ABSTRACT: FragestellungFehler und ihre Folgen spielen in der Medizin eine immer größere Rolle. Gerade in der Intensivmedizin zeigt sich die Anfälligkeit
für Fehler im Vergleich zu anderen medizinischen Bereichen deutlich erhöht. Das Fehlerspektrum imponiert vielfältig, eine
Rolle spielen dabei Informationsverluste. Vor diesem Hintergrund führten wir ein Qualitätsmanagementprojekt mit dem Ziel der
Evaluation der ärztlichen Übergabe auf der Intensivstation durch.
MethodikWir analysierten die Übergabe einer internistischen 12 Betten Intensivstation an einem Universitätsklinikum. Die Auswertung
erfolgte anhand einer Fragebogenaktion der Assistenzärzte sowie einer Videodokumentation zunächst während eines Dreischichtsystems
mit 3 ärztlichen Übergaben pro 24 Stunden. Die Analyse wurde nach Umstellung auf ein Zweischichtsystem mit 2 Übergaben pro
24 Stunden ein Jahr später wiederholt.
Ergebnisse60 Minuten wurden als zeitlicher Rahmen für ausreichend erachtet. Die Übergabe sollte im Patientenzimmer bzw. je nach zu übergebender
Information vor diesem stattfinden und die Pflege sollte beteiligt sein. Wesentliche Informationsverluste wurden nicht bemerkt.
Als eher nachrangig wurden bei der Informationsübermittlung die Übergabe von sozialem Kontext und die Nachvollziehbarkeit
von Änderungen erachtet. Störungen der Übergabe wurden häufig beobachtet. Eine Kombination mit Visiten erschien nicht sinnvoll.
FolgerungenDie Übergabe folgte keinem definiertem Konzept. Wesentliche Informationsverluste konnten dennoch nicht beobachtet werden.
Weitere Untersuchungen zur Optimierung des Ablaufs der ärztlichen Übergabe sind wünschenswert.
IntroductionIn medicine and especially in intensive care, errors lead to significant consequences especially due to the limited time and
resources environment. The range of errors is wide, but a major portion is referred to “information loss” or “information
degrading”. Therefore, we conducted a quality assurance audit to evaluate medical shift changes in the intensive care unit.
MethodsWe analyzed the doctor’s shift change and sharing of information in a medical 12-bed ICU in a university hospital. The questionnaire
was given to the physicians and a video documentation of the actual shift change was recorded. We compared the results of
the audit before and after a switch from an 8-hour shift to a 12-hour shift a year later.
ResultsA 60-minute shift change (for an average of 10 patients) was regarded sufficient. The sharing of information should be performed
at the bed side or in front of the room/slot. Critical loss of information was not noted in this evaluation. Passing on social
context information and the rationale for therapy changes were not regarded as important. We observed many disruptions during
the shift change; combining the shift change with a regular ward round was not regarded useful.
ConsequencesShift changes in our institution are not conducted in a straightforward fashion. Loss of critical information was not observed.
More detailed investigations to optimize medical shift changes are warranted.
Intensivmedizin + Notfallmedizin 04/2012; 46(3):151-157.
ABSTRACT: The progression of acute pancreatitis to necrotizing pancreatitis which often results in high morbidity and mortality is difficult to predict. Here we report that serum concentrations of sCD137 are increased in patients with acute pancreatitis. Admission levels and 10-day median sCD137 levels positively correlate with markers of biliary pancreatitis and the 10-day sCD137 median is significantly higher in metabolic than in alcoholic pancreatitis. Serum concentrations of sCD137 at time of admission and the 10-day median of sCD137 correlate with the Ranson and APACHE II disease scores but not with the radiological Balthazar and Schroeder scores that reflect pancreatic and peripancreatic necrosis. Further, sCD137 levels correlate with the probability of complications and lethality. The association of sCD137, a product of activated T cells, with the severity of acute pancreatitis suggests that T cells contribute to the pathogenesis of acute pancreatitis.
Experimental and Molecular Pathology 09/2011; 92(1):1-6. · 2.42 Impact Factor
ABSTRACT: Adipocytes of peripancreatic and intrapancreatic adipose tissue secret adipocytokines such as leptin, adiponectin, and resistin. For resistin, a role as an early predictor of peripancreatic necrosis and clinical severity in acute pancreatitis has been reported. It was the aim of this study to investigate whether the adipocytokine visfatin is able to serve as an early marker predicting peripancreatic necrosis and clinical severity.
A total of 50 patients (20 females and 30 males) with acute pancreatitis were included in this noninterventional, prospective, and monocentric cohort study on diagnostic accuracy. Clinical severity was classified by the Ranson score and APACHE-II (Acute Physiology and Chronic Health Evaluation II) score. Pancreatic and peripancreatic necrosis were quantified by the computed tomography-based Balthazar score, the Schroeder score, and the pancreatic necrosis score. Visfatin was measured at admission and daily for 10 days by enzyme-linked immunosorbent assay (ELISA).
Visfatin values were significantly and positively correlated with clinical severity (APACHE-II score and Ranson score) and with clinical end points such as death and need for interventions. Admission visfatin levels were significantly elevated in patients with higher pancreatic and extrapancreatic necrosis scores. It was shown by receiver operator characteristics that admission visfatin concentration provides a positive predictive value of 93.3% in predicting the extent of peripancreatic necrosis (area under the curve (AUC): 0.89, P<0.001, sensitivity: 93.3%, specificity: 81.8%, likelihood ratio: 5.1, post-test probability: 93%) by using a cutoff value of 1.8 ng/ml.
Admission visfatin concentration serves as an early predictive marker of peripancreatic necrosis and clinical severity in acute pancreatitis. Visfatin may have potential for clinical use as a new and diagnostic serum marker.
The American Journal of Gastroenterology 01/2011; 106(5):957-67. · 7.28 Impact Factor
ABSTRACT: Peripancreatic necrosis determines clinical severity in acute pancreatitis. Early markers predicting peripancreatic necrosis and clinical severity are lacking. Because adipocytes of peripancreatic adipose tissue secret highly active adipocytokines, the aim of the study was to investigate whether adipocytokines are able to serve as early markers predicting peripancreatic necrosis and clinical severity.
A total of 50 patients (20 women, 30 men) with acute pancreatitis were included in this noninterventional, prospective, and monocentric cohort study on diagnostic accuracy. Clinical severity was classified by the Ranson score and the APACHE (Acute Physiology And Chronic Health Evaluation) II score. Pancreatic and peripancreatic necrosis were quantified by using the computed tomography-based Balthazar score, the Schroeder score, and the pancreatic necrosis score. Adiponectin, leptin, and resistin were measured at admission and daily for at least 10 days by enzyme-linked immunosorbent assay.
In contrast to admission C-reactive protein values, admission resistin values were significantly correlated with clinical severity and even with clinical end points such as death and need for interventions. Admission resistin levels were significantly elevated in patients with higher pancreatic and extrapancreatic necrosis scores. It was shown by receiver-operator characteristics that admission resistin concentration provides a positive predictive value of 89% in predicting the extent of peripancreatic necrosis (area under the curve, 0.8; P=0.002; sensitivity, 80%; specificity, 70%) by using a cutoff value of 11.9 ng/ml.
Admission resistin concentration serves as an early predictive marker of peripancreatic necrosis and clinical severity in acute pancreatitis. Resistin may have potential for clinical use as a new and diagnostic serum marker.
The American Journal of Gastroenterology 11/2010; 105(11):2474-84. · 7.28 Impact Factor
ABSTRACT: Close monitoring of arterial blood pressure (BP) is a central part of cardiovascular surveillance of patients at risk for hypotension. Therefore, patients undergoing diagnostic and therapeutic procedures with the use of sedating agents are monitored by discontinuous non-invasive BP measurement (NIBP). Continuous non-invasive BP monitoring based on vascular unloading technique (CNAP, CN Systems, Graz) may improve patient safety in those settings. We investigated if this new technique improved monitoring of patients undergoing interventional endoscopy.
40 patients undergoing interventional endoscopy between April and December 2007 were prospectively studied with CNAP(R) in addition to standard monitoring (NIBP, ECG and oxygen saturation). All monitoring values were extracted from the surveillance network at one-second intervals, and clinical parameters were documented. The variance of CNAP values were calculated for every interval between two NIBP measurements.
2660 minutes of monitoring were recorded (mean 60.1+/-34.4 min/patient). All patients were analgosedated with midazolam and pethidine, and 24/40 had propofol infusion (mean 90.9+/-70.3 mg). The mean arterial pressure for CNAP was 102.4+/-21.2 mmHg and 106.8+/-24.8 mmHg for NIBP. Based on the first NIBP value in an interval between two NIBP measurements, BP values determined by CNAP showed a maximum increase of 30.8+/-21.7% and a maximum decrease of 22.4+/-28.3% (mean of all intervals).
Conventional intermittent blood pressure monitoring of patients receiving sedating agents failed to detect fast changes in BP. The new technique CNAP improved the detection of rapid BP changes, and may contribute to a better patient safety for those undergoing interventional procedures.
International journal of medical sciences 02/2009; 6(1):37-42. · 2.24 Impact Factor
ABSTRACT: The long-term outcome of patients requiring cardiopulmonary resuscitation depends heavily on swift and appropriate care. The aim of this study was to obtain data on the composition and training of resuscitation teams in specialist departments for internal medicine and anesthesiology.
Between October 2006 and February 2007, 440 questionnaires were sent to departments for anesthesiology and internal medicine in Germany (hospitals with more than 300 beds) and to university hospitals in Switzerland and Austria.
The response rate was 38%. Of 166 participating hospitals, 152 have an emergency team. Resuscitation training (RT) takes place in 111 hospitals. Ninety-two hospitals (55%) hold a course more than once a year. Of those hospitals with RT, 86% use a simulation dummy, 77% conduct theoretical tutorials, and 65% follow a fixed algorithm.
The majority of hospitals that participated in this survey have an emergency team in place and organize resuscitation training for their medical personnel. The training varies greatly, however, in frequency, size of group, and qualification of the trainer. Implementation of standardized training for and management of in-hospital resuscitation measures might further hone staff skills and therefore improve the long-term outcome for the patients concerned.
02/2009; 106(5):65-70. · 2.92 Impact Factor