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ZusammenfassungDie Erhebung klinischer Behandlungsdaten in Registerdatenbanken hat seit Jahren einen hohen Stellenwert in der Versorgungsforschung. Hierdurch kann bspw. eine kritische Prüfung der Sicherheit, Wirksamkeit und Wirtschaftlichkeit klinischer Behandlungskonzepte an großen Untersuchungskollektiven erfolgen. Die erhobenen Erkenntnisse aus der Registerforschung entsprechen der tatsächlichen Patientenklientel und dem Versorgungsalltag der teilnehmenden Kliniken. Sie sind nicht durch strenge Einschlusskriterien oder realitätsferne Rahmenbedingungen klinischer prospektiver Studien beschränkt. Durch die Implementierung des Deutschen Thoraxregisters wurde erstmalig die Möglichkeit geschaffen, die interdisziplinäre Betreuung (Thoraxchirurgie, Anästhesiologie, Intensivmedizin, Schmerztherapie) von Patienten mit operativen Eingriffen am Thorax ganzheitlich in einer Datenbank zu erfassen und auszuwerten. Unter der Schirmherrschaft der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Deutschen Gesellschaft für Thoraxchirurgie (DGT) wurde ein ursprünglich rein thoraxchirurgisches Register des Klinikums der Universität Witten/Herdecke-Köln in enger Kooperation mit dem Universitätsklinikum Freiburg erweitert. Nach Ausarbeitung eines umfangreichen Datenschutzkonzepts und Abschluss der Pilotphase wurde das Deutsche Thoraxregister als erstes perioperatives, interdisziplinäres Behandlungsregister im Januar 2016 offiziell implementiert. Neben der reinen Registerforschung, profitieren die teilnehmenden Kliniken vor allem durch die „benchmarking“-Funktionen. Das „benchmarking“, also der Vergleich der Behandlungsqualität verschiedener Kliniken, erlaubt es, individuelle Profile, Stärken und Schwächen im nationalen Vergleich zu identifizieren und eigene Fortschritte über mehrere Jahre zu verfolgen. Das Eingabe- und Benchmarkportal ist jederzeit online verfügbar (www.thoraxregister.de). Seit Oktober 2016 wurde das Teilnehmerspektrum erweitert, sodass sämtliche Kliniken mit mindestens 50 thoraxchirurgischen Eingriffen im Jahr teilnahmeberechtigt sind.

Background In June 2010, the Helsinki Declaration was passed. As a result, an online nationwide critical incident reporting system named CIRSmedical Anaesthesiology (CIRSains) was implemented in Germany. The aim of the article is to evaluate CIRSains for practicability and to provide solutions to the problems detected during evaluation. Methods Every medical staff member could take part voluntarily. Data were deidentified. All reports for anesthesiology (1548) were taken into account. Data collection lasted from April 2010 to February 2011. Incident report forms were classified according to World Health Organization and National Patient Safety Agency taxonomy. Results Most reports (1347; 87.0%) contained American Society of Anaesthesiologists (ASA) classification, stratifying the severity of patients' underlying disease. Only some mentioned patients' age, even less sex. Physicians filed more reports than nurses. Staff-related factors constituted 794 (51.3%) choices, with attention issues (433; 28.0%) and routine violations (143; 9.2%) leading. Clinical processes (443; 28.6%), medication (347; 22.4%), and medical devices (530; 34.2%) were the leading incident category types. Most consequences ranged in low (398; 25.7%) and moderate (826; 53.4%) risk categories. Mitigating factors were barely mentioned. Conclusion CIRSains displays the German effort to establish the Helsinki declaration. Easy accessibility, anonymity, medicolegal safety, and high flexibility resulted in high usage. The study shows a sufficient practicability of the database, but the data input has to be improved for better scientific use, for example, by implementation of more multiple-choice questions. Given the high magnitude and importance of patient safety problems, improving CIRSains remains a priority for the future.

Background Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. Methods We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. Results Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. Conclusions We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level

The collection of clinical treatment data in registry databases is an important aspect of health services research. It allows for a critical evaluation of the safety, efficacy and cost-effectiveness of clinical treatment concepts in large patient populations. The findings of registry research represent real-world patients and treatment structures as they are not limited by strict inclusion criteria or unrealistic conditions as applied in prospective clinical trials. The implementation of the German Thorax Registry has enabled the collection and analysis of data on the interdisciplinary care (thoracic surgery, anaesthesiology, intensive care, pain management) of patients undergoing thoracic surgery. Under the auspices of the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Thoracic Surgery, a registry of the Hospital of the University Witten/Herdecke-Cologne, purely surgical at first, was expanded in close cooperation with the University Hospital of Freiburg. After a comprehensive data protection concept was drafted and a test phase completed, the German Thorax Registry was officially launched in January 2016. Most notably, participating hospitals profit from the registry's "benchmarking" services. "Benchmarking", i.e. the comparison of treatment quality between different hospitals, enables participants to identify individual profiles, strengths and weaknesses on a nation-wide level and follow their own progress over the course of several years. An online database for data entry and benchmarking is always accessible (www.thoraxregister.de). In October 2016, the spectrum of participants was expanded to include all hospitals performing at least 50 thoracic operations a year.Die Erhebung klinischer Behandlungsdaten in Registerdatenbanken hat seit Jahren einen hohen Stellenwert in der Versorgungsforschung. Hierdurch kann bspw. eine kritische Prüfung der Sicherheit, Wirksamkeit und Wirtschaftlichkeit klinischer Behandlungskonzepte an großen Untersuchungskollektiven erfolgen. Die erhobenen Erkenntnisse aus der Registerforschung entsprechen der tatsächlichen Patientenklientel und dem Versorgungsalltag der teilnehmenden Kliniken. Sie sind nicht durch strenge Einschlusskriterien oder realitätsferne Rahmenbedingungen klinischer prospektiver Studien beschränkt. Durch die Implementierung des Deutschen Thoraxregisters wurde erstmalig die Möglichkeit geschaffen, die interdisziplinäre Betreuung (Thoraxchirurgie, Anästhesiologie, Intensivmedizin, Schmerztherapie) von Patienten mit operativen Eingriffen am Thorax ganzheitlich in einer Datenbank zu erfassen und auszuwerten. Unter der Schirmherrschaft der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Deutschen Gesellschaft für Thoraxchirurgie (DGT) wurde ein ursprünglich rein thoraxchirurgisches Register des Klinikums der Universität Witten/Herdecke-Köln in enger Kooperation mit dem Universitätsklinikum Freiburg erweitert. Nach Ausarbeitung eines umfangreichen Datenschutzkonzepts und Abschluss der Pilotphase wurde das Deutsche Thoraxregister als erstes perioperatives, interdisziplinäres Behandlungsregister im Januar 2016 offiziell implementiert. Neben der reinen Registerforschung, profitieren die teilnehmenden Kliniken vor allem durch die „benchmarking“-Funktionen. Das „benchmarking“, also der Vergleich der Behandlungsqualität verschiedener Kliniken, erlaubt es, individuelle Profile, Stärken und Schwächen im nationalen Vergleich zu identifizieren und eigene Fortschritte über mehrere Jahre zu verfolgen. Das Eingabe- und Benchmarkportal ist jederzeit online verfügbar (www.thoraxregister.de). Seit Oktober 2016 wurde das Teilnehmerspektrum erweitert, sodass sämtliche Kliniken mit mindestens 50 thoraxchirurgischen Eingriffen im Jahr teilnahmeberechtigt sind.

Niemand arbeitet fehlerfrei – auch nicht im Krankenhaus oder in der Praxis. Damit ein Fehler moglichst nicht ein zweites Mal passiert, sollte man ihn dokumentieren und potenzielle Fehlerquellen beheben. Ein Instrument dafur sind sogenannte Critical Incident Reporting Systeme (CIRS). Unsere Autoren stellen das Konzept anhand des CIRS-AINS vor.

Background The profession of the anesthetist in Germany includes the disciplines anesthesia, intensive care, emergency and pain medicine. Despite the versatility and competence of the profession, patients do not appear to have recognized anesthesiology as a medical discipline or anesthetists as medical doctors. Aim This study was conducted with the aim of estimating how previous experience and information gathered before contact with the anesthetist for premedication have influenced and changed the perception of patients with regards to the professional fields and the characteristics of anesthetists. Material and methods A total of 3,950 patients from 3 German hospitals were asked to answer a questionnaire handed out by the assistance nurse in the premedication area prior to the medical consultation with the duty anesthetist. The questions involved the patient perception of the discipline, the characteristics of anesthetists and also evaluated the patient previous experience and provision of information. According to the answers 1,753 patients were considered eligible for the study and were categorized into subgroups I-IV (group I interested and experienced with operations, group II interested but inexperienced, group III uninterested but experienced and group IV neither interested nor experienced) for statistical analysis. Results Of the respondents 56.2 % had obtained previous information from a general practitioner followed by acquaintances (21.4 %) and the internet (19.9 %), which significantly differed with age. Interested and experienced patients showed the best perception of the profession. Often, the knowledge of interested and uninterested persons did not significantly differ. Interested patients and those with experience of anesthesiology had the best knowledge of anesthesiology. Performing anesthesia was most often identified by all groups (50.9-95.3 %) as a function of anesthetists while the other professional fields were recognized correctly by only 5.8-26.6 %. Depending on the group 41.0-84.4 % regarded anesthetists as medical doctors. Only 15.0-78.3 % of other attributes were associated with anesthetists. Conclusion Unfortunately, the perception of patients on the versatility and characteristics of anesthetists are poorly developed. However, the knowledge differs significantly depending on previous experience and gathered information. Interestingly patients with previous experience mostly showed better knowledge compared to interested patients. Results suggest that personal interaction, patient-physician communication in general and improved collaboration between general practitioners and anesthetists are the key elements for better patient knowledge, which could lead to increased patient satisfaction.

Bereits 3 min nach einem Herzkreislaufstillstand treten unwiderrufliche Schaden des Gehirns auf – Minuten, welche uber ein Menschenleben entscheiden konnen. Menschen jeder Altersklasse und jeden Gesundheitszustands konnen betroffen sein. Wenngleich die Behandlungsmoglichkeiten unseres modernen, hoch technisierten und spezialisierten Gesundheitssystems nahezu optimal sind, ist die Uberlebensrate bei einem Herzstillstand in der Bundesrepublik Deutschland im internationalen Vergleich vergleichbar und nur vereinzelt besser. Begrundet ist diese Tatsache darin, dass trotz der haufig beobachteten Situation „Herzstillstand“ nur in ca. 16 % der Falle bereitwillige Ersthelfer vor Ort die lebensrettenden, aber einfachen Wiederbelebungsmasnahmen einleiten. Genau diese beschriebenen einfachen Masnahmen entscheiden uber das Uberleben. Mit einer Erhohung der Wiederbelebungsrate durch Laienhelfer direkt vor Ort des Geschehens konnten in der Bundesrepublik Deutschland jahrlich ca. 5000 Menschenleben gerettet werden.

Niemand arbeitet absolut fehlerfrei – auch nicht im Krankenhaus. Damit ein Fehler aber moglichst nicht ein zweites Mal passiert, sollte man ihn dokumentieren und potenzielle Fehlerquellen beheben. Ein Instrument dafur sind sogenannte Critical Incident Reporting Systeme (CIRS). Dort werden Fehlermeldungen gesammelt, kommentiert und systematisch ausgewertet. Unsere Autoren stellen das Konzept anhand des CIRS-AINS vor.

BACKGROUND The introduction of the diagnosis-related groups reimbursement system has increased cost pressures. Due to the interaction of many different professional groups, analysis and optimization of internal coordination and scheduling in the operating room (OR) is mandatory. The aim of this study was to analyze the processes at a university hospital in order to optimize strategies by identifying potential weak points. METHODS Over a period 6 weeks before and 4 weeks after intervention processes time intervals in the OR of a tertiary care hospital (university hospital) were documented in a structured data collection sheet. RESULTS The main reason for lack of efficiency of labor was underused OR utilization. Multifactorial reasons, particularly in the management of perioperative interfaces, led to vacant ORs. A significant deficit was in the use of OR capacity at the end of the daily OR schedule. After harmonization of working hours of different staff groups and implementation of several other changes an increase in efficiency could be verified. CONCLUSIONS These results indicate that optimization of perioperative processes considerably contribute to the success of OR organization. Additionally, the implementation of standard operating procedures and a generally accepted OR statute are mandatory. In this way an efficient OR management can contribute to the economic success of a hospital.

BACKGROUND The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization. METHODS To analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes. RESULTS The use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods. CONCLUSION The introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patient's portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.

Preventing patient harm is one of the main tasks for the field of anesthesiology from early on. With the introduction of the national German incident reporting system PaSOS, which is hosted by the German anesthesia society, anesthesiology is again leading the field of patient safety. Important elements, success factors and background information for the introduction of successful incident reporting systems in an organization are given. Examples by and from PaSOS are given.

INTRODUCTION: In neurosurgical patients, EEG-controlled and non-EEG-controlled propofol-remifentanil anaesthetics were compared. The effects of EEG monitoring, age, and gender on the dosage of propofol were investigated. METHODS: Anaesthetics with propofol (Disoprivan 2%) in 76 patients (16-78 years old) undergoing tumour craniotomies were evaluated. In 50 patients, EEG monitoring was performed (group 1), while in 26 patients, the anaesthetics were guided by clinical criteria (group 2). The patients of groups 1 and 2 received either 0.25 μg/kg body weight/min (without nitrous oxide) or 0.15 μg/kg body weight/min (with nitrous oxide) remifentanil. The target EEG stages during the steady state were D 2 /E 0 , which correspond to deep hypnosis [EEG monitor: Narcotrend ® (MT MonitorTechnik, Bad Bramstedt, Germany)]. RESULTS: EEG monitoring resulted in a lower (p

Ziel Ziele dieser Studie waren die Bestimmung der tatsachlichen Kosten pro Intensivbehandlungstag in Deutschland auf der Basis von Routinedaten eines computergestutzten Patienten-Daten-Management-Systems sowie die Analyse der hauptsachlichen Kostenverursacher. Dabei sollte zwischen Tagen mit und ohne maschineller Beatmung differenziert werden.

In der Medizin erfolgt Lernen typischerweise privat und individuell, weil das berufliche Umfeld Autonomie und personliche Verschwiegenheit fordert. Institutionelles Lernen ist daher eine Herausforderung, denn Individuen lernen von Natur aus, Teams und Organisationen nicht. Organisationales Lernen entspricht jedoch nicht einfach der Lernsumme der ihr angehorigen Individuen. Institutionelles Lernen erfolgt im Gegensatz zum individuellen Lernen nicht durch eigenen Antrieb und ist nicht einfach eine vermeidbare Folge von Wiederholungen, sondern muss gefuhrt werden. Organisationen lernen uber veranderte oder neue Fahigkeiten der ihr angehorenden Individuen, uber neue Systeme und Strukturen, aber auch durch eine neue strategische Ausrichtung und eine veranderte Unternehmenskultur. Anpassungsfahigkeit, Flexibilitat und Innovation sind die herausragenden Herausforderungen fur das moderne Krankenhaus. Diesem Anspruch kann ein Leistungserbringer nur genugen, wenn er zur lernenden Organisation wird. Um Kompetenz zu erreichen, ist zunachst Repetition erforderlich. Eine Steigerung des Leistungsvolumens garantiert jedoch noch lange nicht die verbesserte Performance einer Organisation. Entscheidend ist, wie Individuen und Teams Erfahrungen verarbeiten. So ist die Patientensicherheit nicht das Resultat einer individuellen Fahigkeit, sondern eine Systemeigenschaft. Wissen wird individuell schrittweise gescharft und gleichzeitig kollektiv reflektiert. Robuste Organisationen akkumulieren, bewahren und verwenden Wissen und Fahigkeiten trotz erheblicher Personalfluktuation. Es werden verschiedene Formen organisationalen Lernens unterschieden: „Single“- und „Double-loop“-Lernen, Entlernen (Verlernen) und Metalernen. Diese Lernformen sind fur anasthesiologische Abteilungen als wichtige Querschnittdienstleister im Krankenhaus von groser Bedeutung. Fur erfolgreiches organisationales Lernen sind eine umsichtige Fuhrung und ein Wandel der Unternehmenskultur mit offener Kommunikation und gegenseitigem Respekt erforderlich. Organisationales Lernen erfordert eine Kombination von Werthaltungen, Fahigkeiten und Strukturen. Die Entwicklung von Wissen, Kompetenzen und Lernkapazitaten sowie von Informations- und Kommunikationssystemen sind zentraler Gegenstand lernbezogener Managementaktivitaten. Organisationales Lernen kann zu strategischen Vorteilen durch den Erhalt oder die Verbesserung von Wettbewerbsfahigkeit, Produktivitat oder Innovativitat fuhren. Die Bedeutung des organisationalen Lernens wird diskutiert und deren Umsetzung an Beispielen erlautert.

Die Intensivmedizin der Charite wurde und wird einem umfangreichen Reorganisationsprojekt unterzogen. Ziel dieser Untersuchung war es zu evaluieren, ob die derzeit geschaffenen Strukturen dem Vergleich mit DRG-basierten Personalkosten standhalten konnen. Die medizinischen Personalkosten aller intensivmedizinischen Bereiche der „Erwachsenenmedizin“ der Charite: Intensivstationen, Uberwachungsstationen und „post-anaesthesia care units“ (PACUs), wurden mit den modularen Erlosen fur Personalkosten fur den Kostenstellenbereich „Intensivmedizin“, die sich aus der Summe aller effektiv erlosten DRGs der Falle uber 14 Lebensjahren der Charite des Jahres 2005 zusammensetzen, verglichen. Diese wurden in das G-DRG 4.0 des Jahres 2006 uberfuhrt. Der Vergleich beruht auf der aktuellen Personalkostenentwicklung an der Charite im Jahr 2006. Die ansteigenden Personalkosten wurden beziffert aufgrund der Tatsache, dass an der Charite unlangst ein Vorschalttarifvertrag fur die in der Krankenversorgung tatigen Mediziner und anderen Wissenschaftler geschlossen wurde. Fur die anderen Dienstarten wird ebenfalls eine Personalkostensteigerung erwartet, die sich derzeit aber nur ungefahr abschatzen lasst. Der Vergleich zeigt, dass die Personalkosten der universitaren Intensivmedizin an der Charite auf der Grundlage des bundeseinheitlichen Basisfallwerts von derzeit 2836 EUR eine Deckungslucke von nur 4,2% aufweisen. Allerdings zeigt der Vergleich aber auch, dass eine deutliche Angleichung der Personalkosten an die im DRG-System erzielbaren Erlosanteile als Ergebnis der Reorganisationsmasnahmen stattgefunden hat. Mit dem im Land Berlin fur das Jahr 2006 vereinbarten (gekappten) Basisfallwert von 2955 EUR wird eine Kostendeckung moglich sein. Mit Blick darauf, dass infolge des Projektes verbesserte Kostenstrukturen erst mit der Zeit wirksam werden, besteht an der Charite die begrundete Erwartung, spatestens im Jahr 2010 mit dem bundeseinheitlichen Basisfallwert von geschatzten 2949 EUR in der universitaren Intensivmedizin profitabel arbeiten zu konnen. Die Intensivmedizin an der Charite umfasst das maximale Spektrum der konservativen und operativen Medizin. Nach einer umfassenden Reorganisation ist diese Intensivmedizin unter den Bedingungen des 4.0 G-DRG-Systems im Hinblick auf die Personalkosten kostendeckend moglich. Durch konsequente strukturelle Reorganisationen lassen sich Skaleneffekte positiv nutzen; dies fuhrt in der Folge zu einer kostendeckenden Personalstruktur auch in der „High-end-Intensivmedizin“.

Unter der Pramisse eines fallbezogenen Entgeltsystems kommt der Analyse von medizinischen Leistungen in zunehmendem Mas Bedeutung zu. Dabei spielen die Qualitat der Behandlung und auch der dafur benotigte Zeitaufwand eine wichtige Rolle. Anasthesieverfahren erfordern ein hohes Mas an Qualitat und Sicherheit, zudem sind sie sehr personalintensiv. Im Bereich der Regionalanasthesie lassen neue Verfahren, wie z. B. der Einsatz von hochauflosendem Ultraschall bei Nervenblockaden, einen moglichen Zeitgewinn bei verbesserter Qualitat erkennen. Ziel der vorliegenden Untersuchung war die Analyse der Zeitablaufe und der Ergebnisse bei der Verwendung der Verfahren Ultraschall und Nervenstimulation bei axillaren Plexusblockaden. Fur einen Zeitraum von 9 Monaten wurden anhand der Anasthesiedokumentation die ultraschallgefuhrte Plexusanasthesie (Sono) und die Neurostimulationsmethode (NStim) bei handchirurgischen Patienten untersucht. Aufgenommen wurden nur die Falle, bei denen axillare Plexusblockaden durchgefuhrt worden waren. Als Medikation wurde 1,5%iges Mepivacain verwendet. Unvollstandige Protokolle wurden ausgeschlossen. Es erfullten 130 handchirurgische Patienten die Kriterien der Untersuchung. Erfasst wurden die Erfolgsraten und alle Zeiten sowie die daraus resultierenden Zeitablaufe. Alle Daten wurden als Excel-Tabelle gespeichert und statistisch ausgewertet. Die Ergebnisse der Untersuchung zeigen eine signifikante Steigerung der Erfolgsrate der Plexusblockaden bei der Patientengruppe mit Ultraschallfuhrung (98,2% Sono vs. 83,1% NStim). Die Freigabe zur Operation erfolgte in der Gruppe Sono 15 min fruher (5 min vs. 20 min; p

Management bedeutet Entwicklung, Veranderung und Controlling von komplexen produktiven und sozialen Systemen. Operationssaal- (OP-)Manager mussen daher uber spezifische Controllingkompetenzen verfugen. Nur so konnen sie erfolgreich ein strategisches und operatives Controlling in ihrem Bereich ausuben. Dafur mussen sie mit den Grundlagen des finanziellen und betrieblichen Rechnungswesens, v. a. der Methodik der Kostenrechnung, vertraut sein. Management bedeutet aber nicht nur die Erzielung von Kostendeckung, sondern die Sicherung des Fortbestandes eines Betriebes am Markt. Controllinginstrumente brauchen daher neben einer operativen immer auch eine strategische Komponente. Hilfreiche Controllingwerkzeuge, wie Portfolioanalyse, Wertschopfungsketten- und ABC-Analyse, werden vorgestellt. Insbesondere die integrierten Managementkonzepte mit mehrdimensionaler Zielfuhrung werden erlautert. So wird das von Galweiler entwickelte Navigationssystem dem Modell der „balanced score card“ nach Kaplan u. Norton gegenubergestellt.

Background Overlapping induction (OI), i.e., induction of anesthesia with an additional team while the previous patient is still in the operating room (OR), was investigated. Methods The study period was 60 days in two followed by three ORs during surgical Block Time (7:30 am until 3:00 pm). Patients were admitted the day before surgery and were thus available and did not have surgery that day unless there was a time reduction. Facilities were already constructed. Number of cases, Nonsurgical Time (Skin Suture Finish until next Procedure Start Time), Turnover Time, and Anesthesia Control Time plus Turnover Time were studied. In addition, economic benefit was calculated. Results Three hundred thirty-five cases were studied. Using OI, the time of care of regularly scheduled cases was shortened, and the number of cases performed within OR Block Time increased (151 to 184 cases; P < 0.05). Nonsurgical Time (in h:min) decreased (1:08 +/- 0:26 to 0:57 +/- 0:18; P < 0.001), Turnover Time decreased (0:38 +/- 0:24 to 0:25 +/- 0:15; P < 0.05), and Anesthesia Control Time plus Turnover Time decreased (0:43 +/- 0:23 to 0:28 +/- 0:18; P < 0.001). Subgroup analysis showed a significant benefit of OI only in three ORs. In three ORs, economic benefit can be gained at a case mix index greater than 0.3 besides additional costs. Conclusions Overlapping induction increased productivity and profit despite the expense of additional staff. Subgroup analysis emphasizes the importance of the number of ORs involved in OI.

Laienersthelfer ergreifen bei Herz-Kreislauf-Stillstanden oft aus Angst vor methodischen Fehlern nicht oder zu spat die erforderlichen Masnahmen. Dies ist ein wesentlicher Grund fur das schlechte Outcome nach kardiopulmonaler Reanimation (CPR). Der Effektivitatsverlust bei Thoraxkompressionen ist oft bedingt durch die muskulare Erschopfung des Helfers. Daher wurde die CardioPump® als eine Thoraxkompressionshilfe untersucht, die eine Moglichkeit bietet, den Kompressionsdruck zu standardisieren und zu kontrollieren. In der prospektiven Cross-over-Untersuchung mit 10 Probanden wurde eine CPR als aktive Kompressions-Dekompression-CPR (ACD-CPR) bzw. nach ERC-Standardmethode (C-CPR) unter Anwendung der CardioPump® und der Resusci Anne® Skillguide durchgefuhrt. Mittels statistischer Prozesskontrolle wurde die Qualitat der Kompressionen analysiert. Die Prozessqualitat der durchgefuhrten Thoraxkompressionen unterschied sich zwischen beiden Verfahren. Bei Anwendung der CardioPump® bei der ACD-CPR fand sich ein stabiler Prozess mit einer signifikant hoheren Prozessqualitat verglichen mit der Standardmethode. Die CardioPump® kann auch von ungeubten Personen eingesetzt werden, um die Effektivitat der Thoraxkompressionen wahrend der CPR zu optimieren.

Because of demographic developments, the fraction of the German population over 65 years of age in the year 2025 will have risen to 20% and will continue to rise so that in 2030 this number will have doubled compared to today's numbers. This has a huge impact on the requirements for anaesthesiologic procedures. In addition to the frequent multi-morbidity in this age group, physiologic changes also occur in the elderly which have to be taken into consideration during the entire perioperative management of these patients. Renal, cardiovascular and hepatic function are impaired in many elderly patients. A major concern in addition to cardiovascular and operative complications is the postoperative cognitive dysfunction (POCD), not only because of its implications for the patient but also because of economical consequences. Regional anaesthesia has some benefits when compared to general anaesthesia as it leads to a reduction in thromboembolic and respiratory complications.

Multidisciplinary pain management in pain centers can only be guaranteed if the DRG reimbursement system takes into account the multiple risk factors. The German pain associations prospectively analyzed clinical and administrative (DRG-related) data sets (n=3943) of inpatient and day care pain treatment facilities. The index diagnoses of 84% of the patient sample were grouped into nine basic DRGs. The most frequent pain procedure code was 8-918 ("multimodal pain management"). The minimal length of stay for this code set to 7 days was 17.2 days for the study sample. The DRG grouper software 2003 categorized 68.6% of the patients into PCCL 0 despite the proven complexity of risks and secondary diseases. The mean case weight in the sample was set at about 1. The pain-related data set analyzing pain severity, chronicity, and its influence on various functions emphasizes the total severity and burden of disease and thus the necessity for multimodal pain management. The German pain societies carried the motion that a new complex ICD code for chronic pain (with biopsychosocial consequences) should be established in the German Modification of the ICD. The new ICD code F62.80 and the procedure code 8-918 had not yet been implemented into the German DRG algorithm. Due to modifications in DRG systematics and the DRG algorithm, to be activated in 2005, the procedure code 8-918 will now automatically trigger into four special basic pain DRGs corresponding to the index pain diagnosis.

Starting January 1st 2004 the German diagnosis-related group (DRG) system was established for in-patient cases. Consequently, the detection and realization of cost-saving potentials are becoming more and more important. For a successful future, efficient allocation of resources is essential. Economically, anaesthesia-related time delays during perioperative work-flow should be minimized. Since numerous entities contribute to perioperative care, it is extremely complex to analyze and optimize this process flow. In this publication single steps leading to an optimized perioperative process flow will be presented: documentation of predefined time points, calculation of relevant time intervals and analysis of key numbers for complex settings. Single steps of the given process analysis will be demonstrated using data from surgical patients at the University Hospital Schleswig-Holstein, Campus Kiel. The attached data collection sheets can be used by interested hospital departments and are meant to serve as a template for further process analyses. Based on the shown analysis, an example will be given to develop an optimized work-flow as a standard operating procedure (SOP). The implementation of the SOP module in an interdisciplinary clinical pathway (CP), which defines efficient medical care from admission to discharge, is mainly responsible for decreased process costs but increased quality of care.

The operating theatre is one of the most expensive facilities in most hospitals. In order to meet the increasing demands of a professional and process-oriented management, it will be necessary to introduce clear and unambiguous management concepts in all hospitals. To optimise the workflow and the organisation as part of a future-oriented OR management, operating room resources were allocated to the surgeons according to an internal assessment and budgeting procedure that permitted an objective evaluation of the efficiency and effectiveness of each user.

Background Improved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS). Methods Cases from 1999 to 2010 were filtered from the CDS database. Cases were defined as elective patients classified as ASA physical status grades I and II (without relevant risk factors) resulting in death or serious complication. Four experts reviewed the cases to determine anaesthetic involvement. Results Of 1 374 678 otherwise healthy, ASA I and II patients in the CDS database, 36 met the study inclusion criteria resulting in a death or serious complication rate of 26.2 per million [95% confidence interval (CI), 19.4–34.6] procedures, and for those with possible direct anaesthetic involvement, 7.3 per million cases (95% CI, 3.9–12.3). Conclusions This is the first study assessing severe incidents and complications from a national outcome-tracking database. Annual identification and review of cases, perhaps with standardized database queries in the respective departments, might provide more detailed information about the cascades that lead to unfortunate outcomes.

The profession of the anesthetist in Germany includes the disciplines anesthesia, intensive care, emergency and pain medicine. Despite the versatility and competence of the profession, patients do not appear to have recognized anesthesiology as a medical discipline or anesthetists as medical doctors.This study was conducted with the aim of estimating how previous experience and information gathered before contact with the anesthetist for premedication have influenced and changed the perception of patients with regards to the professional fields and the characteristics of anesthetists.A total of 3,950 patients from 3 German hospitals were asked to answer a questionnaire handed out by the assistance nurse in the premedication area prior to the medical consultation with the duty anesthetist. The questions involved the patient perception of the discipline, the characteristics of anesthetists and also evaluated the patient previous experience and provision of information. According to the answers 1,753 patients were considered eligible for the study and were categorized into subgroups I-IV (group I interested and experienced with operations, group II interested but inexperienced, group III uninterested but experienced and group IV neither interested nor experienced) for statistical analysis.Of the respondents 56.2 % had obtained previous information from a general practitioner followed by acquaintances (21.4 %) and the internet (19.9 %), which significantly differed with age. Interested and experienced patients showed the best perception of the profession. Often, the knowledge of interested and uninterested persons did not significantly differ. Interested patients and those with experience of anesthesiology had the best knowledge of anesthesiology. Performing anesthesia was most often identified by all groups (50.9-95.3 %) as a function of anesthetists while the other professional fields were recognized correctly by only 5.8-26.6 %. Depending on the group 41.0-84.4 % regarded anesthetists as medical doctors. Only 15.0-78.3 % of other attributes were associated with anesthetists.Unfortunately, the perception of patients on the versatility and characteristics of anesthetists are poorly developed. However, the knowledge differs significantly depending on previous experience and gathered information. Interestingly patients with previous experience mostly showed better knowledge compared to interested patients. Results suggest that personal interaction, patient-physician communication in general and improved collaboration between general practitioners and anesthetists are the key elements for better patient knowledge, which could lead to increased patient satisfaction.

Hintergrund: Medikationsfehler zählen zu den häufigsten Behandlungsfehlern im Gesundheitswesen [ref:1]. Patientensicherheitsexperten empfehlen zur Verbesserung der Medikationssicherheit u.a. die „Doppelkontrolle“ als effektive Maßnahme. Darunter versteht man, dass[for full text, please go to the a.m. URL], Entscheiden trotz Unsicherheit; 14. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Aims Return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation from cardiac arrest (CA) depends on numerous variables. The aim of this study was to develop a score to predict the initial resuscitation outcome-the RACA (ROSC after cardiac arrest) score. Methods and results Based on 5471 prospectively registered out-of-hospital CAs patients between 1998 and 2008 within the German Resuscitation Registry, calculation of the RACA score was performed by multivariate logistic regression analysis with ROSC as the outcome variable. The probability of ROSC was defined as 1/(1 + e(-X)), where X is the weighted sum of independent factors. Additional 2218 patients documented between 2009 and 2010 were used for validation of the RACA score. The following independent variables were found to have a significant positive (+) or negative (-) impact on the probability of ROSC: male gender (-0.2); age >/=80 years (-0.2); witnessing by lay people (+0.6) and by professionals (+0.5); asystole (-1.1); location at doctor's office (+1.2), medical institution (+0.5), public place (+0.3) and nursing home (-0.3); presumable aetiology of hypoxia (+0.7), intoxication (+0.5) and trauma (-0.6); and time until professionals arrival (-0.04 per minute). In a validation cohort, observed ROSC (43.8) did not differ from predicted ROSC (43.7). Conclusion The RACA score represents a simple tool and enables comparison between observed and predicted ROSC rates based on readily available variables after CA. Thereby, the RACA score may contribute to preclinical quality assessment and may help analysing the effects of different (post)-resuscitation strategies.

Hintergrund: Critical-Incident-Reporting-Systeme (CIRS) ermöglichen es Mitarbeitern im Gesundheitswesen, anonym und sicher über sicherheitsrelevante Ereignisse in der Medizin zu berichten und andere aus diesen Berichten lernen zu lassen. In der Anästhesie existiert seit vielen Jahren [for full text, please go to the a.m. URL], EbM & Individualisierte Medizin; 12. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

For years now, the German Society of Anaesthesiology and Intensive Care Medicine and the Professional Association of German Anaesthesiologists have been actively involved in efforts to improve patient safety. To this end, a whole range of activities have been initiated in recent years and, since February 2011, collected together on our home page ‘PATSI' (www.patientensicherheit-ains.de). Further, the implementation of syringe labelling (ISO 26825) with additional information on drugs frequently used in intensive care was carried out. Under the item Helsinki Declaration, all decisions and recommendations so far worked out by our speciality have, in structured form, been assigned to individual points and saved as PDF files. This has made it possible for every anaesthesiological department in Germany to integrate all the relevant instructions and conditions of the Helsinki Declaration into their own individual work structures. These systematic solutions represent a major contribution towards reducing the possibility of errors at the workplace. We are certainly still in the early stages of our efforts to achieve a nationwide integration of a cultural change in the way we deal with mistakes in medicine. We have incorporated the item ‘learning from mistakes' in our project ‘critical incident reporting system for anaesthesia, intensive care medicine, emergency care, and pain therapy, CIRS-AINS', and have brought out a range of relevant illustrative publications. Accepting these ‘mistakes' as an opportunity to critically examine ourselves and our work with a view to learning from them and further improving our speciality service is, we believe, a great challenge for future developments in anaesthesia.

The introduction of the diagnosis-related groups reimbursement system has increased cost pressures. Due to the interaction of many different professional groups, analysis and optimization of internal coordination and scheduling in the operating room (OR) is mandatory. The aim of this study was to analyze the processes at a university hospital in order to optimize strategies by identifying potential weak points.Over a period 6 weeks before and 4 weeks after intervention processes time intervals in the OR of a tertiary care hospital (university hospital) were documented in a structured data collection sheet.The main reason for lack of efficiency of labor was underused OR utilization. Multifactorial reasons, particularly in the management of perioperative interfaces, led to vacant ORs. A significant deficit was in the use of OR capacity at the end of the daily OR schedule. After harmonization of working hours of different staff groups and implementation of several other changes an increase in efficiency could be verified.These results indicate that optimization of perioperative processes considerably contribute to the success of OR organization. Additionally, the implementation of standard operating procedures and a generally accepted OR statute are mandatory. In this way an efficient OR management can contribute to the economic success of a hospital.

Ongoing healthcare reforms in Germany have required strenuous efforts to adapt hospital and operating room organizations to the needs of patients, new technological developments, and social and economic demands. This review addresses the major developments in German operating room management research and current practice.The introduction of the diagnosis-related group system in 2003 has changed the incentive structure of German hospitals to redesign their operating room units. The role of operating room managers has been gradually changing in hospitals in response to the change in the reimbursement system. Operating room managers are today specifically qualified and increasingly externally hired staff. They are more and more empowered with authority to plan and control operating rooms as profit centers. For measuring performance, common perioperative performance indicators are still scarcely implemented in German hospitals. In 2008, a concerted time glossary was established to enable consistent monitoring of operating room performance with generally accepted process indicators. These key performance indicators are a consistent way to make a procedure or case - and also the effectiveness of the operating room management - more transparent.In the presence of increasing financial pressure, a hospital's executives need to empower an independent operating room management function to achieve the hospital's economic goals. Operating room managers need to adopt evidence-based methods also from other scientific fields, for example management science and information technology, to further sustain operating room performance.

The complexity of the operating room (OR) requires that both structural (eg, department layout) and behavioral (eg, staff interactions) patterns of work be considered when developing quality improvement strategies. In our study, we investigated how these contextual factors influence outpatient OR processes and the quality of care delivered. The study setting was a German university-affiliated hospital performing approximately 6000 outpatient surgeries annually. During the 3-year-study period, the hospital significantly changed its outpatient OR facility layout from a decentralized (ie, ORs in adjacent areas of the building) to a centralized (ie, ORs in immediate vicinity of each other) design. To study the impact of the facility change on OR processes, we used a mixed methods approach, including process analysis, process modeling, and social network analysis of staff interactions. The change in facility layout was seen to influence OR processes in ways that could substantially affect patient outcomes. For example, we found a potential for more errors during handovers in the new centralized design due to greater interdependency between tasks and staff. Utilization of the mixed methods approach in our analysis, as compared with that of a single assessment method, enabled a deeper understanding of the OR work context and its influence on outpatient OR processes.

Background: Shorter pre-operative fasting improves clinical outcome without an increased risk. Since October 2004, German Anaesthesiology Societies have officially recommended a fast of 2 h for clear fluids and 6 h for solid food before elective surgery. We conducted a nationwide survey to evaluate the current clinical practice in Germany. Methods: Between July 2006 and January 2007, standardized questionnaires were mailed to 3751 Anaesthesiology Society members in leading positions requesting anonymous response. Results: The overall response rate was 66% (n=2418). Of those, 2148 (92%) claimed familiarity with the new guidelines. About a third (n=806, 34%) reported full adherence to the new recommendations, whereas 1043 (45%) reported an eased fasting practice. Traditional Nil per os after midnight was still recommended by 157 (7%). Commonest reasons reported for adopting the new guidelines were: ‘improved pre-operative comfort’ (84%), and ‘increased patient satisfaction’ (83%); reasons against were: ‘low flexibility in operation room management’ (19%), and ‘increased risk of aspiration’ (13%). Conclusion: Despite the apparent understanding of the benefits from reduced pre-operative fasting, full implementation of the guidelines remains poor in German anaesthesiology departments.

National and international evidence based recommendations for anti-infective therapies in the intensive care unit are difficult to implement into daily clinical work. However, adequate and early applications of anti-infective therapies are important outcome factors for the clinical course of severe infections. With support of the German Society of Anaesthesiology and Intensive Care Medicine and the Association of German Anaesthesiologists (DGAI/BDA) a web based anti-infective program was developed to address these issues. The program includes interdisciplinary consented evidence based algorithms to help with immediate diagnostics and initial anti-infective therapies. Currently, with the title "ABx local" a subproject is launched to broaden program functions. It unifies current evidence based recommendations and local internal standards or comments on one platform to achieve priority of therapy options e.g. based on resistance patterns.

The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization.To analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes.The use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods.The introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patient's portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.

We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

Preventing patient harm is one of the main tasks for the field of anesthesiology from early on. With the introduction of the national German incident reporting system PaSOS, which is hosted by the German anesthesia society, anesthesiology is again leading the field of patient safety. Important elements, success factors and background information for the introduction of successful incident reporting systems in an organization are given. Examples by and from PaSOS are given.

The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed.On the ICU of a German focused-care hospital (896 beds, 12 anesthesiology ICU beds), cost per treatment day was calculated with or without mechanical ventilation from the perspective of the hospital. Costs were derived retrospectively with respect to the period between January and October 2006 by cost-unit accounting based on routine data collected from the ICU patients. Patients with a length of stay of at least 2 days on the ICU were included. Demographic, clinical and economical data were analyzed for patient characterization.Data of 407 patients (217 male and 190 female) were included in the analysis, of which 159 patients (100 male, 59 female) were completely or partially mechanically ventilated. The mean simplified acute physiology (SAPS) II score at the onset of ICU stay was 28.2. Average cost per ICU day was 1,265 EUR and costs for ICU days with and without mechanical ventilation amounted to 1,426 EUR and 1,145 EUR, respectively. Personnel costs (50%) showed the largest cost share followed by drugs plus medicinal products (18%) and infrastructure (16%).For the first time, a cost analysis of intensive care in Germany was performed with routine data based on the matrix of the institute for reimbursement in hospitals (InEK). The results revealed a higher resource use on the ICU than previously expected. The large share of personnel costs on the ICU was evident but is comparable to other medical departments in the hospital. The need for mechanical ventilation increases the daily costs of resources by approximately 25%.

The operating room (OR) is one of the most expensive facilities in most hospitals. The demands on a professional and process-oriented controlling and reporting in the OR are increased due to the increasingly more limited financial margins at the end of the diagnosis related groups (DRG) convergence phase. This study gives an overview of the current situation for cost calculation, controlling and reporting in OR management in German hospitals in 2007. The data from 69 hospitals were evaluated and this represents the largest currently available data pool on this topic.