1
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Cornelius C, Deffner T, Hill A, Rohlfes C, Ellner B, Klarmann S, Riedel S, Pelz S, Kopp S, Borgstedt L, Freund D, Schöpfel A, Meybohm P, Walcher F, Brenner T, Klenke S. [Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU]. Anaesthesiologie 2024; 73:263-271. [PMID: 38530388 DOI: 10.1007/s00101-024-01402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find a personal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to a traffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.
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Affiliation(s)
- Celina Cornelius
- Medizinische Fakultät Heidelberg, Klinik für Anästhesiologie, Universität Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - Teresa Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Aileen Hill
- Klinik für Anästhesiologie und Klinik für Operative Intensivmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | | | - Bernd Ellner
- Klinik rechts der Isar, Technische Universität München, München, Deutschland
| | - Silke Klarmann
- Therapiezentrum, Imland Klinik gGmbH Rendsburg, Rendsburg, Deutschland
| | - Sabine Riedel
- Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Sabrina Pelz
- Universitäts- und Rehabilitationskliniken Ulm, Ulm, Deutschland
| | - Sabrina Kopp
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Laura Borgstedt
- TUM School of Medicine, Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Diana Freund
- Klinik für Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Andreas Schöpfel
- Betriebsärztlicher Dienst, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Patrick Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie A.ö.R, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
- DIVI e.V., Berlin, Deutschland
| | - Thorsten Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Deutschland
| | - Stefanie Klenke
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Deutschland
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Cornelius C, Deffner T, Hill A, Rohlfes C, Ellner B, Klarmann S, Riedel S, Pelz S, Kopp S, Borgstedt L, Freund D, Schöpfel A, Meybohm P, Walcher F, Brenner T, Klenke S. [Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01122-2. [PMID: 38530386 DOI: 10.1007/s00063-024-01122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 03/28/2024]
Abstract
The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find a personal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to a traffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.
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Affiliation(s)
- Celina Cornelius
- Medizinische Fakultät Heidelberg, Klinik für Anästhesiologie, Universität Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - Teresa Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Aileen Hill
- Klinik für Anästhesiologie und Klinik für Operative Intensivmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | | | - Bernd Ellner
- Klinik rechts der Isar, Technische Universität München, München, Deutschland
| | - Silke Klarmann
- Therapiezentrum, Imland Klinik gGmbH Rendsburg, Rendsburg, Deutschland
| | - Sabine Riedel
- Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Sabrina Pelz
- Universitäts- und Rehabilitationskliniken Ulm, Ulm, Deutschland
| | - Sabrina Kopp
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Laura Borgstedt
- TUM School of Medicine, Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Diana Freund
- Klinik für Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Andreas Schöpfel
- Betriebsärztlicher Dienst, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Patrick Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie A.ö.R, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
- DIVI e.V., Berlin, Deutschland
| | - Thorsten Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Deutschland
| | - Stefanie Klenke
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Deutschland
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3
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. [Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]. Med Klin Intensivmed Notfmed 2023; 118:39-46. [PMID: 37548658 DOI: 10.1007/s00063-023-01054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Alexander Krohn
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
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Waydhas C, Riessen R, Markewitz A, Hoffmann F, Frey L, Böttiger BW, Brenner S, Brenner T, Deffner T, Deininger MM, Janssens U, Kluge S, Marx G, Schwab S, Unterberg A, Walcher F, van den Hooven T. [DIVI-Recommendations on the infrastruture of adult intensive care units]. Med Klin Intensivmed Notfmed 2023; 118:564-575. [PMID: 37115243 DOI: 10.1007/s00063-023-01021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This document on the Structure and Equipment for Intensive Care Units of the German Association for Intensive and Emergency Care (DIVI) aims at providing guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units. The recommendations are based on a systematic literature search and a formal consensus process from a group of multi-disciplinary and multiprofessional specialists from the DIVI. The recommendations comprise a 3-staged level of intensive care units, a 3-staged level of care with respect to severity of illness, the staffing requirement of physicians, nurses, physiotherapists, pharmacists, psychologists, and other specialists. Furthermore, proposals concerning the equipment and the construction of ICUs are supplied.
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Affiliation(s)
- Christian Waydhas
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - Reimer Riessen
- Department für Innere Medizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | | | - Florian Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig Maximilians-Universität, Campus Innenstadt, München, Deutschland
| | - Lorenz Frey
- MMI Munich Medical International GmbH, München, Deutschland
| | - Bernd W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Sebastian Brenner
- Pädiatrische Intensivmedizin im Fachbereich Neonatologie und Pädiatrische Intensivmedizin, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus der TU Dresden, Dresden, Deutschland
| | - Thorsten Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Deutschland
| | - Teresa Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Matthias Manfred Deininger
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Gernot Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum RWTH Aachen, Aachen, Deutschland
| | - Stefan Schwab
- Neurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Andreas Unterberg
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. [Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]. Anaesthesiologie 2023; 72:654-661. [PMID: 37544933 DOI: 10.1007/s00101-023-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Alexander Krohn
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. Empfehlungen zur Sonografieausbildung in der prähospitalen Notfallmedizin (pPOCUS): Konsensuspapier von DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI und DGIIN. Notf Rett Med 2023. [DOI: 10.1007/s10049-023-01196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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7
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. Empfehlungen zur Sonografieausbildung in der prähospitalen Notfallmedizin (pPOCUS): Konsensuspapier von DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI und DGIIN. NOTARZT 2023; 39:195-203. [DOI: 10.1055/a-2114-7667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
ZusammenfassungDie Point-of-Care-Sonografie ist in der Akut- und Notfallmedizin ein fester Bestandteil der Diagnostik und Therapieeinleitung von kritisch kranken und verletzten Patienten. Während die
Notfallsonografie im Rahmen der Zusatzweiterbildung für klinische Akut- und Notfallmedizin vorausgesetzt wird, wird diese für die prähospitale Notfallmedizin lediglich im (Muster-)Kursbuch
Allgemeine und spezielle Notfallbehandlung als Weiterbildungsinhalt definiert. Obwohl einige Fachgesellschaften in Deutschland bereits eigene Lernkonzepte für die Notfallsonografie etabliert
haben, fehlt bis dato ein einheitliches nationales Ausbildungskonzept für den Einsatz der Notfallsonografie im prähospitalem Umfeld. Experten mehrerer Fachgesellschaften haben daher als
Empfehlung für die notfallmedizinische Weiterbildung ein Kurskonzept für die spezielle Ausbildung in der prähospitalen Notfallsonografie erarbeitet, welche gleichermaßen zu deren
Qualitätssicherung beitragen soll.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
- gleichberechtigte Erstautoren
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
- gleichberechtigte Erstautoren
| | - Alexander Krohn
- Department für interdisziplinäre Akut-, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut-, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité – Universitätsmedizin Berlin
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F. Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
- gleichberechtigte Letztautoren
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
- gleichberechtigte Letztautoren
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Waydhas C, Riessen R, Markewitz A, Hoffmann F, Frey L, Böttiger BW, Brenner S, Brenner T, Deffner T, Deininger MM, Janssens U, Kluge S, Marx G, Schwab S, Unterberg AW, Walcher F, van den Hooven T. Recommendations on the structure, personal, and organization of intensive care units. Front Med (Lausanne) 2023; 10:1196060. [PMID: 37425314 PMCID: PMC10325721 DOI: 10.3389/fmed.2023.1196060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 07/11/2023] Open
Abstract
Background Intensive care units (ICU) are central facilities of medical care in hospitals world-wide and pose a significant financial burden on the health care system. Objectives To provide guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units. Design and setting Development of recommendations based on a systematic literature search and a formal consensus process from a group of multidisciplinary and multiprofessional specialists from the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI). The grading of the recommendation follows the report from an American College of Chest Physicians Task Force. Results The recommendations cover the fields of a 3-staged level of intensive care units, a 3-staged level of care with respect to severity of illness, qualitative and quantitative requirements of physicians and nurses as well as staffing with physiotherapists, pharmacists, psychologists, palliative medicine and other specialists, all adapted to the 3 levels of ICUs. Furthermore, proposals concerning the equipment and the construction of ICUs are supplied. Conclusion This document provides a detailed framework for organizing and planning the operation and construction/renovation of ICUs.
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Affiliation(s)
- Christian Waydhas
- Trauma Intensive Care, Department of Trauma Surgery, University Hospital Essen, Essen, Germany
- Department of Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Reimer Riessen
- Medical Intensive Care Unit, Department of Medicine, University of Tübingen, Tübingen, Germany
| | - Andreas Markewitz
- Medizinische Geschäftsführung, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin, Berlin, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Lorenz Frey
- Munich Medical International, Munich, Germany
| | - Bernd W. Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Crologne, Germany
| | - Sebastian Brenner
- Division of Neonatology and Pediatrics Intensive Care, Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Teresa Deffner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| | - Matthias M. Deininger
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St.-Antonius Hospital, Eschweiler, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Heamburg, Germany
| | - Gernot Marx
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Eerlangen, Germany
| | | | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
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Fröhlich S, Obertacke U, Rüsseler M, Walcher F, Seemann R. Nationaler Kompetenzbasierter Lernzielkatalog (NKLM) und neue Ärztliche Approbationsordnung ÄApprO 2025 – ein Wegweiser für O & U. Z Orthop Unfall 2023; 161:121-126. [PMID: 37015236 DOI: 10.1055/a-2017-1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Susanne Fröhlich
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Deutschland
| | - Udo Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Deutschland
| | - Miriam Rüsseler
- Frankfurter interdisziplinäres Simulationszentrum, Universitätsklinikum Frankfurt, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Ricarda Seemann
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Deutschland
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Stieger P, Schildberg C, Gottschalk M, Werwick K, Hunger J, Walcher F, Meyer F, Albert C, Braun-Dullaeus RC. Erratum zu: Innovative fakultative Seminarkonzepte besonders klinisch-praktisch ausgerichteter Lehre zur Famulatur- und PJ-Vorbereitung aus spezifisch chirurgischer Sicht. Chirurgie (Heidelb) 2023:10.1007/s00104-022-01791-9. [PMID: 36995423 PMCID: PMC10374740 DOI: 10.1007/s00104-022-01791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Philipp Stieger
- Universitätsklinik für Kardiologie und Angiologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland
| | - Claus Schildberg
- Universitätsklinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum der MHB im Verbund Brandenburg an der Havel, Brandenburg an der Havel, Deutschland
| | - Marc Gottschalk
- Universitätsklinik für Kardiologie und Angiologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland
| | - Katrin Werwick
- Studiendekanat der Medizinischen Fakultät, Otto-von-Guericke-Universität zu Magdeburg, Magdeburg, Deutschland
| | - Jonathan Hunger
- Klinik für Neurologie, Klinikum Magdeburg GmbH, Magdeburg, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland
| | - Frank Meyer
- Universitätsklinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Christian Albert
- Universitätsklinik für Kardiologie und Angiologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland
| | - Rüdiger C Braun-Dullaeus
- Universitätsklinik für Kardiologie und Angiologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland
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Lucas B, Lippisch R, Pliske G, Piatek S, Walcher F. [Conservative management of distal radius fractures]. Unfallchirurgie (Heidelb) 2023; 126:227-237. [PMID: 36881137 DOI: 10.1007/s00113-023-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
Distal radius fractures are the third most frequent fractures in Germany. The decision for conservative treatment and the weighing up of surgical treatment need an exact consideration of the indications based on instability criteria and the extent of possible articular involvement. Indications for an emergency operation must be excluded. In cases of stable fractures or multimorbid patients in a poor general condition conservative treatment is indicated. The principles for a successful treatment are the precise reduction and stable retention in a plaster splint. In the further course, fractures are closely monitored by biplanar radiography. This is necessary to rule out a secondary displacement until the swelling of the soft tissues has subsided and the plaster splint is changed to a circular cast approximately 11 days after the traumatic event. The total duration of immobilization is 4 weeks. Physiotherapy and ergotherapy including adjacent joints, starts after 2 weeks of treatment. This treatment is extended to the wrist after removal of the circular cast.
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Affiliation(s)
- Benjamin Lucas
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
| | - Roland Lippisch
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Gerald Pliske
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Stefan Piatek
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
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Behrens R, Pliske G, Piatek S, Walcher F, Elkmann N. A statistical model to predict the occurrence of blunt impact injuries on the human hand-arm system. J Biomech 2023; 151:111517. [PMID: 36893519 DOI: 10.1016/j.jbiomech.2023.111517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
Biomechanical limits based on pain thresholds ensure safety in workplaces where humans and cobots (collaborative robots) work together. Standardization bodies' decision to rely on pain thresholds stems from the assumption that such limits inherently protect humans from injury. This assumption has never been verified, though. This article reports on a study with 22 human subjects in which we studied injury onset in four locations of the hand-arm system using an impact pendulum. During the tests, the impact intensity was slowly increased over several weeks until a blunt injury, i.e., bruising or swelling, appeared in the body locations under load. A statistical model, which calculates injury limits for a given percentile, was developed based on the data. A comparison of our injury limits for the 25th percentile with existing pain limits confirms that pain limits provide suitable protection against impact injuries, albeit not for all body locations.
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Affiliation(s)
- R Behrens
- Fraunhofer IFF, Sandtorstr. 22, 39106 Magdeburg, Germany.
| | - G Pliske
- Department of Trauma Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - S Piatek
- Department of Trauma Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - F Walcher
- Department of Trauma Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - N Elkmann
- Fraunhofer IFF, Sandtorstr. 22, 39106 Magdeburg, Germany
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Gottschalk M, Schildberg C, Meyer F, Werwick K, Hunger J, Walcher F, Braun-Dullaeus R, Albert C, Stieger P. Innovative fakultative Seminarkonzepte besonders klinisch-praktisch ausgerichteter Lehre zur Famulatur- und PJ-Vorbereitung aus spezifisch chirurgischer Sicht. Chirurgie 2022; 94:432-440. [PMID: 36418573 PMCID: PMC10156815 DOI: 10.1007/s00104-022-01757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/25/2022]
Abstract
Zusammenfassung
Hintergrund
Die großen Praxisphasen der Famulaturen und des Praktischen Jahres (PJ) nehmen für Medizinstudierende eine besondere Stellung innerhalb ihres Kurrikulums ein.
Ziel
Bezüglich Famulatur und PJ in der medizinischen Ausbildung wird exemplarisch ein Konzept zu vorbereitenden Seminarreihen einschließlich initialer Praxiserfahrungen vorgestellt.
Methode
Es wird eine narrative Übersicht gegeben.
Ergebnisse
Als gemeinsames Ziel der fakultativ initiierten Lehrveranstaltungen sollen die Studierenden zum Absolvieren von Famulatur und PJ besser qualifiziert und befähigt werden sowie das empfundene Zutrauen der Studierenden substanziell erhöhen. Die Erfahrungen in Famulaturen und PJ prägen Interesse und die Entscheidungen für ein Fach und den weiteren ärztlichen Berufsweg. Die Inhalte der hier vorgestellten Seminare zur Vorbereitung der ersten Famulatur und des ersten PJ-Tertials leisten einen Beitrag zur späteren selbstständigen ärztlichen Tätigkeit. Sie sollen vor dem folgenden Berufsstart für das Konzept einer umfassenden, d.h. komplexen interdisziplinären, -professionellen und -sektoralen Patientenversorgung sensibilisieren. Unter Berücksichtigung der jeweils unterschiedlichen Vorerfahrungen aus vorangegangenen Praktikumsabschnitten werden die Studierenden gezielt zu breit gefächerten, chirurgisch-interdisziplinären Lernzielen einer „Versorgungskompetenz“ unterrichtet. Studierende sollen auf diese Weise von den anregungsreich zu gestaltenden Phasen der Famulatur und des PJs vermehrt profitieren.
Schlussfolgerung
Von einer Verbesserung der Lehre durch eine statusgerechte Vorbereitung, die neben typischen Tätigkeiten Studierender des Praktikums auch unmittelbar auf den ärztlichen Alltag vorbereitet, sind ein größerer Lernerfolg und ein verbessertes Praktikumserleben zu erwarten.
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Lucas B, Meng M, Schirrmeister W, Pliske G, Walcher F, Schüttrumpf JP. Lessons learned during the sliding gantry CT implementation in a trauma suite. Eur J Trauma Emerg Surg 2022:10.1007/s00068-022-02080-0. [PMID: 35988107 DOI: 10.1007/s00068-022-02080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Early detection of bleeding is important for managing trauma cases in the emergency department (ED). Several trauma suites are equipped with computed tomography (CT) scanners to reduce the time to CT. In the last decade, sliding gantry CT has been implemented in trauma suites, highlighting conventional techniques' advantages. We investigated the change in the time to CT and the challenges faced during the implementation. METHODS Trauma suite treatments with a conventional CT scanner between January and December 2016 formed the control group. From January to April 2017, trauma suites were modified, and treatment was outsourced to an interim trauma suite. By May 2017, trauma suites were equipped with a sliding gantry CT scanner. Treatments from May to July 2017 formed the transition group, and those from August to December 2017 formed the routine use group. We evaluated the time to CT in all groups and considered the reasons for the delays in the transition and routine use groups. RESULTS On sliding gantry CT implementation, although time to CT remained unaffected in the transition group, it significantly reduced in the routine use group, independent of injury severity score. The incidence of cable management problems was significantly higher in the latter group. CONCLUSIONS We have demonstrated a decrease in the time to CT with the implementation of a sliding gantry CT. However, due to a higher number of cable management problems in the routine use group, we recommend regular refresher team training with routine use.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Matthias Meng
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Jan Philipp Schüttrumpf
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Otto R, Schirrmeister W, Walcher F, Drynda S. Length of Stay – ein guter
Qualitätsindikator? Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Drynda S, Otto R, Schirrmeister W, Walcher F. ENQuIRE- Evaluation von Qualitätsindikatoren in der
Notaufnahme – Ergebnisse und lessons learned. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lucas B, Hempel D, Otto R, Brenner F, Stier M, Marzi I, Breitkreutz R, Walcher F. Prehospital FAST reduces time to admission and operative treatment: a prospective, randomized, multicenter trial. Eur J Trauma Emerg Surg 2022; 48:2701-2708. [PMID: 34661691 PMCID: PMC9360060 DOI: 10.1007/s00068-021-01806-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The focused assessment with sonography in trauma (FAST) exam is an established trauma care diagnostic procedure. Ultrasound performed during prehospital care can improve early treatment and management of the patients. In this prospective randomized clinical trial, we wanted to assess whether a pre-hospital FAST (p-FAST) influences pre-hospital strategy and the time to operative treatment. METHODS We studied 296 trauma victims in a prehospital setting. Inclusion criteria were potential abdominal injuries identified either by clinical examination or suggested by the mechanism of injury. Physician-staffed helicopters and emergency ambulances were equipped with portable ultrasound devices. According to a scheme related to calendar weeks, a clinical exam only (CEX) or a clinical exam together with a p-FAST (CEX-p-FAST) was conducted. Outcome variables were prehospital diagnosis and strategy, the time to admission to the trauma room and to operation theater. The study was approved by the university ethical committee (REB#: 46/06). RESULTS CEX-p-FAST showed a high sensitivity (94.7%) and specificity (97.6%) in detection of free fluid compared to CEX-only (80.0%, 84.4%). The median time to admission was reduced significantly by 13 min and to operative treatment by 15 min after CEX-p-FAST. We observed a cross-over rate of 30.8% of p-FAST (n = 36) to CEX-p-FAST during the CEX-only weeks. CONCLUSION According to the experience of the principal investigators, CEX-p-FAST was superior to CEX-only. Despite the time needed for p-FAST, the relevant admission time was significantly shorter. Thus, p-FAST is recommended in addition to CEX if possible for decision-making in prehospital trauma care. TRIAL REGISTRATION German Clinical Trials Register #DRKS00022117-Registered 10 July 2020-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022117 .
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Dorothea Hempel
- Central Emergency with Admission Ward, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Emergency Department, Asklepios Klinik Wandsbek, Alphonsstr. 14, 22043, Hamburg, Germany
| | - Ronny Otto
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Franziska Brenner
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
- Department of Hand Surgery, Agaplesion Diakonieklinikum Hamburg Gemeinnützige GmbH, Hamburg, Germany
| | - Mario Stier
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Raoul Breitkreutz
- Institute for Health and Social (IfGS), FOM University of Economy and Management, Frankfurt Campus, Frankfurt, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
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Schmid L, Otto R, Walcher F, Drynda S. Patienteneinwilligung in der Notaufnahme – Ist ein
Selektionsbias vermeidbar? Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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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: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Ritter Z, Vogel S, Schultze F, Pischek-Koch K, Schirrmeister W, Walcher F, Röhrig R, Kesztyüs T, Krefting D, Blaschke S. Using Explainable Artificial Intelligence Models (ML) to Predict Suspected Diagnoses as Clinical Decision Support. Stud Health Technol Inform 2022; 294:573-574. [PMID: 35612150 DOI: 10.3233/shti220529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The complexity of emergency cases and the number of emergency patients have increased dramatically. Due to a reduced or even missing specialist medical staff in the emergency departments (EDs), medical knowledge is often used without professional supervision for the diagnosis. The result is a failure in diagnosis and treatment, even death in the worst case. Secondary: high expenditure of time and high costs. Using accurate patient data from the German national registry of the medical emergency departments (AKTIN-registry, Home - Notaufnahmeregister (aktin.org)), the most 20 frequent diagnoses were selected for creating explainable artificial intelligence (XAI) models as part of the ENSURE project (ENSURE (umg.eu)). 137.152 samples and 51 features (vital signs and symptoms) were analyzed. The XAI models achieved a mean area under the curve (AUC) one-vs-rest of 0.98 for logistic regression (LR) and 0.99 for the random forest (RF), and predictive accuracies of 0.927 (LR) and 0.99 (RF). Based on its grade of explainability and performance, the best model will be incorporated into a portable CDSS to improve diagnoses and outcomes of ED treatment and reduce cost. The CDSS will be tested in a clinical pilot study at EDs of selected hospitals in Germany.
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Affiliation(s)
- Zully Ritter
- Institute of Medical Informatics, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Stefan Vogel
- Institute of Medical Informatics, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Frank Schultze
- Central Emergency Department, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Kerstin Pischek-Koch
- Institute of Medical Informatics, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Aachen, Germany
| | - Rainer Röhrig
- AKTIN-Research Group, Germany.,Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Aachen, Germany
| | - Tibor Kesztyüs
- Institute of Medical Informatics, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Dagmar Krefting
- Institute of Medical Informatics, University Medicine Göttingen, Georg-August University, Göttingen, Germany
| | - Sabine Blaschke
- Central Emergency Department, University Medicine Göttingen, Georg-August University, Göttingen, Germany.,Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Aachen, Germany
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Rothhardt J, Piedmont S, Swart E, Robra BP, Branse D, Comos P, Grimaldi G, Walcher F, Goldhahn L. Integrierte Versorgung von Rettungsdienstpatienten. Konsentierte Empfehlungen für optimale Prozesse und Strukturen. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-00995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Zusammenfassung
Hintergrund
Das vom Innovationsfonds geförderte Projekt „Integrierte Notfallversorgung: Rettungsdienst im Fokus“ (Inno_RD) bringt anhand datenbasierter Analysen Handlungsempfehlungen zur Verbesserung der (Notfall‑)Versorgung in den Diskurs zum Gesetzentwurf zur Reformierung der Notfallversorgung ein.
Methoden
Die Handlungsempfehlungen (HE) basieren auf Analysen von drei Fokusgruppen mit Experten der Notfallversorgung, auf Rettungsdienst- und Krankenkassendaten und einer schriftlichen Patientenbefragung. Im Rahmen einer anschließenden Online-Befragung wurden 55 Aussagen (davon 35 HE und 20 vertiefende Statements) zwei getrennten Gruppen, d. h. den Fokusgruppenteilnehmern („purposive sampling“) und weiteren Experten der Notfallversorgung („convenience sample“ mit gesondertem Befragungslink) vorgelegt. Die Teilnehmer wurden gebeten, die Empfehlungen zu bewerten. 442 Fragebögen wurden für die Analyse berücksichtigt.
Ergebnisse
Alle 55 Aussagen wurden von beiden Gruppen mehrheitlich positiv bewertet (≥50 % Zustimmung), d. h. 19 Aussagen für den Bereich Leitstelle, 14 für Patientenversorger, 19 zur Dokumentation und Evaluation sowie drei HE, die die Bevölkerung adressieren. Vorschläge für die Leitstellen und die Dokumentation und Evaluation von Einsätzen wurden überwiegend mit starkem Konsens (>95 %) und Empfehlungen für den Bereich bevölkerungsbezogene HE und Patientenversorger mehrheitlich mit Konsens (>75–95 %) bewertet.
Schlussfolgerung
Die Aussagen fanden bei den an der Umfrage teilnehmenden Experten große Zustimmung. Die Empfehlungen sollten im Diskurs zur Organisation und Qualitätssicherung der Notfallversorgung berücksichtigt werden.
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Lucas B, Mathieu SC, Pliske G, Schirrmeister W, Kulla M, Walcher F. The impact of a qualified medical documentation assistant on trauma room management. Eur J Trauma Emerg Surg 2022; 48:689-696. [PMID: 33025169 PMCID: PMC8825361 DOI: 10.1007/s00068-020-01513-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To improve quality of trauma room management, intra- and inter-hospital benchmarking are important tools. However, primary data quality is crucial for benchmarking reliability. In this study, we analyzed the effect of a medical documentation assistant on documentation completeness in trauma room management in comparison to documentation by physicians involved in direct patient treatment. METHODS We included all patients treated in the trauma room from 2016/01/01 to 2016/12/31 that were documented with the trauma module of the German Emergency Department Medical Record V2015.1. We divided the data into documentation by medical documentation assistant (DA, 07:00 to 17:00), physician in daytime (PD, 07:00 to 17:00), and physician at night (PN, 17:00 to 07:00). Data were analyzed for completeness (primary outcome parameter) as well as diagnostic intervals. RESULTS There was a significant increase in complete recorded data for DA (74.5%; IQR 14.5%) compared to PD (26.9%; IQR 18.7%; p < 0.001) and PN (30.8%; IQR 18.9; p < 0.001). The time to whole-body computed tomography (WBCT) significantly decreased for DA (19 min; IQR 8.3) compared to PD (24 min; IQR 12.8; p = 0.007) or PN (24.5 min; IQR 10.0; p = 0.001). CONCLUSION In presence of a qualified medical documentation assistant, data completeness and time to WBCT improved significantly. Therefore, utilizing a professional DA in the trauma room appears beneficial for data quality and time management.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Sophie-Cecil Mathieu
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- Department of Orthopaedic Surgery, Otto-Von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Martin Kulla
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
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Wallstab F, Greiner F, Schirrmeister W, Wehrle M, Walcher F, Wrede C, Habbinga K, Behringer W, Brammen D. German emergency department measures in 2018: a status quo based on the Utstein reporting standard. BMC Emerg Med 2022; 22:5. [PMID: 35016633 PMCID: PMC8753932 DOI: 10.1186/s12873-021-00563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background Compelling data on clinical emergency medicine is required for healthcare system management. The aim of this survey was to describe the nationwide status quo of emergency care in Germany at the healthcare system level using the Utstein reporting template as the guideline to measure the data collected. Methods This cross-sectional survey collected standardized data from German EDs in 2018. All 759 of the EDs listed in a previously collected ED Directory were contacted in November 2019 using the online-survey tool SoSci Survey. Exclusively descriptive statistical analyses were performed. Absolute as well as relative frequencies, medians, means, ranges, standard deviations (SD) and interquartile ranges (IQR) were reported depending on distribution. Main Results A total of 150 questionnaires of contacted EDs were evaluated (response rate: 19.8%). Hospitals had a median of 403 inpatient beds (n=147). The EDs recorded a median of 30,000 patient contacts (n=136). Eighty-three EDs (55%) had observation units with a median of six beds. The special patient groups were pediatric patients (< 5 years) and older patients (> 75 years) with a median of 1.7% and 25%, respectively. Outpatients accounted for 55%, while 45% were admitted (intensive care unit 5.0%, standard care unit 32.3%, observation unit 6.3%) and 1.2% transferred to another hospital. Conclusions The use of the Utstein reporting template enabled the collection of ED descriptive parameters in Germany. The data can provide a baseline for upcoming reforms on German emergency medicine, and for international comparisons on admission rates, initial triage categories, and patient populations.
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Affiliation(s)
- Florian Wallstab
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Felix Greiner
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Markus Wehrle
- Department of Anesthesiology and Intensive Therapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Wrede
- Department of Emergency Medicine, Hospital Berlin-Buch, Berlin, Germany
| | - Kirsten Habbinga
- Department of Interdisciplinary Emergency Medicine, Pius-Hospital, Oldenburg, Germany
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Brammen
- Department of Anesthesiology and Intensive Therapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
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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] [What about the content of this article? (0)] [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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Marx G, Hoffmann F, Walcher F. [Overtreatment in intensive care medicine-important topics in a challenging time that need a sophisticated dialog]. Med Klin Intensivmed Notfmed 2021; 116:279-280. [PMID: 33956180 PMCID: PMC8100354 DOI: 10.1007/s00063-021-00822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/21/2022]
Affiliation(s)
- G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Lucas B, Riebau C, Mohr J, Pliske G, Walcher F, Piatek S. Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture - a randomized clinical trial. BMC Musculoskelet Disord 2021; 22:113. [PMID: 33499843 PMCID: PMC7836593 DOI: 10.1186/s12891-021-03983-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most common complications of hip arthroplasty is excessive blood loss that could necessitate allogenic blood transfusion, which is further associated with other complications, such as infections, transfusion reactions or immunomodulation. In gynecology, 4DryField®PH, an absorbable polysaccharide-based formulation, is used for hemostasis and adhesion prophylaxis. In this study, we evaluated its hemostatic effect in patients undergoing hip bipolar hemiarthroplasty following intracapsular femoral neck fracture. METHODS We studied 40 patients with intracapsular femoral neck fractures (Garden III or IV) admitted at our institution between July 2016 and November 2017. We included patients above 60 years with simple fracture and without pathologic fractures. Patients were randomized into intervention and control groups. The intervention group received 5 g of 4DryField® PH (subfascially and subcutaneously) during wound closure. Three drainages were inserted in a standardized manner (submuscular, subfascial, and subcutaneous) and drainage volume was measured immediately before extraction. Total blood loss was calculated using Mercuriali's formula and standard hemograms upon admission and five days after surgery. Volume of postoperative hematoma was measured using point-of-care ultrasound seven days after surgery. RESULTS Volume of the postoperative hematoma was reduced by 43.0 mL. However, significant reduction of total blood loss and drainage volume was not observed. CONCLUSIONS We observed that 4DryField® PH had a local hemostatic effect, thereby reducing volume of the postoperative hematoma. However, this reduction was small and had no effect on the total blood loss. Further studies are warranted to improve the application algorithm. TRIAL REGISTRATION DRKS, DRKS00017452 , Registered 11 June 2019 - Retrospectively registered.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany.
| | - Christian Riebau
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Juliane Mohr
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
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Brammen D, Greiner F, Kulla M, Otto R, Schirrmeister W, Thun S, Drösler SE, Pollmanns J, Semler SC, Lefering R, Thiemann VS, Majeed RW, Heitmann KU, Röhrig R, Walcher F. [AKTIN - The German Emergency Department Data Registry - real-time data from emergency medicine : Implementation and first results from 15 emergency departments with focus on Federal Joint Committee's guidelines on acuity assessment]. Med Klin Intensivmed Notfmed 2020; 117:24-33. [PMID: 33346852 PMCID: PMC7750913 DOI: 10.1007/s00063-020-00764-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/03/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022]
Abstract
Hintergrund Die Notfallversorgung befindet sich im Umbruch. In Notaufnahmen werden Patienten ausgehend von Symptomen und Dringlichkeit versorgt; dies bildet sich jedoch in den etablierten Routinedaten der gesetzlichen Sozialversicherung nicht ab. Ziel des AKTIN-Projekts war der Aufbau einer datenschutzkonformen Registerinfrastruktur zur Nutzung von klinischen Routinedaten aus Notaufnahmen. Methoden Über eine standardisierte Schnittstelle werden aus den verschiedenen Dokumentationssystemen kontinuierlich Daten der Notaufnahmebehandlung in ein lokales Data Warehouse exportiert. Dort stehen sie sowohl für lokale Nutzungen, wie interne Berichte und Qualitätsmanagement, als auch gleichzeitig datenschutzkonform für multizentrische Auswertungen zur Verfügung. Anhand der Registerpopulation wird die Ersteinschätzung sowie die Erhebung von Vitalparametern in Abhängigkeit von Vorstellungsgründen für einen 12-Monats-Zeitraum analysiert. Ergebnisse Für den Zeitraum 04/2018 bis 03/2019 wurden 436.149 gültige Fälle aus 15 Notaufnahmen übermittelt. In 86,0 % der Fälle ist eine Ersteinschätzung dokumentiert. Diese fand in 70,5 % innerhalb von 10 min nach Ankunft des Patienten statt. In 10 Kliniken wird regelhaft (82,3 %) ein Vorstellungsgrund erfasst. Die Erfassung von Vitalparametern variiert plausibel zwischen den Vorstellungsgründen. Schlussfolgerung Das AKTIN-Notaufnahmeregister bietet einen zeitnahen Einblick in das Versorgungsgeschehen der Notaufnahmen ohne zusätzlichen Dokumentationsaufwand und unabhängig vom primären IT-System, Kostenträger, Fallart und Abrechnungsmodus. Die Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung werden weitgehend umgesetzt. Durch die Etablierung von standardisierten Vorstellungsgründen werden symptombasierte Analysen und Gesundheitssurveillance ermöglicht. Zusatzmaterial online Die Onlineversion dieses Beitrags (10.1007/s00063-020-00764-2) enthält die Abb. S1 und S2. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- D Brammen
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
- Universitätsklinik für Anästhesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
| | - F Greiner
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - M Kulla
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - R Otto
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - W Schirrmeister
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - S Thun
- Competence Center eHealth, Hochschule Niederrhein, Krefeld, Deutschland
| | - S E Drösler
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Krefeld, Deutschland
| | - J Pollmanns
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Krefeld, Deutschland
| | - S C Semler
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
| | - R Lefering
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | - V S Thiemann
- Abteilung Medizinische Informatik, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - R W Majeed
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - K U Heitmann
- Heitmann Consulting and Services, Hürth, Deutschland
- hih - health innovation hub, Bundesministerium für Gesundheit, Berlin, Deutschland
| | - R Röhrig
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - F Walcher
- Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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Reinhold AK, Greiner F, Schirrmeister W, Walcher F, Erdmann B. [Even low-acuity patients prefer hospital-based emergency care : A survey of non-urgent patients in an emergency department with unique regional position]. Med Klin Intensivmed Notfmed 2020; 116:511-521. [PMID: 32291507 DOI: 10.1007/s00063-020-00681-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/10/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Besides increasing numbers of cases in German emergency departments (ED), the spectrum of attending patients is also changing. Patients with acute illnesses tend to prefer EDs to ambulatory care as primary contact point. This study examines the motives for use and use behavior of low-urgent ED-patients. METHODS Anonymous patient survey in the ED of Wolfsburg Hospital between 12/2015 and 03/2016 with descriptive analysis. All patients with low urgency (Manchester-Triage-System (MTS), levels blue and green) were eligible. RESULTS 81.5% of respondents (729 evaluable out of 7000 questionnaires distributed) attended the ED between 8:00 a. m. and 5:00 p. m., 70.1 % of them were walk-in patients. The motive most frequently cited was that they would receive better care in the ED (48.3 %). Contrary to acuity assessment, 67.8 % of respondents considered themselves a medium to life-threatening emergency. As alternative option, 49.2 % would choose a nearby clinic in the region for their complaints. CONCLUSION Self-assessed urgency differs with acuity assessment according to MTS. Patients who fear an acute threat to their health do not use services provided in the ambulatory sector such as the emergency practice of the Association of Statutory Health Insurance Physicians in the immediate proximity sufficiently. Previous approaches for patient navigation do not seem to be successful in this setting. Strengthening of EDs as a single 24/7 access point for emergency care with simultaneous abolition of parallel care structures should be discussed.
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Affiliation(s)
- A K Reinhold
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - F Greiner
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - W Schirrmeister
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - F Walcher
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - B Erdmann
- Zentrale Notfallaufnahme, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440, Wolfsburg, Deutschland.
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Witzel K, Ballaschk A, Altmann S, Haß HJ, Chiapponi C, Walcher F, Werwick K, Croner RS, Piatek S, Meyer F. [Magdeburg Medical School - Logbook for Surgical Training of Final Year Medical Students - an Interdisciplinary, Medical School-Specific Concept Based on the Guidelines Issued by the Medical School Association ("Medizinischer Fakultätentag") in 2012]. Zentralbl Chir 2020; 145:549-558. [PMID: 32268391 DOI: 10.1055/a-1084-4127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The final year is the last part of the study of human medicine and can be regarded as an essential period, during which medical knowledge should be consequently converted into medical expertise. Since the amendment of the medical license policy ("Ärztliche Approbationsordnung" [ÄApprO]) from July 17, 2012, in particular, since April 01, 2013, German universities have been obliged to provide a training schedule such as a "logbook" for this final year, specifically for the mandatory time periods within surgery and internal medicine. In preparation for this innovation, the German Medical School Association ("Medizinischer Fakultätentag") presented basic logbooks as consensus documents in June 2012. The portfolio for each surgery discipline and the Magdeburg Medical School, had been developed on the basis of individual initiatives and used for years, and was revised, specified and further developed into a "logbook of the medical study's final year" - specific for daily practice and the Magdeburg Medical School, and to the guidelines of the Medical School Association ("Medizinischer Fakultätentag"). The aim of the present commentary is i) to present the Magdeburg Medical School logbook and its clinical planning for cases, diagnoses and (surgical) interventions, as a summary of institutional experience and ii) to describe the mandatory surgical part of the "Magdeburg's final year of the study of human medicine". METHOD Narrative short overview including individual teaching experiences and topic-related references from "PubMed" using terms for literature search such as "surgical logbook", "practical year" and "medical teaching". The background and aims of the document's modifications are explained for each surgical discipline. RESULTS The "Logbook" is subdivided into 6 chapters: introduction, basics, statement of requirement, selected surgical diseases and interventions as well as information on final year-associated events and courses and instructions for creating the obligatory case report. CONCLUSION The presented "Magdeburg Medical School Final Year Logbook of the Surgical Disciplines" has been created according to the requirements of the German Medical School Association ("Medizinischer Fakultätentag") and has been simultaneously adapted to the conditions and established medical teaching at the presenting Medical School. In particular, the medical students are given a document related to daily clinical practice, which allows them, within an overall teaching concept, to acquire indispensable expertise.
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Affiliation(s)
- Katharina Witzel
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Anne Ballaschk
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Silke Altmann
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Hans-Jürgen Haß
- Bereich Kinderchirurgie, Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Costanza Chiapponi
- Klinik für Allgemein-, Viszeral- und onkologische Chirurgie, Uniklinik Köln, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Katrin Werwick
- Studiendekanat, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Roland S Croner
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
| | - Frank Meyer
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland
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von Winning D, Lippisch R, Pliske G, Adolf D, Walcher F, Piatek S. Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years. Foot Ankle Surg 2020; 26:71-77. [PMID: 30554933 DOI: 10.1016/j.fas.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/20/2018] [Accepted: 11/23/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND We retrospectively evaluated the mid-term results of surgery for talar process fractures (lateral and posterior processes) and exploratively analyzed parameters that potentially impact treatment outcomes. METHODS Fifteen patients who underwent internal fixation (January 2000 to December 2015) were examined for radiological and clinical functional outcomes. The independent parameters evaluated were age, sex, extent of general injury, soft-tissue damage, surgical latency, and fracture type. RESULTS All fractures healed completely. Three patients developed osteoarthritis. The American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Scale score was 79.5±18.6, the Functional Foot Index score was 31.1±31.4, and the physical and mental component summary scores of the Short Form 36, version 2, were 46.6±11.8 and 50.3±9.1, respectively. No influence on the above scores was determined. CONCLUSIONS The clinical outcomes of internal fixation of talar process fractures were good. Delayed surgical treatment (≥14days) did not significantly lead to poorer outcomes in our patients.
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Affiliation(s)
- Dominik von Winning
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany.
| | - Roland Lippisch
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Daniela Adolf
- Gesellschaft für klinische und Versorgungsforschung mbH, Halberstädter Str. 40a, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
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Sterz J, Adili F, Bender M, Dahmen U, Heinemann MK, Hofmann HS, König S, Obertacke U, Rüsseler M, Stefanescu C, Voß SH, Walcher F, Kadmon M. [National Learning Objectives Catalogue in Surgery - General Part Defining Competences of Medical School Graduates in Surgery]. Zentralbl Chir 2019; 144:573-579. [PMID: 31842239 DOI: 10.1055/a-1033-7769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Competency-based medical education is needed in order to meet the requirements of medical care currently and in the future. The basis of this are activity-based learning objectives that are merged in competency-based catalogues. A basis for a core curriculum of undergraduate medical training is the National Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). Already in 2013, for surgery, the competencies which medical students should have achieved after completing the practical year (PJ) in relation to surgical diseases were defined in the special part of the National Catalogue of Learning Objectives in Surgery (NKLC). In the now amended general part of the NKLC, interdisciplinary competencies were defined and consented from all surgical disciplines, that are relevant for all surgical disciplines and that all representatives from the different surgical disciplines should incorporate in their surgical training. The complete NKLC is now available for faculties, teachers and students for trial (available online: https://www.dgch.de/index.php?id=190&L=528). The guiding principle for the entire development process was to make sure that students gain all competencies they need when starting to work as a medical doctor and therefor to increase patient safety.
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Affiliation(s)
- Jasmina Sterz
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | - Farzin Adili
- Klinik für Gefäßmedizin-Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| | - Michael Bender
- Klinik für Innere Medizin 1, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Deutschland
| | - Uta Dahmen
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland
| | - Markus K Heinemann
- Klinik und Poliklinik für Herz-, Thorax und Gefäß-Chirurgie, Universitätsmedizin Mainz, Deutschland
| | | | - Sarah König
- Institut für Medizinische Lehre und Ausbildungsforschung, Universitätsklinikum Würzburg, Deutschland
| | - Udo Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Deutschland
| | - Miriam Rüsseler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | - Christina Stefanescu
- Klinik für Kinderchirurgie und Kinderurologie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | | | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Martina Kadmon
- Gründungsdekanat, Medizinische Fakultät der Universität Augsburg, Deutschland
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Lucas B, Schirrmeister W, Pliske G, Leenen M, Walcher F, Kopschina C. Existence and role of standard operating procedures in the emergency department : A national online survey. Med Klin Intensivmed Notfmed 2019; 116:50-55. [PMID: 31811310 DOI: 10.1007/s00063-019-00642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 10/01/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In recent years, increases in the number of patients in emergency departments (ED) have led to continuous work intensification. To handle this problem, the treatment effectiveness has to be maximized. One strategy that may help to optimize workflow is the use of standard operating procedures (SOPs). We investigated the existence of SOPs and subjective effects on treatment in German EDs. METHODS We performed an online survey from February 2015 until June 2016. We collected data regarding the existence of SOPs, health care level, medical field, work experience, and education. All professional groups participating in the treatment of patients were requested to take part in the survey. RESULTS Seventy-five percent of the 589 participants in the survey confirmed the existence of SOPs in their EDs. SOPs were more frequently available in hospitals with higher health care levels. Participants working in EDs without SOPs felt less confident regarding treatment of patients. More than 85% of these participants were in favor of having SOPs. The absence of SOPs was associated with a subjective delay in patient treatment. CONCLUSION Most of the EDs had available SOPs. In departments without SOPs, most physicians wanted them to be implemented. SOPs seemed adequate in terms of supporting workflow and satisfaction with patients' treatment.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany.
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Michael Leenen
- Emergency Department, Community Hospital Nettetal GmbH, Sassenfelder Kirchweg 1, 41334, Nettetal, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Carsten Kopschina
- Department of Trauma and Orthopaedic Surgery, Hospital Lauf a.d. Pegnitz, Krankenhäuser Nürnberger Land GmbH, Simonshofer Straße 55, 91207, Lauf an der Pegnitz, Germany
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Lucas B, Weidert S, Krause M, Rickert M, Walcher F, Reppenhagen S. OP-Simulationen, 3-D-Druck und Virtual Reality in der chirurgischen Weiterbildung. Z Orthop Unfall 2019; 157:622-625. [PMID: 31794992 DOI: 10.1055/a-1020-7736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Benjamin Lucas
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg
| | - Simon Weidert
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München
| | - Matthias Krause
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - Markus Rickert
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum Gießen und Marburg GmbH, Gießen
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg
| | - Stephan Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Julius-Maximilians-Universität Würzburg
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Greiner F, Slagman A, Stallmann C, March S, Pollmanns J, Dröge P, Günster C, Rosenbusch ML, Heuer J, Drösler SE, Walcher F, Brammen D. [Routine Data from Emergency Departments: Varying Documentation Standards, Billing Modalities and Data Custodians at an Identical Unit of Care]. Gesundheitswesen 2019; 82:S72-S82. [PMID: 31597189 PMCID: PMC7939518 DOI: 10.1055/a-0996-8371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hintergrund
Nicht nur im Kontext der Neuordnung der Notfallversorgung in
Deutschland besteht derzeit ein hoher Bedarf an Daten aus Notaufnahmen.
Für die Versorgungsforschung bieten sich Daten an, welche auf
gesetzlicher Grundlage generiert werden. Unterschiedliche Kostenträger
und Abrechnungsmodi stellen eigene Anforderungen an die Dokumentation dieser
Routinedaten.
Methodische Herausforderungen
Aufgrund der sektoralen Trennung gibt es
keinen Datensatz oder Datenhalter, der Auskunft über alle
Notaufnahmebehandlungen geben kann. Aus administrativer Sicht gilt die gesamte
Notaufnahmebehandlung als ambulant oder stationär, tatsächlich
wird die Entscheidung darüber erst während der Versorgung
getroffen. Für die stationäre Versorgung existiert ein
administratives Notfallkennzeichen, allerdings kein direktes Merkmal für
Notaufnahmebehandlungen. Bei Abrechnung ambulanter Fälle über
die kassenärztlichen Vereinigungen ist mindestens eine Diagnose
(ICD-10-Kode) zu erfassen, versehen mit einem Kennzeichen zur
Diagnosesicherheit. Es können mehrere ICD-10-Kodes ohne Hierarchie
angegeben werden. Bei stationär behandelten Patienten ist eine
Aufnahmediagnose und nach Behandlungsende die Hauptdiagnose und ggf.
Nebendiagose(n) an die zuständige Krankenkasse zu übermitteln.
Die gesetzliche Unfallversicherung hat eigene Dokumentationsanforderungen.
Lösungsansätze
Je nach Forschungsfrage und Studiendesign
sind unterschiedliche Vorgehensweisen erforderlich. Stammen die Daten
unmittelbar aus Notaufnahmen bzw. Kliniken ist eine Information über den
Kostenträger und den Abrechnungsmodus hilfreich. Bei Nutzung von
Krankenkassendaten muss die Identifikation von stationär behandelten
Patienten in einer Notaufnahme aktuell indirekt erfolgen. Dazu können
unter anderem die Parameter Aufnahmegrund und definierte
„eindeutige“ Notfall-Diagnosen herangezogen werden. Die
fallpauschalenbezogene Krankenhausstatistik hat eigene Limitationen,
enthält dafür aber die stationären Fälle aller
Kostenträger.
Diskussion
Die divergierenden Anforderungen an die administrative
Dokumentation verursachen einen hohen Aufwand in den Kliniken. Perspektivisch
ist eine Vereinheitlichung der Leistungserfassung und Dokumentation von
Notfallbehandlungen aller Kostenarten auch zur Generierung von validen,
vergleichbaren und repräsentativen Daten für die
Versorgungsforschung erstrebenswert. Die Einführung eines eigenen
Fachabteilungsschlüssels würde zur Identifikation von
Notaufnahmebehandlungen beitragen.
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Affiliation(s)
- Felix Greiner
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Anna Slagman
- Notfall- und Akutmedizin (CVK, CCM), Charité - Universitätsmedizin Berlin, Berlin.,Australian Institute of Tropical Health and Medicine, Cairns, James Cook University, Australia
| | - Christoph Stallmann
- Medizinische Fakultät, Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Stefanie March
- Medizinische Fakultät, Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | | | - Patrik Dröge
- Wissenschaftliches Institut der AOK (WIdO), Qualitäts- und Versorgungsforschung, Berlin
| | - Christian Günster
- Wissenschaftliches Institut der AOK (WIdO), Qualitäts- und Versorgungsforschung, Berlin
| | | | - Joachim Heuer
- Zentralinstitut für die kassenärztliche Versorgung in Deutschland, Berlin
| | | | - Felix Walcher
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Dominik Brammen
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg.,Medizinische Fakultät, Universitätsklinik für Anästhesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Magdeburg
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Hossfeld B, Lechner R, Josse F, Bernhard M, Walcher F, Helm M, Kulla M. [Prehospital application of tourniquets for life-threatening extremity hemorrhage : Systematic review of literature]. Unfallchirurg 2019; 121:516-529. [PMID: 29797031 DOI: 10.1007/s00113-018-0510-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The effectiveness of a tourniquet in the case of life-threatening hemorrhages of the extremities is well recognized and led to the recommendations on "Tourniquet" of the German Society of Anaesthesiology and Intensive Care (DGAI) in 2016. The aim of this systematic review was to re-evaluate the current medical literature in relation to the published DGAI recommendations. MATERIAL AND METHODS Based on the analysis of all studies published from January 2015 until January 2018 in the PubMed databases, the publicized recommendations for action on "Tourniquet" of the DGAI were critically re-evaluated. For this purpose, 17 questions on 6 subjects were formulated in advance. The systematic review followed the PRISMA recommendations and is registered in PROSPERO (International prospective register of systematic reviews, Reg.-ID: CRD42018091528). RESULTS Of the 284 studies identified with the keywords tourniquet and trauma in the period from January 2015 to January 2018 in PubMed, 50 original papers discussing the prehospital application of tourniquet for life-threatening hemorrhage of the extremities were included. The overall level of evidence is low. No article addressed any of the formulated questions with a prospective randomized interventional study. Scientific deductions could be found only in an indirect way in a descriptive manner. CONCLUSION The 50 original articles included in this qualitative, systematic review revealed that the recommendations "Tourniquet" of the DGAI published in 2016 are mostly still up to date despite an inhomogeneous study situation. A deviation occurred in the conversion of a tourniquet but due to the short prehospital treatment time in the civilian setting this is of little importance; however, in the future a strict distinction should be made between tourniquets which were placed for tactical reasons and those placed as a medical necessity.
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Affiliation(s)
- B Hossfeld
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.,Arbeitsgruppe "Taktische Medizin", Arbeitskreises Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland.,Tactical Rescue and Emergency Medicine Association (TREMA e. V.), Tübingen, Deutschland
| | - R Lechner
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.,Tactical Rescue and Emergency Medicine Association (TREMA e. V.), Tübingen, Deutschland
| | - F Josse
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.,Arbeitsgruppe "Taktische Medizin", Arbeitskreises Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland.,Tactical Rescue and Emergency Medicine Association (TREMA e. V.), Tübingen, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.,Arbeitsgruppe "Trauma- und Schockraummanagement", Arbeitskreis Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland
| | - F Walcher
- Universitätsklinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland.,Sektion Notfall‑, Intensivmedizin und Schwerverletztenversorgung (NIS), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berlin, Deutschland
| | - M Helm
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.,Arbeitsgruppe "Taktische Medizin", Arbeitskreises Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland
| | - M Kulla
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland. .,Arbeitsgruppe "Taktische Medizin", Arbeitskreises Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland. .,Sektion Notfall‑, Intensivmedizin und Schwerverletztenversorgung (NIS), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berlin, Deutschland.
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Otto R, Schirrmeister W, Majeed RW, Greiner F, Lucas B, Röhrig R, Walcher F, Brammen D. Implementation of Emergency Department Performance Benchmarking Using R and LaTeX. Stud Health Technol Inform 2019; 267:238-246. [PMID: 31483278 DOI: 10.3233/shti190833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The German Emergency Department Data Registry (GEDD-registry, AKTIN) provides an infrastructure for collecting and querying up-to-date medical records in a distributed manner. Within this framework, a benchmark report on cross-institutional comparison using the program R is prepared using routine data of participating hospitals. Currently, 16 emergency departments (EDs) routinely transfer data of 1,200 to approximately 5,000 patients per month to a federated GEDD-registry datawarehouse. Using various packages in the R environment, hospitals receive a monthly visual report on their data among all participating hospitals. Graphical representations are implemented using column diagrams and box plots. Reports currently contain 25 tables and 40 graphs. Benchmark reports are created in R-Studio and exported using Portable Document Format, PDF. Quarterly expert meetings with the heads of participating EDs are currently performed for further improvements. Preparation of external benchmarking reports with R enables a detailed data presentation for participating hospitals and ED managers.
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Affiliation(s)
| | | | - Raphael W Majeed
- Division of Medical Informatics, University of Oldenburg, Germany.,Institute of Medical Informatics, University Hospital RWTH Aachen, Germany
| | | | | | - Rainer Röhrig
- Division of Medical Informatics, University of Oldenburg, Germany.,Institute of Medical Informatics, University Hospital RWTH Aachen, Germany
| | | | - Dominik Brammen
- Department of Trauma Surgery.,Department of Anesthesiology, Otto von Guericke University, Magdeburg, Germany
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Lucas B, Schladitz P, Schirrmeister W, Pliske G, Walcher F, Kulla M, Brammen D. The way from pen and paper to electronic documentation in a German emergency department. BMC Health Serv Res 2019; 19:558. [PMID: 31399096 PMCID: PMC6688333 DOI: 10.1186/s12913-019-4400-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 08/05/2019] [Indexed: 11/12/2022] Open
Abstract
Background Some of the advantages of implementing electronic emergency department information systems (EDIS) are improvements in data availability and simplification of statistical evaluations of emergency department (ED) treatments. However, for multi-center evaluations, standardized documentation is necessary. The AKTIN project (“National Emergency Department Register: Improvement of Health Services Research in Acute Medicine in Germany”) has used the “German Emergency Department Medical Record” (GEDMR) published by the German Interdisciplinary Association of Intensive and Emergency Care as the documentation standard for its national data registry. Methods Until March 2016 the documentation standard in ED was the pen-and-paper version of the GEDMR. In April 2016 we implemented the GEDMR in a timeline-based EDIS. Related to this, we compared the availability of structured treatment information of traumatological patients between pen-and-paper-based and electronic documentation, with special focus on the treatment time. Results All 796 data fields of the 6 modules (basic data, severe trauma, patient surveillance, anesthesia, council, neurology) were adapted for use with the existing EDIS configuration by a physician working regularly in the ED. Electronic implementation increased availability of structured anamnesis and treatment information. However, treatment time was increased in electronic documentation both immediately (2:12 ± 0:04 h; n = 2907) and 6 months after implementation (2:18 ± 0:03 h; n = 4778) compared to the pen-and-paper group (1:43 ± 0:02 h; n = 2523; p < 0.001). Conclusions We successfully implemented standardized documentation in an EDIS. The availability of structured treatment information was improved, but treatment time was also increased. Thus, further work is necessary to improve input time.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany.
| | - Peter Schladitz
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Martin Kulla
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Dominik Brammen
- Department of Anaesthesiology and Intensive Care, Otto-von-Guericke University Magdeburg, D-39120, Magdeburg, Germany
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Grimaldi G, Beerlage I, Hinzmann D, Wieprich D, Walcher F. [Not Available]. Z Orthop Unfall 2019; 157:240-242. [PMID: 31189212 DOI: 10.1055/a-0874-6639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Grimaldi G, Beerlage I, Hinzmann D, Wieprich D, Walcher F. [Not Available]. Z Orthop Unfall 2019; 157:e2. [PMID: 31311040 DOI: 10.1055/a-0966-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Weinlich M, Martus P, Blau MB, Wyen H, Walcher F, Piatek S, Schüttrumpf JP. Competitive advantage gained from the use of helicopter emergency medical services (HEMS) for trauma patients: Evaluation of 1724 patients. Injury 2019; 50:1028-1035. [PMID: 30591228 DOI: 10.1016/j.injury.2018.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of the study was to analyze helicopter emergency medical service (HEMS) in comparison to EMS, in respect to patient's mortality and morbidity. DESIGN From a cohort of traumatized patients (n = 1724) prospectively enrolled in the German trauma registry (DGU-R) at Frankfurt University Hospital from 2009 to 2013, 1646 could be analyzed for in-hospital mortality and short-term outcome (GOS) at discharge and compared between HEMS and EMS. MEASUREMENTS AND MAIN RESULTS 129 patients (7.8%) died in the hospital. Unadjusted mortality was significantly lower in the HEMS group compared to EMS (p = 0.001). In a multiple logistic regression analysis after adjustment of variables including reanimation and age as the strongest predictors, in-hospital mortality was significantly reduced in HEMS (p = 0.014, OR = 0.21). Further predictors in the multiple logistic regression analysis were GCS > = 8 (p = 0.001), RRsys (p < 0.001), ISS at Head/Neck > = 3 (p = 0.003), and total ISS > = 9 (p < 0.001). Total rescue time and on scene time were associated with mortality (p < 0.001) but not included in the multiple logistic regression model. Without adjustment, short-term outcome (GOS) was significantly improved (p = 0.014). In a linear model, after adjusting for multiple variables including age, ISS Head/Neck > = 3, ISS Extremities > = 3, GCS > = 8, and RRsys as the strongest predictors (p < 0.001), the association remained significant (p = 0.043). Further predictors in the multiple linear regression analysis were total ISS > = 9 (p = 0.002), ISS abdomen (p = 0.001), and ISS Chest (p = 0.011). CONCLUSIONS A significant improvement for in-hospital survival for HEMS could be demonstrated. Especially in Germany, with a high number of secondary call outs (about 44%) after EMS has already reached the traumatized patient, HEMS must be the first choice for severely injured trauma patients. Dispatch criteria for immediate alarm of HEMS are recommended under practical considerations.
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Affiliation(s)
- M Weinlich
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - P Martus
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - M B Blau
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - H Wyen
- University of Frankfurt, Dept. of Traumatology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - F Walcher
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - S Piatek
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - J P Schüttrumpf
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
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Sterz J, Bender B, Linßen S, Stefanescu MC, Höfer SH, Walcher F, Voss J, Seifert LB, Ruesseler M. Effects and Consequences of Being an OSCE Examiner in Surgery-A Qualitative Study. J Surg Educ 2019; 76:433-439. [PMID: 30213735 DOI: 10.1016/j.jsurg.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/30/2018] [Accepted: 08/04/2018] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Even though objective structured clinical examination (OSCE) is a well-investigated format for competency-based practical examination, only a few studies have explored the motivations of OSCE examiners and their opinions, both positive and negative, toward being an examiner. The aim of this study was to gain insights into the views of OSCE examiners using semi-structured interviews. DESIGN Surgical OSCE examiners were queried at two medical faculties in Germany via semi-structured interviews. The interviews were transcribed verbatim and analyzed using the techniques of structured qualitative content analysis. SETTING This study was conducted at the medical faculties of the Goethe University, Frankfurt, Germany and of the Otto-von-Guericke University, Magdeburg, Germany. PARTICIPANTS All of the study participants were surgeons working at the university hospital of one of the faculties. RESULTS A total of 29 examiners were queried until a saturation of content was achieved. A critical reflection of one's own teaching was described as a major benefit by most participants. Furthermore, they noted that the standards and competences examined during the OSCE boosted the detail of their teaching sessions in the wards. However, the examiners criticized missed operations due the examination and were not appreciated by superiors for being an examiner. Most of the examiners (22/29) preferred to be an examiner themselves rather than appointing student peer examiners. If they had appointed someone else, that would mean they would miss valuable experiences useful for their own teaching. CONCLUSIONS Being an OSCE examiner confers several advantages, notably the reflection of one's own teaching, which was described as highly valuable by the examiners.
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Affiliation(s)
- Jasmina Sterz
- University Hospital Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt, Germany.
| | - Bernd Bender
- University Hospital Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt, Germany.
| | - Svea Linßen
- University Hospital Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt, Germany.
| | - Maria-Christina Stefanescu
- University Hospital Frankfurt, Department of Pediatric Surgery and Pediatric Urology, Frankfurt, Germany.
| | - Sebastian Herbert Höfer
- University Hospital Frankfurt, Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt, Germany.
| | - Felix Walcher
- University Hospital Magdeburg, Department of Trauma Surgery, Magdeburg, Germany.
| | - Julia Voss
- University Hospital Magdeburg, Department of Trauma Surgery, Magdeburg, Germany.
| | - Lukas Benedikt Seifert
- University Hospital Frankfurt, Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Frankfurt, Germany.
| | - Miriam Ruesseler
- University Hospital Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt, Germany.
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Lucas B, Wiegand S, Jahn O, Greiner F, Walcher F, Piatek S. [Patient Motivation to Participate in Medical Education]. Zentralbl Chir 2019; 145:481-486. [PMID: 30808049 DOI: 10.1055/a-0820-5959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Student education focuses increasingly on case-related teaching. Often the consent of the patient to participate in student education is supposed to be provided. In most instances this is taken for granted - which it is not. Here, we investigated the motivation of the patients to participate in student education and influence factors using an anonymised survey. MATERIAL AND METHODS The survey was performed from 2017/01/01 until 2017/04/30 and recruited inpatients of a university department of trauma surgery. The questionnaire contained 10 multiple choice questions targeting socio-demographic factors and the motivation of the patients to participate in different aspects of medical education. This was captured using a 5-point Likert scale. The electronic analysis of the questionnaire was performed with the program KLAUS (Blubbsoft GmbH, Berlin, Germany) after digitalizing the data. RESULTS In total 162 questionnaires were analysed. The patients were generally highly motivated to participate in bedside teaching and a student examination as well as consenting to the collection of pictures, videos and X-ray images or subsequent contact. Patient satisfaction was a principle factor. There was a positive correlation between the satisfaction with the motivation to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact. There was significantly decreased motivation for participation in a lecture. In comparison, male patients had greater motivation to participate in a lecture. Moreover 40- to 49-year-old patients were significantly less motivated to participate in a lecture than 20- to 29-year-old and 50- to 59-year-old patients. Patient satisfaction had no influence on motivation to participate in a lecture. CONCLUSION The motivation of the patients to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact correlated with patient satisfaction. Socio-demographic factors are less important. Patient motivation to participate in a lecture is lower regardless of patient satisfaction.
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Affiliation(s)
- Benjamin Lucas
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Stefan Wiegand
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Oliver Jahn
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Felix Greiner
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Felix Walcher
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
| | - Stefan Piatek
- Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg
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König S, Stieger P, Sippel S, Kadmon M, Werwick K, Sterz J, Hoefer SH, Rüsseler M, Walcher F, Adili F. Train-the-Trainer: Professionalisierung der Lehre im klinischen Alltag – Selbsteinschätzung Lehrender zur didaktischen Kompetenz und den Rahmenbedingungen des Unterrichts. Zentralbl Chir 2019; 144:551-559. [DOI: 10.1055/a-0824-7666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Zusammenfassung
Hintergrund Didaktiktrainings tragen zur Verbesserung der Qualität der medizinischen Lehre bei. In einem Kurs des Train-the-Trainer-Konzepts (TTT-Konzepts) der Chirurgischen Arbeitsgemeinschaft Lehre (CAL) wurden dabei Lehrende (TN) verschiedener Professionen und Karrierestufen gemeinsam unterrichtet.
Ziel der Arbeit Einschätzungen zur eigenen Lehrtätigkeit im klinischen Alltag durch verschiedene Gruppen, wie assistenzärztliches (AÄ), oberärztliches Personal (OÄ) und Pflegende (KP), deren Wahrnehmung von Erschwernissen und Artikulation von Wünschen zur Lehrverbesserung.
Material und Methoden Vor Kursbeginn wurden biografische Daten, didaktische Vorerfahrungen, Lehrhindernisse sowie Wünsche zur Lehrverbesserung erfragt. Nach Abschluss wurden die TN gebeten, den Kurs zu bewerten. Die Antworten zu den geschlossenen und offenen Fragen wurden quantitativ und qualitativ ausgewertet.
Ergebnisse Von 2014 bis 2017 wurden 6 Basiskurse (TTT-A) an 3 Standorten durchgeführt. 97 TN nahmen an den Befragungen teil (AÄ n = 44, OÄ n = 19, KP n = 17). Mehr als ⅔ verfügten bereits über didaktische Vorkenntnisse. Zwischen ärztlichen und pflegerischen Berufsgruppen fanden sich hierbei keine signifikanten Unterschiede. Während AÄ und KP primär am Krankenbett unterrichteten, lehrten OÄ überwiegend im Rahmen von Vorlesungen, Wahlfächern und Seminaren. Für die Lehre im klinischen Alltag fühlte sich nur ein geringer Anteil aus allen Berufsgruppen gut vorbereitet. Als Haupterschwernisse wurden Zeit- und Personalmangel, eine zu hohe Anzahl von Studierenden und zu geringe eigene didaktische Vorkenntnisse angegeben. Fast ⅔ der AÄ empfanden die studentische Lehre als starke oder moderate Belastung, gegenüber ca. 50% der OÄ und 60% KP. Als Wünsche zur Lehrverbesserung wurden differenziertere Vorgaben zu Inhalt und Aufbau der Lehrveranstaltungen, eine höhere Wertschätzung der Lehre insgesamt sowie die regelmäßige didaktische Qualifizierung der Lehrenden genannt.
Diskussion Berufsgruppenbedingte Unterschiede im klinischen Alltag und individueller Karrierefortschritt üben einen Einfluss auf Art, Umsetzung und Wahrnehmung der Lehrtätigkeit aus. Durch Fokussierung auf Lernziele und wesentliche für den Unterricht am Krankenbett relevante Lehr- und Prüfungsformate können Dozententrainingsprogramme berufsgruppenübergreifend zum Wissens- und Kompetenzzuwachs beitragen. Hinweise auf einen nachhaltigen Effekt ermutigen zur Fortsetzung und Weiterentwicklung des TTT-Konzepts.
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Affiliation(s)
- Sarah König
- Institut für Medizinische Lehre und Ausbildungsforschung, Universitätsklinikum Würzburg, Deutschland
| | - Philipp Stieger
- Institut für Medizinische Lehre und Ausbildungsforschung, Universitätsklinikum Würzburg, Deutschland
| | - Sonia Sippel
- Institut für Medizinische Lehre und Ausbildungsforschung, Universitätsklinikum Würzburg, Deutschland
| | - Martina Kadmon
- Gründungsdekanat, Medizinische Fakultät der Universität Augsburg, Deutschland
| | - Katrin Werwick
- Studiendekanat, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Jasmina Sterz
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Deutschland
| | - Sebastian H. Hoefer
- Klinik für Mund-, Kiefer- und plastische Gesichtschirurgie, Universitätsklinikum Frankfurt, Deutschland
| | - Miriam Rüsseler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Farzin Adili
- Klinik für Gefäßmedizin, Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
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Lucas B, Brammen D, Schirrmeister W, Aleyt J, Kulla M, Röhrig R, Walcher F. [Requirements for a sustainable standardization and digitalization in clinical emergency and acute medicine]. Unfallchirurg 2019; 122:243-246. [PMID: 30666344 DOI: 10.1007/s00113-019-0603-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Digitalization and standardization of documentation in medicine are increasingly progressing. In the decision of the Federal Joint Committee (G-BA) for a staged system of emergency structures in hospitals and in the report of the expert committee for development in the healthcare system on needs-oriented guidance of healthcare, the actuality of the topic is underlined with concrete naming of future tasks. The section on emergency admission protocols of the German Interdisciplinary Association of Intensive and Emergency Care Medicine (DIVI) has been working for years on this topic and has repeatedly reported on the progress of the topic in clinical emergency care. Standardization and digitalization represent the foundation for health services research spread across locations as well as the possibility for benchmarking. Digitalization makes the secondary use of primary clinical routine data possible. Digitalization decreases redundancies of data transmission by avoiding manual data input in, for example registers.
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Affiliation(s)
- Benjamin Lucas
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
| | - Dominik Brammen
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
| | - Wiebke Schirrmeister
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
| | - Jacob Aleyt
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Charlottenstraße 42/Ecke Dorotheenstraße, 10117, Berlin, Deutschland
| | - Martin Kulla
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Rainer Röhrig
- Abteilung Medizinische Informatik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, 26111, Oldenburg, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Walcher F, Marzi I, Bühren V. The impact of liver preservation in HTK and UW solution on microcirculation after liver transplantation. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marzi I, Walcher F, Bühren V. Improvement of liver preservation by the calcium channel blocker nisoldipine. An experimental study applying intravital microscopy to transplanted rat livers. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Weinlich M, Kurz P, Blau MB, Walcher F, Piatek S. Significant acceleration of emergency response using smartphone geolocation data and a worldwide emergency call support system. PLoS One 2018; 13:e0196336. [PMID: 29791450 PMCID: PMC5965832 DOI: 10.1371/journal.pone.0196336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/11/2018] [Indexed: 11/18/2022] Open
Abstract
Importance When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours. Objectives A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS). Design To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured. Results GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay. Conclusions and relevance The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.
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Affiliation(s)
- Michael Weinlich
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
- * E-mail:
| | - Peter Kurz
- Hospital am Steinenberg Reutlingen, teaching facility affiliated with the University of Tübingen, Department of Trauma Surgery, Reutlingen, Germany
| | | | - Felix Walcher
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
| | - Stefan Piatek
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
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