[Quality assurance at the interface between anesthesia and transfusion medicine]. / Qualitätssicherung an der Schnittstelle zwischen Anästhesie und Transfusionsmedizin.

BACKGROUND: The current situation in hospitals is characterized by financial limitations and simultaneously by increasing demands on quality and safety. The operative interface between anesthesia and transfusion medicine affects both factors. AIM: A detailed analysis was performed to evaluate the process quality at this operative interface at the University Hospital of Göttingen. The aim of the project was to revise und develop the structures and responsibilities at this interface, to dispose of weak points and to realize the optimization potential in the supply of blood products. MATERIAL AND METHODS: A databank-based electronic data processing solution was established with the clear definition of responsibilities for the various workflow procedures and the written documentation of these definitions in standard operating protocols. In order to guarantee the necessary transparency a routine reporting system to the department of surgery was established. In addition, a continuous further development of the blood supply standard based on electronic report data was implemented. RESULTS: By implementing the above named measures the rate of supplied to transfused blood products could be increased from 43.1 % to 55.7 %. The compliance with the blood supply standard improved continually over the first 18 months from 60.3 % to 92.3 %. The rate of supplied blood product deliveries without subsequent operation could be reduced from 9.0 % to 4.6 %. As a result of this optimization the supply costs in the internal cost allocation were reduced from 9,406  to 3,544 . CONCLUSION: The measures described are appropriate to cost-effectively improve quality and patient safety. The optimization measures presented in this article can be implemented in other hospitals to increase quality and safety after individual adjustment to the local circumstances.

Antihypertensive regimen and quality of life in a disadvantaged population.

A sample of family practice patients with essential hypertension (N = 106) who were predominantly elderly, black, and disadvantaged were studied to determine psychosocial and physiological side effects from antihypertensive therapy regimens. Patients were assigned randomly to one of four monotherapy treatment groups: Hydrochlorothiazide-triamterene, metoprolol, captopril, and methyldopa. These medications have been reported to have contrasting effects on quality of life. Measurements of quality of life, physical symptoms, and depression taken at baseline and during therapy revealed few significant changes in these indicators. Changes in mean levels of diastolic and systolic hypertension over time were clinically and statistically significant. Findings raise issues regarding medication effectiveness and cost given the disadvantaged population studied.