Identification of emergencies in the telephone queue and routing to a fast track (FAST): study protocol for a prospective, two-armed cohort study.

BACKGROUND: In Germany, the telephone patient service 116,117 for callers with non-life-threatening health issues is available 24/7. Based on structured initial assessment, urgency and placement of suitable medical care offer have been offered since 2020. The service has been in increasing demand for several years: Depending on time and residence, this can result in longer waiting times. METHODS: Prospective, two-armed cohort study with two intervention groups and one control group, alternating between blinding and unblinding for employees of 116,117 regarding prioritization status. Two interventions based on automated voice dialogues (1: Simple self-rating tool, 2: Automated brief query of emergency symptoms). In case of high level of urgency, callers are prioritized. Validation of urgency and need for care is carried out routinely based on structured initial assessment. DISCUSSION: By creating and providing a largely reproducible documentation of the implemented solutions for a waiting queue management, the developed approach would be available for comparable projects in the German health care system or in the European context. This potentially leads to a reduction in the use of resources in the development of comparable technical solutions based on automated voice dialogs. TRIAL REGISTRATION: DRKS00031235, registered on 10th November 2023, https://drks.de/search/de/trial/DRKS00031235 .

Frequency of resuscitation attempts with dying nursing home residents. A full survey in an urban district in Germany based on registry data from 2018-2021.

Aim: The realities of emergency care and resuscitation research involving nursing home (NH) residents suggest an overuse of resuscitation attempts in NHs. A complete analysis of all NH resident deaths is needed to provide a complementary perspective of potential underuse. The present research investigated whether residents of different NH homes died at the NH during attempted resuscitation or after transfer to hospital. Methods: A full survey of resuscitation attempts and deaths among NH residents, via retrospective analysis of data from the death registry and the German Resuscitation Registry for the years 2018 to 2021. Results: Over the 4-year study period, 14,598 individuals died, of whom 3,288 (22.5%) were residents of 31 different NHs. The mean age of the deceased NH residents was 87 years (±8.6); 2,196 (66.8%) were female, 118 (3.6%) underwent a resuscitation attempt, and 58.5% died at the NH. NH averages were as follows: deaths per NH: 106 (±51; min-max: 36-292); number of beds: 102 (±39; 34-210); deaths per bed per year 0.27 (±0.07; 0.15-0.51); resuscitation attempts per 1,000 beds per year: 9.5 (±5.5; 0-21.1); and ratio of futile resuscitation attempts to deaths: 6.0% (0-12.5%). Considering the entire study region before and during the COVID-19 pandemic, a slight underuse of resuscitation attempts with female NH residents emerged. On a facility level, substantial disparities and opposing trends were found. The incidence of deaths and resuscitation attempts, as well as the place of death and the ratio of futile resuscitation attempts to deaths, varied considerably. Conclusion: Resuscitation attempts are rarely administered to dying NH residents. However, their frequency varies considerably between NHs.

[Trends in place of death for nursing home residents in an urban district during the COVID-19 pandemic: An analysis of death registry data]. / Entwicklung der Sterbeorte von Pflegeheimbewohnern in einem städtischen Versorgungsbereich während der COVID-19-Pandemie ­ eine Auswertung von Daten des Sterberegisters.

BACKGROUND: The nursing home is a common place of death; however, little is known about the place of death with respect to the people living there. Was there a difference in the frequencies of the places of death of nursing home residents in an urban district and in the individual facilities before and during the COVID-19 pandemic? METHODS: Full survey of deaths by retrospective analysis of death registry data from the years 2018 to 2021. RESULTS: Over the four-year period 14,598 people died, with 3,288 (22.5%) being residents of 31 different nursing homes. Over the reference period before the pandemic (March 1, 2018 to December 31, 2019) 1,485 nursing home residents died: 620 (41.8%) in hospital, 863 (58.1%) in a nursing home. During the pandemic period (March 1, 2020 to December 31, 2021) 1,475 death were registered: 574 (38.9%) in hospital and 891 (60.4%) in a nursing home. The mean age over the reference period was 86.5 years (±8,6; median 88.4; 47.9 to 106.2), in the pandemic period it was 86.7 years (±8,5; median 87.9; 43.7 to 111.7). Before the pandemic 1,006 deaths (67.7%) occurred in females, during the pandemic it was 969 (65.7%). The relative risk (RR) as a measure for the increase in the probabilty for an "in-hospital" death during the pandemic period was 0.94. In different facilities, the number of deaths per bed during the reference and the pandemic period varied between 0.26 and 0.98, and the RR from 0.48 to 1.61. DISCUSSION: For all nursing home residents, the frequency of deaths was not increasing and no shift towards an "in-hospital" death was observed. Several nursing homes revealed substantial differences and opposing trends. The strength and the type of effects of facility-related circumstances remain unclear.

Opportunities and Risks of Resuscitation Attempts in Nursing Homes.

BACKGROUND: Data supporting decision-making regarding cardiopulmonary resuscitation (CPR) in German nursing homes is insufficient. METHODS: A retrospective evaluation of pre-hospital CPR was carried out with data from the German Resuscitation Registry (Deutsches Reanimationsregister) for the years 2011-2018. Patients under age 65 were excluded, as were patients from districts in which long-term data was available for less than 60% of patients. Subgroups were analyzed based on age and certain prehospital situations; patients treated outside nursing homes were used for comparison. RESULTS: The study group consisted of 2900 patients, whose mean age was 83.7 years (standard deviation, 7.5 years). 1766 (60.9%) were women and 1134 (39.1%) were men. 118 patients (4.0%) were discharged alive, including 64 (2.2%) with a cerebral performance category (CPC) of 1 or 2, 30 (1.0%) with an unknown CPC, and 24 (0.8%) with a CPC of 3 or 4. 902 patients (31.1%) died in the hospital, including five (0.2%) who died more than 30 days after resuscitation, 279 (9.6%) between 24 hours and 30 days, and 618 (21.3%) within 24 hours. 1880 patients (64.8%) died at the site of attempted resuscitation. In 1056 cases (36.4%), CPR was initiated before the arrival of the emergency medical services. In the "initially shockable" subgroup, 13 of 208 patients (6.3%) were discharged alive with a CPC of 1 or 2. CONCLUSION: CPR can lead to a good neurological outcome in rare cases even when carried out in a nursing home. The large percentage of CPR attempts that were initiated only after a delay indicates that nursing home staff may often be uncertain how to proceed. Uncertainty among caregivers points to a potential for advance care planning.

[Emergency care in nursing homes in the City of Braunschweig: A cross-sectoral view with indicators from deaths, resuscitation, emergency department visits and EMS deployment]. / Notfallversorgung in Pflegeeinrichtungen in der Stadt Braunschweig: Ein sektorenübergreifender Blick anhand von Kennzahlen aus Sterbefällen, Reanimationen, Krankenhauszuweisungen und Rettungsdiensteinsätzen.

INTRODUCTION: General survey of emergency care in nursing homes in the City of Braunschweig. METHODS: Retrospective analysis of data from death registry, resuscitation registry and further routine data from the local health authorities and the emergency medical services (EMS). RESULTS: 30 nursing homes with 3,100 beds (mean: 103; range: 35-250) were included; operators of nursing homes were 18 non-profit organizations; 7 private (local); 5 private (nationwide). Among the inhabitants of these 30 nursing homes 880 deaths occurred, 406 (46 %) in hospital; 4,895 EMS deployments for emergency care; 4,493 (92 %) resulting in emergency department visits; 19 CPRs. EMS deployments without a physician order per bed 1.0 (0.4-1.6); emergency department visits per bed 1.4 (0.7-3.1); rate of EMS deployments without physicians order / emergency department visits 70 % (41-96 %); deaths per bed 0,29 (0.12-0.48); rate of deaths in hospital 46 % (0-62 %); CPRs per 1,000 beds 6.1 (0-28); CPR failure rate 22 (0-83) per 1,000 deaths per year. EMS deployment without physician order was significantly more frequent in privately (nationwide) operated nursing homes 1.2 (1.0-1.4). In the entire urban region, the incidence of EMS deployment without a physician order was 0.2 per inhabitant per year and the rate of hospital deaths was 64 %. CONCLUSION: Compared to the entire population of the City of Braunschweig, EMS deployment was more frequent in nursing homes. The chance of hospital death or failed CPR was slightly lower. There are large variations between the different nursing homes. Indicators from routine data can provide guidance for more specific surveys but do not allow benchmarking.