Comprehensive Wound Center am Universitätsklinikum Hamburg-Eppendorf

Comprehensive treatment of patients with chronic wounds requires a multidisciplinary team of healthcare professionals. In January 2010 the Comprehensive Wound Center was established at the University Clinic of Hamburg-Eppendorf. The main objective is an interdisciplinary healthcare provision for patients with chronic wounds taking patient needs into consideration. In addition to a close collaboration of different healthcare professionals, the department offers inpatient as well as outpatient evidence-based care. Given the excellent cooperation between the outpatient care providers and the nursing services, a multidiscipline wound care management can be guaranteed at any time. In addition the Comprehensive Wound Center focuses on clinical research, basic research and health services research. This holistic approach of wound care management aims at competent, patient-oriented wound treatment and contributes to new research results and insights into evidence-based medicine.     

Elzacher Notfalltag für Medizinstudierende der Universität Freiburg

The department of anaesthesiology and critical care medicine of the University Hospital Freiburg organized the first Elzacher emergency day for medical students of the Albert-Ludwigs-University Freiburg in cooperation with the Elzacher Fire Department and the German Red Cross (DRK) society Emmendingen. The medical students had the unique opportunity to practice medical care for trauma patients in realistic scenarios in team work with other occupational groups as a common care team. By means of application of standardized patients, a patient simulator, and integration of the professional rescue organizations with personnel, equipment, and vehicles, a realistic picture of true emergency situations could be created. Simultaneously, the students became acquainted with the work and equipment of the fire department and the emergency medical service. Because of the positive resonance of all parties involved, the Elzacher emergency day will become an integral part of the curriculum “emergency medicine” at the University Hospital Freiburg.     

Analyse und Möglichkeiten der Optimierung von Prämedikationsgesprächen an einem Universitätsklinikum

Die Anaesthesiologie - Das Prämedikationsgespräch als Risikoevaluation vor einem operativen Eingriff ist ein wichtiges Element der perioperativen Betreuung. Bisher liegen wenige Arbeiten...     

Organisationsmodelle der präklinischen Notfallmedizin

When comparing the well-established model of the functional organization structure with the model of the process-orientated organization structure, problems are perceived in the effective coordination of all system partners. A lack of communication, documentation and feedback, a large number of unnecessary emergency missions with physicians and undue costs in some areas of the system have a negative effect on motivation, efficient teamwork and satisfaction of staff and patients. Therefore, a restructuring of out-of-hospital emergency medicine towards a process-orientated approach to organization is highly recommended in the context of quality management.     

Universitäres Benchmarking

Lump sum reimbursement and the resulting concentration of medical treatment in maximum care clinics have led to substantial increase in economic pressure on university hospitals. Nearly all hospitals have introduced business ratios to economically judge each department. In order to evaluate the validity and comparability the business ratios of seven university traumatology departments were evaluated. Structural data as well as cost calculation results in different cost groups were evaluated. Major differences could be identified despite the fact that the cost calculations were all based on the same method (InEK method). In particular the costs for distribution to other medical specialties such as radiology or anesthesiology differed widely. Costs for infrastructure also showed a great variation. Differences in efficiency cannot be the only cause for these discrepancies and lacking standardization of cost calculation methodology is also another major cause. All the business ratios analyzed must be looked at critically and unless a thoroughly standardized methodology of cost calculation is implemented, cost ratios will have a limited potential for hospital benchmarking.     

Die Aufklärungspflicht in der Notfallmedizin

Physicians and other health care providers are obliged to obtain informed consent from patients before starting medical treatment. This is valid for preclinical and clinical emergency medicine and must be carried out by personal dialogue. Even correct and indicated medical measures can lead to medical compensation claims because a patient cannot give consent without prior proper information. Under Austrian law there is no definition of the extent of the required medical information and has to be defined in each case individually. In doing so the health care provider has to take into account the patient’s intellectual ability, medical knowledge, mental condition and in particular, the urgency of the situation. Information may be condensed or even skipped altogether. only if immediate treatment is necessary and any delay would pose a serious threat to the patient’s life. This should only occur in exceptional cases, which can be well justified and must be well documented, in the same way as therapeutic informed consent.     

Sepsis in der prähospitalen Notfallmedizin

Notfall + Rettungsmedizin - Die Sepsis ist eine notfallmedizinische Herausforderung – denn diese lebensbedrohliche Organdysfunktion, verursacht durch eine dysregulierte Wirtsantwort...     

Kontinuierliche Qualitätsverbesserung in der präklinischen Notfallmedizin

In this article the first implementation step of a quality management (QM) model for continuous quality improvement (CQI), in particular the PDCA cycle, by using the example of the Medical University Innsbruck emergency department and the Austrian Red Cross, Freiwillige Rettung (Voluntary Rescue) Innsbruck (FRI) is described. Using two questionnaires concerning personnel satisfaction main problem areas were identified and improvements suggested. The results serve to discuss whether the two organizations involved fulfil the necessary conditions for the QM approach of CQI.     

Vorsorgedokumente in der präklinischen Notfallmedizin

Background

The handling of advance directives (AD) in prehospital emergency treatment in Germany is characterized by instability. In the project “Advance directives in preclinical emergency medical aid” (“Patientenverfügungen in der präklinischen Notfallmedizin”) the frequency and quality of ADs in emergency situations was investigated.

Aim

The aim of this study was to fill the gaps in research and to collate data on how consideration of the self-determination of patients in emergency situations can be optimized.

Material and methods

Over a period of 12 months from December 2007 to December 2008 a questionnaire was included in the emergency documentation of the medical emergency service in Aachen. Emergency patients were asked by emergency physicians to provide an AD and the quantitative as well as qualitative features of these ADs were examined. Furthermore, the study recorded what kinds of problems occurred with ADs in emergency situations and what measures were needed to correct this deficiency. The reactions of patients were documented on a numeral rating scale with a score of 1 reflecting a negative and 10 reflecting a positive reaction. In the 12-month period emergency doctors recorded 1,321 missions and after application of the exclusion criteria (e.g. missing signature, incomplete documentation and late delivery) 1,047 documented questionnaires were available for the analysis.

Results

A total of 127 out of 1,047 emergency patients provided an AD, 44 had a durable power of attorney and 27 had appointed a legal representative for healthcare. Of the emergency patients 20 had a legal attendant and 43 out of the 127 ADs could be presented to the emergency team during the emergency mission. The emergency team often encountered difficulties regarding the handling of the ADs due to the time factor and unclear wording. The latter included the following problems: misleading formulation (19.1?%), difficulty with the complexity (14.9?%) and contradicting information (4?%). Only 29 (61.7?%) of the durable powers of attorney were signed and legally binding. From the view of the emergency physicians the following information was lacking but would be helpful in emergency situations: emergency plan, hierarchy of those given power of attorney, knowledge of risks regarding ADs and medication requirements.

Conclusion

The results show that for an AD to apply in an emergency situation certain standards are necessary that assure the practicability, especially if a patient does not wish to be resuscitated. Most difficulties with ADs occurred with imprecise formulation, text length and inconsistency of statements. The following instructions were usually missing: hierarchy of those given power of attorney and specification on medication, information about the scope of the ADs, statement about resuscitation, extent and limitations of the desired treatment, especially with patients certified as terminally ill and instructions on who should decide about medical treatment in a conflict situation. A so-called emergency instruction which gives on a single page the patient’s statement on resuscitation would have been very helpful in individual cases. The results suggest that patients may need more information and education about AD to guarantee patients rights and self-determination.     

Pädiatrische Notfälle in der präklinischen Notfallmedizin

BACKGROUND: The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed.PATIENTS AND METHODS: In a 3-year study period, a total of 9,274 pediatric emergencies covered by the ADAC air rescue service are compared to 4,344 pediatric patients of ground ambulance services in Saarland.RESULTS: In aeromedical services pediatric emergencies are more frequent (12.9% vs. 6.4%), trauma predominates (59.9% vs. 35.6%) and severe injuries or diseases occur more frequently (30.5% vs. 15.0%). In both groups pediatric emergency cases are concentrated into very few diagnostic groups: more than one third of the cases involving pre-school children is due to convulsions. Respiratory diseases and intoxication are the next most frequent causes and are more common in ground ambulance patients. Head trauma is the most common diagnosis in cases of pediatric trauma, followed by musculoskeletal and thoracoabdominal trauma. All types of severe trauma are more frequent in pediatric patients of the aeromedical services.CONCLUSIONS: Training of emergency physicians should include pediatric life support and specific information about frequent pediatric emergency situations. For emergency physicians in aeromedical services, an intensive training in pediatric trauma life support is also necessary.