[Inadequate ICU-admissions : A 12-month prospective cohort study at a German University Hospital]. / Nicht indizierte Aufnahmen auf der Intensivstation : 12-Monats-Observationsstudie an einem Universitätsklinikum.

BACKGROUND: Intensive care medicine (ICM) is increasingly utilized by a growing number of critically ill patients worldwide. The reasons for this are an increasingly ageing and multimorbid population and technological improvements in ICM. Inappropriate patient admissions to the intensive care unit (ICU) can be a threat to rational resource allocation and to patient autonomy. OBJECTIVES: In this study, the incidence, characteristics, and resource utilization of patients inappropriately admitted to ICUs are studied. METHODS: This prospective study included all consecutive patients admitted from 01 September 2012 to 31 August 2013 to the Department of Intensive Care Medicine of a German university hospital comprised of 10 ICUs and 120 beds. Inappropriate admission was defined according to category 4B of the recommendations of the Society of Critical Care Medicine (SCCM; "futility of ICU treatment" or "ICU declined by patient") and was determined in each suspected case by structured group discussions between the study team and all involved care givers including the referring team. RESULTS: In all, 66 of 6452 ICU admissions (1 %) were suspected to have been inappropriate on retrospective evaluation the day after admission. In 50 patients (0.8 %), an interdisciplinary consensus was reached on the inappropriateness of the ICU admission. Of these 50 patients, 41 (82 %) had previously declined ICU treatment in principle. This information was based on the patient's presumed wish as expressed by next of kin (56 %) or in a written advanced directive (26 %). In 9 patients (18 %), ICU treatment was considered futile. In all cases, a lack of information regarding a patient's wishes or clinical prognosis was the reason for inappropriate ICU admission. CONCLUSION: In this study, patients were regularly admitted to the ICU despite their contrary wish/directive or an unfavorable clinical condition. Although this was registered in only 1 % of all admissions, optimizing preICU admission information flow with regard to relevant exclusion criteria not only helps respect patient autonomy but also allows for more adequate resource allocation.

[Concept for a department of intensive care]. / Konzept einer Klinik für Intensivmedizin.

BACKGROUND: Demographic change and increasing complexity are among the reasons for high-tech critical care playing a major and increasing role in today's hospitals. At the same time, intensive care is one of the most cost-intensive departments in the hospital. PREREQUISITES: To guarantee high-quality care, close cooperation of specialised intensive care staff with specialists of all other medical areas is essential. A network of the intensive care units within the hospital may lead to synergistic effects concerning quality of care, simultaneously optimizing the use of human and technical resources. GOAL: Notwithstanding any organisational concepts, development and maintenance of the highest possible quality of care should be of overriding importance.

[Communication in intensive care medicine]. / Kommunikation in der Intensivmedizin.

Communication plays a crucial role in the intensive care unit. Posttraumatic stress syndromes develop in a significant number of patients and their relatives after being in an intensive care unit. The syndromes may persist for several years. Regular open and empathic communication with patients and family members reduces the frequency and severity of the disease. Among the physicians and nurses in the intensive care unit, there is a high prevalence of burnout syndrome. The precipitating factors are mostly conflicts within the working staff, work overload and end-of-life situations. Working team communication reduces the rate of exhaustion syndromes. Rounds of discussions among the work groups are the basis for a healthy team structure. Inadequate communication, e.g., during emergencies or shift change, endangers the safety of patients and in the worst case, results in treatment mistakes. Measures for improved communication in the intensive care unit should always be implemented.