Grundvoraussetzungen herzchirurgischer Einheiten zur Behandlung von Patienten mit angeborenen Herzfehlern.

This document defines fundamental structures of congenital cardiac surgery departments in Germany. It has been developed by the executive boards of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) and the German Society of Pediatric Cardiology (GSPC) in collaboration with the working group for Congenital and Pediatric Heart Surgery of the GSTCVS.This updated consensus paper is based on a previous publication of the European Association for Cardiothoracic Surgery (EACTS) and is a refinement and adaptation of its initial version published by the GSTCVS in 2005. In Germany, pediatric cardiology and cardiac surgery facilities caring for patients with congenital cardiac defects are subject to certain regulations. For example, in 2010 the Federal Joint Committee implemented the resolution on Quality Assurance Measures in the Provision of Cardiac Surgical Care for Children and Adolescents (directive congenital cardiac surgery) which regulates structural and process quality compulsorily. To date, fundamental and considerable differences of the respective departments persist.Congenital cardiac surgery departments have to provide the whole spectrum of the cardiac surgical therapy from the neonate to the adult with congenital cardiac defects (with the exception of heart transplantation) continuously and with the appropriate experience. Furthermore, the departments have to prove their constant scientific activity and ensure that they facilitate education and training for the specialty certification in cardiac surgery. The responsible surgeons of all congenital cardiac surgery departments commit to participate in the currently voluntary national quality assurance for congenital cardiac defects of the GSTCVS and the GSPC and perform an individual surgical outcome assessment and risk stratification. This is supplemented by the willingness for external certification specific to the individual and the facilitation of peer review procedures for quality assurance purposes. Additional measures, such as collaboration in clinical research and ongoing interdisciplinary education and training, are preferable.

A collaborative model for hospital-based cardiovascular secondary prevention.

This article presents a collaborative model for hospital-based cardiovascular secondary prevention. The model employs a stake holder consortium to provide hospitals with a unified approach to improve care and conform to regulatory requirements. Hospital teams use a Web-based tool that embeds data collection in the process of care and supports rapid cycle improvement. Recognition of participation and achievement by the American Heart Association helps to obtain administrative support for the program.

Analysis of patient claims related to care in a university cardiology department over the period 2003-2007.

BACKGROUND: In Europe, the increase in numbers of patients making legal claims might be due to better knowledge of their rights. In France, a law passed in 2002 provided new opportunities for claims. AIM: To assess patient claims related to care in a French cardiology department. METHODS: From 2003 to 2007, claims brought before the courts and actions of conciliation within the scope of the hospital were collected by year. Cardiology department claims were individualized and compared with those for other departments. Characteristics of patients at the time of the care that prompted the claim, percentage of deaths, reasons for claims and claim results were collected. RESULTS: During the 4-year study period, 14% (n=45,272) of hospital admissions concerned cardiology, uniformly distributed across the years. In the same period, 845 procedures were recorded, 81 of which related to cardiology. The complaints index was 2.59/1000 patients for the general population and 1.79/1000 for cardiology. The 81 cardiology complaints (52 mediations; 29 litigations) concerned patients aged 62±13 years (68% men). The number of cardiology claims remained stable from 2003 to 2007. Compared with claims concerning other departments, the nature of the plaintiff (more often heirs or husband/wife) and the reason for the claim (less frequently medical care problems; more often death and nosocomial infections) were statistically different. CONCLUSION: Claims related to cardiology care were low and relatively stable over the past 4 years. Nosocomial infections prompted a high proportion of claims and should lead physicians to be vigilant. Cardiology remains relatively protected from litigation. A national registry of hospital claims might be valuable.

[Effects of minimum volume regulations on the provision of health care services in cardiology]. / Auswirkung von Mindestmengen auf die stationären Versorgungsstrukturen der Kardiologie.

In order to improve the quality of medical care, minimum volumes for services were set. Hospitals are only permitted to continue to provide these services and settle accounts with the health insurance companies if they are able to achieve these minimum annual volumes. This study is based on service data of the year 2002 from 88 neighboring hospitals of the hospital association Cologne, Bonn and region. In the study, the influence of these regulations on the provision of health care services in cardiology were examined. The cases were grouped according to the different examined services, followed by an analysis of the number of cases for each hospital in comparison to four fictitious minimum quantity models. When the hospital's volume remained below the minimum quantity, these cases were assigned to the nearest hospital still able to provide the service. For the services coronary angiography, PTCA, AICD implantation, EPS and ablation, only marginal case redistributions were determined. Depending on the minimum quantity, service concentrations are only expected for pacemaker implantations. Due to the increasing service concentration as a consequence of the DRG-payment system, a bureaucratic regulation of minimum volumes has become superfluous for most cardiological services. Instead of minimum volume regulations, recommendation of minimum volumes should be made in cardiological guidelines.

Handling of transplant cases criticized.

Two separate transplant programs came under fire in recent months--one for betraying the public's trust, the other for denying a transplant for a Downs syndrome patient, as the following articles describe.