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Gräff I, Pin M, Ehlers P, Schacher S, Hossfeld B, Strametz R, Matthes G, Gries A, Seidel M. Der Übergabeprozess in der zentralen Notaufnahme – Konsentierung von Inhalten im Rahmen eines Delphi-Verfahrens. Notf Rett Med 2023. [DOI: 10.1007/s10049-023-01130-3] [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: 03/17/2023]
Abstract
Zusammenfassung
Hintergrund und Ziel der Arbeit
Für die Übergabe in der Notaufnahme – der Nahtstelle von prähospitaler zu klinischer Versorgung – stellen Merkhilfen („mnemonics“) das „Rückgrat“ für eine strukturierte Übermittlung von relevanten Informationen dar. In Deutschland existiert bis zum heutigen Tag keine Standardisierung bzw. konkrete Vorgabe, welche Merkhilfe zur Übergabe genutzt werden soll. Die vorliegende Untersuchung definiert erstmalig anhand eines strukturierten und mehrstufigen Konsentierungsprozesses (Delphi-Verfahren) von Experten (Mandatsträgern), welche Übergabeinhalte für erforderlich gehalten werden. Ziel dabei ist die Schaffung einer Grundlage zur Entwicklung einer bundeseinheitlichen Merkhilfe.
Methodik
Durchgeführt wurde ein Delphi-Verfahren, welches sich an den Regularien der Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften e. V. (AWMF) orientiert.
Ergebnisse
Im Rahmen des durchgeführten Delphi-Verfahrens konnte neben konkreten Inhalten der Merkhilfe auch deren Reihenfolge festgelegt werden. Übergabeinhalte wurden zu den Punkten Crew Resource Management (CRM) und Patientenidentifikation, Beschreibung der Notfallsituation, Notfallpriorität (ABCDE-Schema) und Vitalparameter, durchgeführte Maßnahmen, Anamnese, Zusammenfassung mit der Möglichkeit für Rückfragen durch das übernehmende Team sowie Zeitdauer definiert.
Diskussion
Die Ergebnisse der Arbeit bilden die evidenzbasierte Grundlage für die Entwicklung einer konkreten Merkhilfe („mnemonic“). Weitere Untersuchungen sollten sich nach Entwicklung einer geeigneten Merkhilfe darauf fokussieren, diese im Rahmen einer (prä-)klinischen Anwendungsstudie auf Praxistauglichkeit zu testen. Gleichzeitig sollte ein entsprechendes Schulungskonzept ausgearbeitet werden. Langfristig wird als Ziel eine bundesweit einheitliche Einführung angestrebt.
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Gräff I, Pin M, Ehlers P, Seidel M, Hossfeld B, Dietz-Wittstock M, Rossi R, Gries A, Ramshorn-Zimmer A, Reifferscheid F, Reinhold T, Band H, Kuhl KH, König MK, Kasberger J, Löb R, Krings R, Schäfer S, Wienen IM, Strametz R, Wedler K, Mach C, Werner D, Schacher S. Empfehlungen zum strukturierten Übergabeprozess in der zentralen Notaufnahme. Notf Rett Med 2022. [DOI: 10.1007/s10049-020-00810-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Rygiel K, Fimmers R, Schacher S, Dormann H, Gräff I. [Erratum to: Older emergency patients in the emergency department : A key performance indicator analysis based on the DIVI emergency department protocol]. Med Klin Intensivmed Notfmed 2019; 115:237-238. [PMID: 31463673 DOI: 10.1007/s00063-019-00614-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- K Rygiel
- Interdisziplinäres Notfallzentrum, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - R Fimmers
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - S Schacher
- Zentrale Notaufnahme, Evangelisches Krankenhaus Köln Kalk, Köln, Deutschland
| | - H Dormann
- Zentrale Notaufnahme, Klinikum Fürth, Fürth, Deutschland
| | - I Gräff
- Interdisziplinäres Notfallzentrum, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Gräff I, Dolscheid-Pommerich RC, Ghamari S, Baehner T, Goost H. [Neglected, lonely and sick - the social breakdown : A special patient group in the emergency department]. Med Klin Intensivmed Notfmed 2017; 113:418-425. [PMID: 28589296 DOI: 10.1007/s00063-017-0311-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/13/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The emergency department (ED) is increasingly becoming the primary care unit of patients who are no longer able to meet the necessary minimum requirements for a healthy life. In the emergency medical care of these patients, fixation errors and stereotyped thinking can distract from serious illnesses, which can be tended by emergency medicine. This group of patients, with their multifactorial problems, represents a special challenge for the staff of the ED. The aim of this study is to improve the quality of the care for a special patient group. MATERIALS AND METHODS A monocentric retrospective observation study was conducted at the University Hospital Bonn (UKB). On the basis of case studies, the emergency medical care of this special patient group was examined in the ED. RESULTS Over the period of 7 years (2009 to 2016), 17 patients in a state of total neglect could be examined. The endpoints identified, during the emergency care, are the therapy of life-threatening diseases, laboratory pathologies, introduction of infectious protective measures, initiation of diagnostic measures, measures to be initiated within different departments (operating room, intensive care unit) and outcome. CONCLUSION Patients in a state of total neglect require interdisciplinary primary care at a hospital with extended care structures. The apparent primary impression of these patients must not lead to a fixation error. Due to the often not obtainable history of the patient's and the complex appearance of these patients, the evaluation should be carried out according to a defined algorithm in the emergency room.
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Affiliation(s)
- I Gräff
- Interdisziplinäres Notfallzentrum, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
| | - R C Dolscheid-Pommerich
- Institut für Klinische Chemie und Klinische Pharmakologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - S Ghamari
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - T Baehner
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Goost
- Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Wermelskirchen, Wermelskirchen, Deutschland
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Gräff I, Schütte N, Seinsch P, Glien P, Pröbstl A, Kaschull K. Etablierung einer klinischen Krisenintervention. Notf Rett Med 2017. [DOI: 10.1007/s10049-016-0248-4] [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: 10/20/2022]
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Abstract
Acute medical care in hospital emergency departments has experienced rapid development in recent years and gained increasing importance not only from a professional medical point of view but also from an economic and health policy perspective. The present article therefore provides an update on the situation of emergency departments in Germany. Care in emergency departments is provided with an increasing tendency to patients of all ages presenting with varying primary symptoms, complaints, illnesses and injury patterns. In the process, patients reach the emergency department by various routes and structural provision. Cross-sectional communication and cooperation, prioritization and organization of emergency management and especially medical staff qualifications increasingly play a decisive role in this process. The range of necessary knowledge and skills far exceeds the scope of prehospital medical emergency care and the working environment differs substantially. In addition to existing structural and economic problems, the latest developments, as well as future proposals for the design of in-hospital emergency medical care in interdisciplinary emergency departments are described.
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Affiliation(s)
- M Zimmermann
- Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
| | - J C Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - I Gräff
- Notfallzentrum, Universitätsklinikum Bonn, Bonn, Deutschland
| | - B Kumle
- Zentrale Notaufnahme, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Deutschland
| | - P Wilke
- Zentrale Notaufnahme, Klinikum Frankfurt/Oder, Frankfurt/Oder, Deutschland
| | - A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Gräff I, Lenkeit S. [Hospital-based acute care of emergency patients: the importance of interdisciplinary teamwork]. Med Klin Intensivmed Notfmed 2014; 109:479-84. [PMID: 25330872 DOI: 10.1007/s00063-013-0344-x] [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] [Received: 06/30/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The care of emergency patients with life-threatening injuries or diseases presents a special challenge to the treatment team. Good interdisciplinary cooperation is essential for fast, priority-oriented, and efficient emergency room management. Particularly in complex situations, such as trauma room care, so-called human factors largely determine the safety and performance of the individual as well as the team. Approximately 70 % of all adverse events stem from human factors rather than from a lack of medical expertise. It has been shown that 70-80 % of such incidents are preventable through special training. OBJECTIVES Established course concepts based on so-called ABCDE schemes are a good basis for creating algorithms for targeted therapy, yet they are not sufficient for the training of team-specific issues. For this, special course concepts are required, such as crew resource management, which is provided through simulator-based training scenarios. This includes task management, teamwork, decision-making, and communication. The knowledge of what needs to be done in a team under the adverse and complex conditions of a medical emergency must be gained by training based on realistic and effective measures. CONCLUSION Course concepts that are geared toward interdisciplinary and interprofessional team training optimize patient safety and care by supporting the nontechnical abilities of team members.
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Affiliation(s)
- I Gräff
- Interdisziplinäres Notfallzentrum , Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland,
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Lenkeit S, Ringelstein K, Gräff I, Schewe JC. Medizinische Notfallteams im Krankenhaus. Med Klin Intensivmed Notfmed 2014; 109:257-66. [DOI: 10.1007/s00063-014-0369-9] [Citation(s) in RCA: 10] [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] [Received: 03/10/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
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van Bremen T, Glien A, Gräff I, Gerstner A, Schröck A. [Interdisciplinary emergency departments : first experiences from the ENT and head and neck perspective]. HNO 2013. [PMID: 23202861 DOI: 10.1007/s00106-012-2634-7] [Citation(s) in RCA: 3] [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: 11/30/2022]
Abstract
BACKGROUND Centralized emergency departments are becoming a major source of health care in Germany. In this study, we evaluated the importance for ENT health care. METHODS In a retrospective study, all ENT emergency patients between May and July 2011 were characterized by diagnosis, therapy, and urgency (measured using the Manchester Triage System [MTS]). General epidemiological data from the emergency department were recorded between 2009 and 2011. RESULTS Between 2009 and 2011, 50,699 patients were treated in the centralized emergency department of the University Hospital Bonn. A total of 15,658 (30.8%) needed ENT health care. During May 2011 to July 2011, ENT emergency patients had not only a wide variety of diseases but also a broad range of ages (0-98 years). Using the MTS, emergency patients (4% acute emergencies) were identified and urgency was determined prior to first contact with the physician. CONCLUSION ENT emergency care plays an important role for centralized emergency departments. Most of the patients have ENT diseases treatable as an outpatient in a single visit. MTS can be used to determine the appropriate level of urgency.
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Affiliation(s)
- T van Bremen
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Abstract
Facial impalement in childhood is very rare. In most cases, it is caused by accident. We present two young patients who suffered a facial impalement injury and were treated in the interdisciplinary emergency room of the University Hospital Bonn, Germany. The degree of injury could not be completely determined during the first examination. Serious complications could be excluded after examination via computed tomography (CT) and surgical exploration. The indication to use CT or magnetic resonance imaging in childhood has to be considered in order to obtain full and exact information about the extent of injury.
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Affiliation(s)
- U Sell
- Klinik für Hals-Nasen-Ohrenerkrankungen/Chirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland
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Gräff I, Wittmann M, Dahmen A, Goldschmidt B, Tenzer D, Glien P, Drehsen L, Link N, Hoeft A, Baumgarten G. Prozessoptimierung im interdisziplinären Notfallzentrum. Notf Rett Med 2011. [DOI: 10.1007/s10049-010-1286-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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