnel, hygiene plans, and standards for MRSA and multidrug-resistant organisms (MDRO). The appropriateness of hygiene management measures for outpatient care is the basis for their application in practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07643-w.
Collapse
Affiliation(s)
- Isabel Hoeppchen
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Carola Walter
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria.
| | - Stefanie Berger
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Anna Brandauer
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Nicole Freywald
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Katharina Maria Lex
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Annemarie Strobl
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Irmela Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| |
Collapse
|
9
|
Skazel T, Kippnich M, Klingshirn H, Gerken L, Heuschmann P, Haas K, Schutzmeier M, Brandstetter L, Ahnert J, Koch J, Seese B, Meybohm P, Reuschenbach B, Wurmb T. [Ventilation Patients between Acute Care and Long-term Out-of-Hospital Ventilation - Routine Documentation based Analysis of the Care Situation]. Pneumologie 2021; 75:560-566. [PMID: 34374061 DOI: 10.1055/a-1376-1578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation. MATERIAL AND METHODS In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital. RESULTS In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community). CONCLUSION Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable.
Collapse
Affiliation(s)
- T Skazel
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| | - M Kippnich
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| | - H Klingshirn
- Katholische Stiftungshochschule München, München
| | - L Gerken
- Katholische Stiftungshochschule München, München
| | - P Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg.,Zentrale für Klinische Studien Würzburg, Universitätsklinikum Würzburg, Würzburg.,Deutsches Zentrum für Herzinsuffizienz (DZHI), Universitätsklinikum Würzburg, Würzburg
| | - K Haas
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - M Schutzmeier
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - L Brandstetter
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - J Ahnert
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - J Koch
- Thoraxzentrum Bezirk Unterfranken - Lungenfachklinik, Münnerstadt
| | - B Seese
- Thoraxzentrum Bezirk Unterfranken - Lungenfachklinik, Münnerstadt
| | - P Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| | | | - T Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| |
Collapse
|
10
|
Schwarz SB, Wollsching-Strobel M, Majorski DS, Magnet FS, Mathes T, Windisch W. [Invasive and Non-Invasive Home Mechanical Ventilation in Germany - A Rapid Development with Large Regional Differences]. Pneumologie 2021; 75:942-949. [PMID: 34171929 DOI: 10.1055/a-1509-7014] [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
BACKGROUND The number of patients using home mechanical ventilation (HMV) is steadily increasing in Germany. Detailed data on inpatient initiation and control of HMV are not available. This, however, is absolutely necessary in order to optimize the medical care structures in Germany. Regional diversities must be taken into consideration in order to provide care structures that reflect the local needs. METHOD The data sets of the German Federal Statistical Office on the OPS (Operation and Procedure Classification System) for HMV from 2008 to 2019 were analysed (N = 572,494). RESULTS Between 2008 and 2019 there was a doubling of the number of HMV initiations and controls. The number of initiations (N = 17,958) and controls (N = 49,140) was highest in 2019. Furthermore, at the state level, the development of HMV is very heterogeneous. Finally, the increases were particularly due to an increase in non-invasively ventilated patients. CONCLUSION The rapid increase in HMV is reaching capacity limits of the existing healthcare structure. New healthcare structures should provide an integrated approach between outpatient and inpatient care in order to ensure a high quality of care for patients receiving HMV without compromising the human and economic resources of the system.
Collapse
Affiliation(s)
- Sarah Bettina Schwarz
- Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | | | | | - Friederike Sophie Magnet
- Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Tim Mathes
- IFOM - Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Wolfram Windisch
- Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| |
Collapse
|
11
|
Skazel T, Kippnich M, Klingshirn H, Gerken L, Heuschmann P, Haas K, Schutzmeier M, Brandstetter L, Ahnert J, Koch J, Seese B, Meybohm P, Reuschenbach B, Wurmb T. [Ventilation Patients between Acute Care and Long-term Out-of-Hospital Ventilation - Routine Documentation based Analysis of the Care Situation]. Pneumologie 2021; 75:180-180. [PMID: 33684955 DOI: 10.1055/a-1376-3966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation. MATERIAL AND METHODS In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital. RESULTS In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community). CONCLUSION Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable.
Collapse
Affiliation(s)
- T Skazel
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| | - M Kippnich
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| | - H Klingshirn
- Katholische Stiftungshochschule München, München
| | - L Gerken
- Katholische Stiftungshochschule München, München
| | - P Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
- Zentrale für Klinische Studien Würzburg, Universitätsklinikum Würzburg, Würzburg
- Deutsches Zentrum für Herzinsuffizienz (DZHI), Universitätsklinikum Würzburg, Würzburg
| | - K Haas
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - M Schutzmeier
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - L Brandstetter
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - J Ahnert
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - J Koch
- Thoraxzentrum Bezirk Unterfranken - Lungenfachklinik, Münnerstadt
| | - B Seese
- Thoraxzentrum Bezirk Unterfranken - Lungenfachklinik, Münnerstadt
| | - P Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| | | | - T Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Würzburg
| |
Collapse
|