H Siebert

Deutsche Gesellschaft für Unfallchirurgie, Germany

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Publications (91)43.62 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Following the establishment of the first trauma networks in 2009 an almost nationwide certification could be achieved. Despite the impressive number of 46 certified networks, little is known about the actual improvements and the satisfaction of the participating hospitals.
    Der Unfallchirurg 08/2014; · 0.64 Impact Factor
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    ABSTRACT: In Deutschland werden Patienten mit einen Schenkelhalsbruch noch in einem zu hohen Anteil verzögert operiert. So wurden im Jahr 2008 15,4% der Patienten mit einer Verzögerung von >48 h nach der Aufnahme operiert. Dies führt vermehrt zu chirurgischen und allgemeinen Komplikationen sowie Dekubitalulzera.Mögliche Gründe, die zu einer verzögerten Operation führen, werden in einer bundesweiten Studie untersucht.Anhand der bundesweiten Daten der externen stationären Qualitätssicherung aus dem Jahr 2008 werden die Gründe für die >48 h nach Krankenhausaufnahme durchgeführten Operationen explorativ untersucht und der gemeinsame Einfluss mittels eines multiplen logistischen Regressionsmodells analysiert.Häufiger verzögert operiert werden Patienten, die am Freitag oder Samstag stationär aufgenommen werden, Patienten mit höherer ASA-Klassifikation, Männer, Patienten mit malignen Erkrankungen in der Vorgeschichte, bei Vorliegen einer Infektionskrankheit und herzkranke Patienten. Häufiger innerhalb der ersten 48 h operiert wird bei verschobenen Frakturen, bei Hypertonie oder im Falle einer ebenfalls vorliegenden psychischen Erkrankung. Die Fallzahl pro Krankenhaus hat keinen durchgängigen Einfluss auf den Operationszeitpunkt. Während in der Woche kein signifikanter Unterschied zwischen den Fachabteilungen feststellbar ist, werden Patienten mit Aufnahmetag Freitag oder Samstag in der Allgemeinen Chirurgie häufiger verzögert operiert als in Fachabteilungen der Unfallchirurgie oder Orthopädie.Es liegen medizinische und nicht medizinische Gründe für eine verzögerte Operation bei Schenkelhalsfraktur vor. Durch Studien ist belegt, dass eine verzögerte Operation bei Schenkelhalsfraktur den Patienten schadet. Organisatorische Gründe, die eine umgehende Operation z. B bei Aufnahme am Freitag oder Samstag verhindern, sollten daher durch Verbesserungen der Krankenhausorganisation und der Personalausstattung beseitigt werden. Hierzu kommen Maßnahmen einzelner Krankenhäuser oder eine Zusammenarbeit mehrerer Krankenhäuser in Frage. Ziel sollte es sein, eine flächendeckende und zeitnahe Versorgung auf höchstem Niveau auch am Wochenende zu gewährleisten.
    Der Unfallchirurg 01/2014; 117(2). · 0.64 Impact Factor
  • P C Strohm, H Siebert
    Der Unfallchirurg 10/2013; 116(10):870-871. · 0.64 Impact Factor
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    ABSTRACT: The TraumaNetwork DGU® (TNW) connects hospitals with different capacities for the treatment of severely injured patients who work together as superregional (STC), regional (RTC) and local trauma centres (LTC). The standards of treatment and equipment are defined on the basis of current guidelines as published in the"White book of the Treatment of Severely Injured Patients". An external audit process evaluates the organisation and structure of participating hospitals as well as the cooperation of the trauma centres within a regional TNW. In May 2013 a total of 618 hospitals were visited and assessed according to the White book and 39 fully certified regional TNWs covered around 85% of the area of Germany. Treatment quality in the certified TCs was analyzed on the basis of 25,249 severely injured patients in the TraumaRegister DGU® (2008-2011) and significant differences between the expected and observed mortality rates were found. These differences were most obvious in superregional and regional trauma centres. The TraumaNetwork represents an innovative, cooperative project for successfully improving the treatment of severely injured patients.
    Der Chirurg 08/2013; · 0.52 Impact Factor
  • Der Unfallchirurg 08/2013; 116(8):760-6. · 0.64 Impact Factor
  • H Siebert, P Biberthaler
    Der Unfallchirurg 06/2013; · 0.64 Impact Factor
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    ABSTRACT: BACKGROUND: Due to the heterogeneity of severely injured patients (multiple trauma) it is difficult to assign them to homogeneic diagnosis-related groups (DRG). In recent years this has led to a systematic underfunding in the German reimbursement system (G-DRG) for cases of multiply injured patients. This project aimed to improve the reimbursement by modifying the case allocation algorithms of multiply injured patients within the G-DRG system. METHODS: A retrospective analysis of standardized G-DRG data according to §21 of the Hospital Reimbursement Act (§ 21 KHEntgG) including case-related cost data from 3,362 critically injured patients from 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals was carried out. For 1,241 cases complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of multiply injured patients within the G-DRG system. Analysis of coding and grouping, performance of case allocation and the homogeneity of costs in the G-DRG versions 2008-2012 was carried out. RESULTS: The results showed systematic underfunding of trauma patients in the G-DRG version 2008 but adequate cost covering in the majority of cases with the G-DRG versions 2011 and 2012. Cost coverage was foundfor multiply injured patients from the clinical viewpoint who were identified as multiple trauma by the G-DRG system. Some of the overfunded trauma patients had high intensive care costs. Also there was underfunding for multiple injured patients not identified as such in the G-DRG system. CONCLUSIONS: Specific modifications of the G-DRG allocation structures could increase the appropriateness of reimbursement of multiply injured patients. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical specialist societies.
    Der Chirurg 03/2013; · 0.52 Impact Factor
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    ABSTRACT: PROBLEM: In Germany a disproportionate number of patients with a femoral neck fracture still experience a delay in surgery. In 2008 delays of more than 48 h after admission occurred for 15.4 % of patients. This leads to increases in surgical and general complications as well as pressure sores. OBJECTIVE: Possible reasons that lead to delayed operations were investigated in a nationwide study. DATA AND METHODS: Using nationwide data from the German inpatient external quality assurance program from the year 2008 the reasons for performing operations later than 48 h after hospital admission were examined both exploratory and analytically using a multiple logistic regression model considering combined effects. RESULTS: Surgery was more frequently delayed for patients who were admitted to hospital on Friday or Saturday, patients with a higher American Society of Anesthesiologists (ASA) classification, men, patients with malignant diseases, in the presence of infectious diseases and patients with heart disease. Operations carried out within the first 48 h were more frequent with displaced fractures and in the presence of hypertension or mental illness. The volume per hospital had no consistent effect on the time delay of surgery. During the week no significant differences between the departments were detected. On Friday or Saturday surgery was delayed more often when patients were admitted to a department of general surgery than to a department of trauma surgery or orthopedics. CONCLUSIONS: There are medical and non-medical reasons for delayed surgery of femoral neck fractures. Studies have confirmed that delayed surgery for femoral neck fracture harms the patients. Organizational reasons which prevent an immediate operation, e.g. admission on Friday or Saturday, should therefore be eliminated by improvements in hospital organization and staffing. These can be measures of individual hospitals or of several hospitals in cooperation. The target should be to ensure a comprehensive and timely provision of the highest quality care even at the weekend.
    Der Unfallchirurg 01/2013; · 0.64 Impact Factor
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    ABSTRACT: Mehrfachverletzte Patienten und Polytraumen lassen sich aufgrund ihrer Heterogenität im deutschen DRG-System nur schwer als kostenhomogene Gruppen pauschalieren. In der Vergangenheit war es zu einer systematischen Unterdeckung der Finanzierung im G-DRG-System bei der Schwerverletztenbehandlung gekommen. Ziel dieses Projektes ist es, durch Anpassungsvorschläge für das Fallpauschalensystem eine sachgerechtere Erlössituation zu erreichen.Die DRG-Abrechnungsdaten gemäß § 21 Krankenhausentgeltgesetz sowie fallbezogener Kostendaten gemäß InEK-Kalkulation von 3362 Schwerverletzten aus 2007 und 2008 aus 10 Universitätskliniken und 7 kommunalen Großkliniken wurden retrospektiv analysiert. Für 1241 Fälle lagen ergänzende klinische Informationen des TraumaRegisters®DGU vor. Es wurde eine Gruppierung in den G-DRG-Systemversionen 2008 bis 2012 und eine Analyse der Leistungs- und Kostenhomogenität vorgenommen.In der G-DRG-Version 2008 lag eine systematische Unterfinanzierung von Schwerverletzten vor, in den G-DRG-Versionen 2011 und 2012 bestand dagegen eine nahezu kostendeckende Vergütung. Kostendeckend finanziert werden Fälle, die auch im G-DRG-System als Schwerverletzte erkannt werden. Langzeitbeatmete Fälle werden z. T. deutlich überfinanziert. Aber auch eine relevante Unterfinanzierung für klinisch Schwerverletzte, die im G-DRG-System nicht als solche identifiziert werden, existierte im Untersuchungszeitraum.Die aus dem Projekt entwickelten Anpassungsvorschläge, die in die G-DRG-Systeme 2011 und 2012 übernommen wurden, konnten die Sachgerechtigkeit der Abbildung von Schwerverletzten deutlich erhöhen und die Erlössituation optimieren. Fallbezogene, datenbasierte Analysen sind eine wesentliche Voraussetzung einer konstruktiven Weiterentwicklung des G-DRG-Systems und ein wesentliches Instrument der aktiven Beteiligung medizinischer Fachgesellschaften.
    Der Chirurg 01/2013; 84(11). · 0.52 Impact Factor
  • P.C. Strohm, H. Siebert
    Der Unfallchirurg 01/2013; 116(10). · 0.64 Impact Factor
  • S Ruchholtz, H Siebert
    Der Unfallchirurg 07/2012; 115(7):662. · 0.64 Impact Factor
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    ABSTRACT: Orthopedics and trauma surgery are subject to continuous medical advancement. The correct and performance-based case allocation by German diagnosis-related groups (G-DRG) is a major challenge. This article analyzes and assesses current developments in orthopedics and trauma surgery in the areas of coding of diagnoses and medical procedures and the development of the 2012 G-DRG system. The relevant diagnoses, medical procedures and G-DRGs in the versions 2011 and 2012 were analyzed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes were made for the International Classification of Diseases (ICD) coding of complex cases with medical complications, the procedure coding for spinal surgery and for hand and foot surgery. The G-DRG structures were modified for endoprosthetic surgery on ankle, shoulder and elbow joints. The definition of modular structured endoprostheses was clarified. The G-DRG system for orthopedic and trauma surgery appears to be largely consolidated. The current phase of the evolution of the G-DRG system is primarily aimed at developing most exact descriptions and definitions of the content and mutual delimitation of operation and procedures coding (OPS). This is an essential prerequisite for a correct and performance-based case allocation in the G-DRG system.
    Der Unfallchirurg 07/2012; 115(7):656-62. · 0.64 Impact Factor
  • S Ruchholtz, H Siebert
    Der Unfallchirurg 04/2012; 115(5):465. · 0.64 Impact Factor
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    ABSTRACT: Critically injured patients are a very heterogeneous group, medically and economically. Their treatment is a major challenge for both the medical care and the appropriate financial reimbursement. Systematic underfunding can have a significant impact on the quality of patient care. In 2009 the German Trauma Society and the DRG-Research Group of the University Hospital Muenster initialised a DRG evaluation project to analyse the validity of case allocation of critically injured patients within the German DRG system versions 2008 and 2011 with additional consideration of clinical data from the trauma registry of the German Trauma Society. Severe deficits within the G-DRG structure were identified and specific solutions were designed and realised.A retrospective analysis was undertaken of standardised G-DRG data (§ 21 KHEntgG) including case-related cost data from 3 362 critically injured patients in the periods 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals. For 1 241 cases of the sample, complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of critically injured patients within the G-DRG system. Analyses of coding and grouping, performance of case allocation, and the homogeneity of costs in the G-DRG versions 2008 and 2011 were done.The following situations were found: (i) systematic underfunding of trauma patients in the G-DRG-Version 2008, especially trauma patients with acute paraplegia; (ii) participation in the official G-DRG development for 2011 with 13 proposals which were largely realised; (ii) the majority of cases with cost-covering in the G-DRG version 2011; (iv) significant improvements in the quality of statistical criteria; (v) overfunded trauma patients with high intensive care costs; (vi) underfunding for clinically relevant critically injured patients not identified in the G-DRG system.The quality of the G-DRG system is measured by the ability to obtain adequate case allocations for highly complex and heterogeneous cases. Specific modifications of the G-DRG structures could increase the appropriateness of case allocation of critically injured patients. Additional consideration of the ISS clinical data must be further evaluated. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical societies in this process.
    Das Gesundheitswesen 04/2012; · 0.94 Impact Factor
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    ABSTRACT: In Germany, orthopedic and trauma surgery rank first in the number of alleged malpractice claims amongst all medical disciplines. Thus, the German Association of Trauma and Orthopedic Surgery, together with the Bavarian Chamber of Physicians, set out to identify potential predictors of approved malpractice claims to improve process quality. In a case-control study, 164 cases of approved malpractice claims were matched according to age and gender to 336 controls of rejected claims, based on the 2004 to 2006 dataset of the Bavarian Chamber of Physicians. Potential predictors of acceptance of an alleged incident were modeled by uni- and multivariate logistic regression analysis. The final model explained 71% of the probability of acceptance of an asserted claim. It contained three medical consequences (i.e. delayed healing, reoperation, and loss of motion), one specific entity (i.e. fracture) and one socio-demographic variable (i.e. professional driver) as independent predictors of acceptance. Insufficient or lacking explanation of the planned procedure to patients or relatives and / or lacking informed consent (odds ratio [OR] 2.33, 95% confidence interval [CI]1.23-4.43), as well as inappropriate, low-quality, or erroneously interpreted imaging (OR 1.90, 95% CI 1.06-3.41) independently contributed to the likelihood of acceptance of a legal claim. Strict adherence to the principles of surgical quality assurance in terms of transparent patient information and joint informed consent procedures, as well as intransigent radiological imaging are mandatory to foster surgeon-patients-relationships and to avoid later legal claims.
    Der Unfallchirurg 09/2011; 114(9):768-75. · 0.64 Impact Factor
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    ABSTRACT: Incidents involving implants, whether there is a break in the osteosynthesis plate or a synthetic inlay of an endoprosthesis, are incidents with mostly severe repercussions for the patient with immediate and delayed effects for the clinic involved and the manufacturer.
    Der Unfallchirurg 08/2011; 114(9):786-93. · 0.64 Impact Factor
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    ABSTRACT: The German DRG system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also copayments. This paper analyses and evaluates the relevant developments of the 2011 G-DRG system for orthopaedics and traumatology from the medical and classificatory perspective. An analysis was performed of relevant diagnoses, medical procedures and G-DRGs in the 2010 and 2011 versions based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). A number of codes for surgical measures have been newly established or modified - above all in foot surgery, arthroscopic surgery and wound surgery. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopaedics and traumatology is changed, especially for polytraumata. The allocation of common cases with a standardized treatment pattern appears to be appropriate and the reimbursement adequate. For the less common and more complex cases the 2011 G-DRG system still shows need for further modification (e.g. polytraumata, joint replacement, spine surgery). The proper integration of the modified OPS classification for foot surgery to the appropriate G-DRGs will be essential to maintain the high quality of the reimbursement structure for the future.
    Der Unfallchirurg 08/2011; 114(9):829-36. · 0.64 Impact Factor
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    ABSTRACT: Vorkommnisse mit Implantaten, sei es der Bruch einer Osteosyntheseplatte oder eines Kunststoff-Inlays bei einer Totalendoprothese, sind Vorkommnisse mit meist schwerwiegenden Folgen für den Patienten, mit mittelbarer und unmittelbarer Auswirkung für die beteiligte Klinik und den Produkthersteller. Incidents involving implants, whether there is a break in the osteosynthesis plate or a synthetic inlay of an endoprosthesis, are incidents with mostly severe repercussions for the patient with immediate and delayed effects for the clinic involved and the manufacturer. SchlüsselwörterImplantate–Osteosyntheseplatte–Kunststoffinlay–Totalendoprothese KeywordsImplant–Osteosynthesis plate–Synthetic inlay–Total endoprosthesis
    Der Unfallchirurg 01/2011; 114(9):786-793. · 0.64 Impact Factor
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    Der Unfallchirurg 01/2011; 114(2):181-181. · 0.64 Impact Factor
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    ABSTRACT: Das Fachgebiet Unfallchirurgie und Orthopädie führt in allen Berichterstattungen der jüngeren Vergangenheit in der Anzahl von Vorwürfen potentieller Behandlungsfehler. Daher wurde das Thema vom Grundsatzausschuss der Deutschen Gesellschaft für Unfallchirurgie e.V. (DGU) aufgegriffen, um gemeinsam mit der Bayerischen Landesärztekammer (BLÄK) Gründe eine Analyse der Schadensfälle vorzunehmen und Strategien für deren Vermeidung zum Schutz der Patienten zu entwickeln. In einer alters- und geschlechtsgepaarten Fall-Kontroll-Studie (164Fälle, 336 Kontrollen) wurden auf der Basis von Daten der Gutachterstelle der Bayerischen Landesärztekammer der Jahre 2004–2006 demografische, medizinische und sonstige Variablen identifiziert, welche zur Anerkennung eines Behandlungsfehlervorwurfes beitrugen. Die statistische Modellierung erfolgte mittels logistischer Regressionsanalyse. Das abschließende multivariate Modell erklärte 71% der Varianz bzw. Wahrscheinlichkeit einer Anerkennung eines Behandlungsfehlervorwurfs und beinhaltete drei medizinische Konsequenzen (d.h., Heilverzögerung, Reoperation und Bewegungseinschränkung), eine spezifische Entität (Fraktur) und eine soziodemografische Variable (Berufskraftfahrer). Vermeidbare Faktoren waren die unzureichende Patientenaufklärung [Odds-Ratio (OR) =2,33, 95%-Konfidenzintervall (-KI) =1,23–4,43] und die fehlende oder unzureichende Bildgebung (OR=1,90, 95%-KI=1,06–3,41). Eine konsequente Umsetzung der Prinzipien der chirurgischen Qualitätssicherung wie Transparenz der Patientenaufklärung und leitliniengerechte prä-, intra- und postoperative Bilddokumentation könnte das Vertrauensverhältnis zwischen Patienten und Therapeuten erheblich verbessern und spätere juristische Konsequenzen vermeiden helfen. Mögliche nächste Schritte sind Kooperationen mit Haftpflichtversicherungen und dem Institut für Patientensicherheit sowie die Neuentwicklung von speziellen Curricula zum Risikomanagement. In Germany, orthopedic and trauma surgery rank first in the number of alleged malpractice claims amongst all medical disciplines. Thus, the German Association of Trauma and Orthopedic Surgery, together with the Bavarian Chamber of Physicians, set out to identify potential predictors of approved malpractice claims to improve process quality. In a case-control study, 164 cases of approved malpractice claims were matched according to age and gender to 336 controls of rejected claims, based on the 2004 to 2006 dataset of the Bavarian Chamber of Physicians. Potential predictors of acceptance of an alleged incident were modeled by uni- and multivariate logistic regression analysis. The final model explained 71% of the probability of acceptance of an asserted claim. It contained three medical consequences (i.e. delayed healing, reoperation, and loss of motion), one specific entity (i.e. fracture) and one socio-demographic variable (i.e. professional driver) as independent predictors of acceptance. Insufficient or lacking explanation of the planned procedure to patients or relatives and / or lacking informed consent (odds ratio [OR] 2.33, 95% confidence interval [CI]1.23–4.43), as well as inappropriate, low-quality, or erroneously interpreted imaging (OR 1.90, 95% CI 1.06–3.41) independently contributed to the likelihood of acceptance of a legal claim. Strict adherence to the principles of surgical quality assurance in terms of transparent patient information and joint informed consent procedures, as well as intransigent radiological imaging are mandatory to foster surgeon-patients-relationships and to avoid later legal claims. SchlüsselwörterRisikofaktoren–Behandlungsfehler–Fortbildungsmodule–Gefahrenpotential der Behandlung KeywordsRisk factors–Treatment error–Continuing education module–Risk potential of a treatment
    Der Unfallchirurg 01/2011; 114(9):768-775. · 0.64 Impact Factor

Publication Stats

169 Citations
43.62 Total Impact Points

Institutions

  • 2009–2014
    • Deutsche Gesellschaft für Unfallchirurgie
      Germany
    • Klinikverbund Südwest
      Sindelfingen, Baden-Württemberg, Germany
  • 2013
    • Universitätsklinikum Gießen und Marburg
      • Klinik für Unfall-, Hand- u. Wiederherstellungschirurgie
      Marburg, Hesse, Germany
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
  • 2009–2013
    • Deutsche Gesellschaft für Orthopädie und Unfallchirurgie e.V.
      Berlín, Berlin, Germany
  • 2004–2013
    • Universitätsklinikum Münster
      Muenster, North Rhine-Westphalia, Germany
  • 2009–2012
    • Philipps-Universität Marburg
      • Klinik für Unfall-, Hand- und Wiederherstellungschirurgie (Marburg)
      Marburg an der Lahn, Hesse, Germany
  • 2011
    • St. Marien Hospital
      Bonn, North Rhine-Westphalia, Germany
  • 2010
    • University of Rostock
      • Unfall- und Wiederherstellungschirurgie
      Rostock, Mecklenburg-Vorpommern, Germany
  • 2005–2010
    • Universitätsklinikum Düsseldorf
      • Klinik für Unfall- und Handchirurgie
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2008–2009
    • Heinrich-Heine-Universität Düsseldorf
      • Klinik für Unfall- und Handchirurgie
      Düsseldorf, North Rhine-Westphalia, Germany
    • Berufsgenossenschaftliche Unfallklinik Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 2005–2009
    • Diakonie-Klinikum Schwäbisch Hall gGmbH
      Hall, Baden-Württemberg, Germany
  • 2007
    • University Hospital Essen
      • Klinik für Unfallchirurgie
      Essen, North Rhine-Westphalia, Germany
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2003
    • University of Münster
      Muenster, North Rhine-Westphalia, Germany