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Fichtner D, Flemmer AW, Fischer U, Koncz V, Oechsle AL, Klemme M. [Does the nursing shortage in neonatal intensive care units (NICU) threaten the warranty of healthcare for newborns? : The "Mary and Joseph" project]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1019-1029. [PMID: 37561130 PMCID: PMC10465400 DOI: 10.1007/s00103-023-03749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/29/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Germany has been experiencing a dramatic shortage of nursing staff for years that particularly affects neonatal intensive care units (NICUs). It is assumed that this situation leads to reductions in bed capacities, resulting in negative effects on the healthcare of newborns. These were investigated through a retrospective observational study using the example of three NICUs at the University Hospital of Munich (LMU). METHODS For the four-year observation period from August 2017 to May 2021, time series data from the "Quality Assurance Guideline for Premature and Mature Infants" (QFR-RL) of the Federal Joint Committee, bed resource analysis, planned personnel statistics, clinical logout data, and rescue service data were mutually examined using descriptive statistics and regression analysis. RESULTS During the observation period, around 21% of the necessary nursing staff positions were vacant, although the quality of nursing care for newborns seemed to have been guaranteed. However, to ensure quality, given the staff shortage, several available beds had to be blocked. In this context, both an increase in the number of hours the wards were logged off from population care and an increase in the relative risk of neonatal intensive care transfer were observed, resulting in a transfer every three days on average. DISCUSSION A shortage of nursing staff reduces the neonatal hospital bed capacity, since neonatal nursing care quality is regulated by strict legally binding guidelines, the QFR-RL. This is why the consequences for the security of care for the population through hospital cancellations and a risk of transfer must be accepted on a regular basis.
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Affiliation(s)
- Daniel Fichtner
- Institut für Notfallmedizin und Medizinmanagement - INM, LMU Klinikum, Schillerstraße 53, 80336, München, Deutschland.
| | - Andreas W Flemmer
- Neonatologie der Kinderklinik, Dr. von Haunersches Kinderspital & Perinatalzentrum, LMU Klinikum, München, Deutschland
| | - Uli Fischer
- Stabsstelle klinische Pflegeforschung und Qualitätsmanagement, LMU Klinikum, München, Deutschland
| | - Viola Koncz
- Stabsstelle Versorgungsmanagement Gesundheit und Pflege, Gesundheitsreferat Landeshauptstadt München, München, Deutschland
| | - Anna-Lisa Oechsle
- Institut für soziale Pädiatrie und Jugendmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Mathias Klemme
- Neonatologie der Kinderklinik, Dr. von Haunersches Kinderspital & Perinatalzentrum, LMU Klinikum, München, Deutschland
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Hoffmann F, Landeg M, Rittberg W, Hinzmann D, Steinbrunner D, Hey F, Heinen F, Kanz KG, Bogner-Flatz V. [Childhood emergencies-worsening healthcare bottlenecks for children in a systematic long-term analysis of the EMS system in a German metropolis]. Med Klin Intensivmed Notfmed 2021; 117:358-366. [PMID: 34156483 DOI: 10.1007/s00063-021-00831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children have the right to the best possible medical care. The lack of treatment capacity is rising steadily and increasingly leads to forced centralized allocation of patients by the emergency medical services (EMS) to pediatric emergency departments that are, officially, temporarily "closed". AIM The aim of this study is to present trends in allocation of pediatric emergency patients in greater Munich. MATERIALS AND METHODS Retrospective analysis of hospital admissions of children < 18 years of age collected from 01 January 2015 to 31 December 2019 by means of the web-based IT system IVENA eHealth (manis IT, Frankfurt) used by the emergency medical services. The focus of the evaluation is on patients in category II, who are likely to require inpatient admission. RESULTS During the 5‑year observation period, a total of 44,549 pediatric patients < 18 years of age (90.6% of total admissions) were admitted to a children's hospital by the ambulance service as category II (SKII) in the Munich metropolitan area. These patients showed an increase in the relative frequency of forced allocations from 1.7% (2015) to 9.4% (2019). Parallel to this, there is an increasing frequency of time intervals over the years in which all children's hospitals were temporarily closed due to lack of treatment availability, especially in the winter half-year. CONCLUSION In the examined period from 2015 to 2019, there has been a relevant increase in the number of forced allocations to children's hospitals by the emergency medical services in the Munich area. This observed trend is likely to persist over the coming years, in view of current staff shortages and diminishing hospital capacities.
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Affiliation(s)
- F Hoffmann
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland.
| | - M Landeg
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - W Rittberg
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - D Hinzmann
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland.,Rettungszweckverband München, München, Deutschland
| | | | - F Hey
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - F Heinen
- LMU Klinikum, Campus Innenstadt, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Pädiatrische Intensivmedizin - Kindernotfallmedizin, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland
| | - K-G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland.,Regierung von Oberbayern, München, Deutschland
| | - V Bogner-Flatz
- Klinik für Allgemeine, Unfall und Wiederherstellungschirurgie, Notfallaufnahme Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.,Rettungszweckverband München, München, Deutschland
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