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Digital pen and paper - Introducing a new technology for prehospital data recording in German Helicopter Emergency Medical Service

aFederal Armed Forces Medical Centre, Department of Anaesthesiology and Intensive Care Medicine, HEMS Christoph 22 Ulm, Ulm bADAC Air Rescue - Quality Management, Munich, Germany.
European Journal of Emergency Medicine (Impact Factor: 1.58). 12/2011; 18(6):363-4. DOI: 10.1097/MEJ.0b013e328345d772
Source: PubMed
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    ABSTRACT: Hintergrund Die adäquate prä- und innerklinische Primärversorgung stellt die entscheidende Grundlage für eine erfolgreiche Versorgung Polytraumatisierter dar. Zur Optimierung der Versorgungsabläufe ist hierbei die Implementierung eines medizinisches Qualitätsmanagements (QM) unabdingbar. Ziel der vorgestellten Studie ist ein erweitertes QM durch die Einbeziehung von Daten zur Prozessqualität. Methode Es wurde eine retrospektive Analyse der Primäreinsätze bei Polytraumatisierten am Luftrettungszentrum „Christoph 22“, Ulm, über einen Zeitraum von 2½ Jahren durchgeführt. In einer Detailanalyse der Filterkriterien, bei denen relevante Abweichungen von den QM-Empfehlungen (Nichterfüllung in > 10% der Fälle) auftraten, wurden hierbei Daten zur Prozessqualität einbezogen (Vitaldaten, Maßnahmen und Ereignisse). Ergebnisse Im Studienkollektiv (n = 298; 71,8% männlich; Alter: 39,8 ± 21,8 Lebensjahre) wurden 2 Filterkriterien identifiziert, bei denen relevante Abweichungen von den Empfehlungen auftraten: „Zeitmanagement“ (Prähospitalzeit ≤ 60 min, in 36% der Fälle nicht erfüllt) und „Herz-Kreislauf-Management“ [systolischer Blutdruck, gemessen nach Riva-Rocci (RRsys) ≥ 120 mmHg → Klinikübergabe bei Patienten mit SHT, in 45% der Fälle nicht erfüllt). Patienten, bei denen das Zeitmanagement nicht eingehalten wurde, wiesen eine längere Prähospitalzeit auf (75,6 ± 18,3 min vs. 50,5 ± 6,7 min; p < 0,01). Ursachen waren Verlängerungen der „On-scene“-Zeit (34,1 ± 22,1 min vs. 20,6 ± 9,2 min; p < 0,01) und der Transportzeit (17,3 ± 9,4 min vs. 13,3 ± 4,8 min; p < 0,01). Bei Einklemmungstrauma war die Prähospitalzeit signifikant häufiger verlängert (44% vs.10%; p < 0,01). Patienten, bei denen das Herz-Kreislauf-Management nicht eingehalten wurde, befanden sich bei Eintreffen an der Notfallstelle häufiger im Schock (RRsys ≤ 90 mmHg: 60% vs. 30%; p < 0,01), waren häufiger hypoxämisch [pulsoxymetrisch gemessene Sauerstoffsättigung (SpO2) ≤ 90%: 36% vs. 19%; p < 0,05) und wiesen häufiger ein Thorax- bzw. Thorax- und Abdominal-/Beckentrauma (69% vs. 52% bzw. 42% vs. 28%; p < 0,05) auf. Das kolloidale Infusionsvolumen war erhöht (1241 ± 810 ml vs. 753 ± 359 ml; p < 0,05), und der kombinierte Einsatz von „small volume resuscitation“ sowie Katecholaminen war häufiger (42% vs. 25%; p < 0,05). Schlussfolgerung Die Einbeziehung von routinemäßig erhobenen Prozessdaten der präklinischen Einsatzdokumentation ermöglicht ein deutlich erweitertes QM.
    No preview · Article · Feb 2012 · Der Anaesthesist
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    ABSTRACT: Background Adequate recording of mission data is of utmost importance in prehospital emergency medicine. A large variety of prerequisites for recording prehospital data are contrasted by a difficult framework of data recording in the prehospital setting. The quality of prehospital data recording is influenced by numerous factors but mainly by the emergency physicians themselves. Our knowledge about prehospital mission data recording flow is limited. Therefore, the aim of this monocentric pilot study was to determine the prehospital data recording flow of emergency physicians in order to improve data quality as well as to optimize the layout of prehospital mission data records. Methods A retrospective analysis of prehospital mission data records of a helicopter emergency medical service over a period of 2.5 years was carried out. The digital pen and paper technology used for this pilot study allows the exact chronological assignment of the different steps in mission data recording. Results For this pilot study 3,000 mission data records have been analyzed. Most frequently the mission data recording was started (first pen stroke) with the section patient information (75.2%) and finished (last pen stroke) with the section result (80.1%). In their documentation flow the emergency physicians broadly followed the graphical order of the different sections of the mission data record, with one exception: data recording in the section vital data/monitoring/measures/incidents, which includes very time critical data (vital signs) was started at a very early point of mission data recording and continued until the end of mission data recording. Conclusions From the results of this pilot study it can be concluded that the prehospital documentation flow of emergency physicians is adequate with respect to data completeness and data quality. To improve mission data recording first an optimization of layout of mission data records is of importance and second a special training program for emergency physicians regarding mission data recording seems to be promising.
    No preview · Article · Mar 2011 · Notfall
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    ABSTRACT: Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality. A retrospective study of primary rescue missions of the Helicopter Emergency Medical Service (HEMS) Christoph 22 in Ulm over a period of 2.5 years was performed. In a detailed analysis of filter criteria, in which relevant deviations from the recommendations (not fulfilled in  > 10% of the cases) occurred, process data was included (vital data, measurements and events). In the study population (n = 298, males 71.8%, mean age 39.8 ± 21.8 years) 2 filter criteria were identified in which relevant deviations where observed: time management where prehospital treatment time  ≤ 60 min in 36% of the cases was not fulfilled and circulatory management where the systolic blood pressure, detected with Riva-Rocci method (RR(sys))  ≥ 120 mmHg on hospital admission in patients with severe head trauma was not fulfilled in 45% of the cases. In patients with deviations in time management, prehospital treatment time was prolonged (75.6 ± 18.3 min versus 50.5 ± 6.7 min; p < 0.01) caused by a prolonged on scene attendance time (34.1 ± 22.1 min versus 20.6 ± 9.2 min; p < 0.01) and transport time (17.3 ± 9.4 min versus 13.3 ± 4.8 min; p < 0.01). In entrapment trauma prehospital treatment time was expanded (44% versus 10%; p < 0.01). Patients in whom circulatory management deviations were observed were more often in shock on arrival at the scene (RR(sys)  ≤ 90 mmHg: 60% versus 30%; p < 0.01), more often hypoxemic [pulse oximeter oxygen saturation (S(p)O(2)) ≤ 90%: 36% versus 19%; p < 0.05] and more often sustained a trauma to the chest as well as to chest and abdomen/pelvis (69% versus 52% and 42% versus 28%, respectively; p < 0.05). Furthermore, the infusion volume of colloids was higher (1241 ± 810 ml versus 753 ± 359 ml; p < 0.05) and the combined usage of small volume resuscitation and catecholamines was more often necessary (42% versus 25%; p < 0.05). Including process data of prehospital mission data recording facilitates an extended medical quality management.
    No preview · Article · Feb 2012 · Der Anaesthesist
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