BACKGROUND: Interprofessional training wards (ITW) are increasingly being integrated into teaching and training concepts in visceral surgery clinics. OBJECTIVE: How safe is patient care on an ITW in visceral surgery? MATERIAL AND METHODS: Data collection took place from November 2021 to December 2022. In this nonrandomized prospective evaluation study the frequency and severity of adverse events (AE) in 3 groups of 100 patients each in a tertiary referral center hospital for visceral surgery were investigated. The groups consisted of patients on the ITW and on the conventional ward before and after implementation of the ITW. The Global Trigger Tool (GTT) was used to search for AE. Simultaneously, a survey of the treatment was conducted according to the Picker method to measure patient reported outcome. RESULTS: Baseline characteristics and clinical outcome parameters of the patients in the three groups were comparable. The GTT analysis found 74 nonpreventable and 5 preventable AE in 63 (21%) of the patients and 12â¯AE occurred before the hospital stay. During the hospital stay 50â¯AE occurred in the operating theater and 17 on the conventional ward. None of the five preventable AE (in 1.7% of the patients) was caused by the treatment on the ITW. Patients rated the safety on the ITW better than in 90% of the hospitals included in the Picker benchmark cohort and as good as on the normal ward. CONCLUSION: The GTT-based data as well as from the patients' point of view show that patient care on a carefully implemented ITW in visceral surgery is safe.
Digestive System Surgical Procedures , Patient Care Team , Humans , Tertiary Care Centers , Surveys and Questionnaires , Length of Stay , Digestive System Surgical Procedures/adverse effects
BACKGROUND: In the professional public there is agreement that healthcare professionals worldwide should already be prepared for safety in patient care during their education. OBJECTIVE: How can the topic of patient safety be successfully integrated into the curricula of healthcare professions? MATERIAL AND METHODS: Overview of the Marburg curriculum on patient safety during the practical year as well as of other approaches to teaching patient safety described in the literature. RESULTS: In recent years teaching initiatives on patient safety have significantly increased; however, they are still not comprehensively distributed in German-speaking countries or throughout Europe. In the context of implementation, the multiprofessional edition of the World Health Organization (WHO) patient safety curriculum guide may be used as guideline. A current, very promising development in connection with acquiring and examining the competences that are necessary for safe patient care is the establishment of interprofessional training wards. CONCLUSION: In the meantime, there are clearly defined strategies for the integration of the topic of patient safety into the curricula of healthcare professionals. On the way towards a successful restructuring of the curricula including the necessary competences and behavioral changes of the students, however, relevant support by the management of faculties and teaching hospitals is essential.
Education, Medical, Undergraduate , Patient Safety , Curriculum , Europe , Humans , Students, Medical
To deliver patient-specific advice at the time and place of a consultation is an important contribution to improving clinician performance. Using computer-based decision support on the basis of clinical pathways is a promising strategy to achieve this goal. Thereby integration of IT applications into the clinical workflow is a core precondition for success. User acceptance and usability play a critical role: additional effort has to be balanced with enough benefit for the users and interaction design and evaluation should be handled as an intertwined, continuous process. Experiences from routine use of an online surgical pathway at Marburg University Medical Center show that it is possible to successfully address this issue by seamlessly integrating patient-specific pathway recommendations with documentation tasks which have to be done anyway, by substantially reusing entered data to accelerate routine tasks (e.g. by automatically generating orders and reports), and by continuously and systematically monitoring pathway conformance and documentation quality.
Clinical Competence , Critical Pathways , Decision Making, Computer-Assisted , Guideline Adherence , Academic Medical Centers , Attitude of Health Personnel , Germany , Humans , Systems Integration
To deliver patient-specific advice at the time and place of a consultation, to improve clinician performance and compliance by using computer-based decision support, and to integrate such IT solutions with the clinical workflow are important strategies for the implementation of clinical pathways. User acceptance plays a critical role: additional effort has to be balanced with enough benefit for the users. Experiences from routine use of an online surgical pathway at Marburg University Medical Center show that it is possible to successfully address this issue by seamlessly integrating patient-specific pat documentation tasks which have to be done anyway and by substantially reusing entered data to accelerate routine tasks (e.g. by automatically generating orders and reports).
Critical Pathways , Patient Compliance , Academic Medical Centers , Decision Support Systems, Clinical , Humans , Workflow
Due to typical problems (heterogeneity, lack of clinical functionality, Y2K problems) the board of directors of the university hospital of Marburg decided in 1997 to replace major components of the existing system by commercially available software. The products available on the market were analyzed, and, under participation of different user groups, a comprehensive functional specification was generated. This was the basis for a Europe-wide vendor selection process. In this context, several key aspects were identified, which are critically important for realizing a HIS that fulfills the specified functional requirements. Among these key aspects are the integration of heterogeneous system components, the support of cross-departmental workflow, and flexibility as well as adaptability to specific clinical requirements. As a result, we found that with today's commercially available products and standards there is no single solution that fully meets all requirements. However, some "generalist" vendors are offering integrated systems with acceptable clinical functionality. Tools are emerging which enable the clinical user to generate forms for data input and data flow. Still, a hospital information system will consist of separate components that have to be integrated, but the role of integrated, component-based approaches is becoming more important.
Hospital Information Systems , Software , Computer Systems , Germany , Humans , Medical Records Systems, Computerized
All doctors in Germany are required to cooperate in the implementation of the health system reform and the new system for reimbursement of the hospitals to limit the negative consequences to the patients. It would be absolutely wrong to leave the medical services of the insurance companies to define the diagnosis-related groups and determine the charges. The revision of the health system is beneficial in that it supports the economical independence of hospital departments. It is a good idea for them to be paid by results; however, there are no established methods of measuring results or efficacy in medicine. Germany is about 10 years behind the USA in this, so that our country is not yet ready for this reform. Hospital departments do have the freedom to make economic decisions, being heavily dependent on the insurances and the government, because most people who work in hospital are paid from these sources. Departments of trauma or orthopaedic surgery are disadvantaged by the reform, because of the number and kind of diagnosis related groups and the method of reimbursement. This leads to a profit-oriented system of medical documentation, with possible upcoding of diagnoses in future. The present health reform most probably will not increase the efficiency of hospitals; it will not be possible to attain cost reductions with the same level of medical care. The reduced reimbursement will force doctors to cut down their expenses and restrict diagnostic and therapeutic procedures. On the other hand the administration sector in hospitals and insurances will expand dramatically in future.(ABSTRACT TRUNCATED AT 250 WORDS)
Documentation/methods , National Health Programs/legislation & jurisprudence , Reimbursement Mechanisms/legislation & jurisprudence , Wounds and Injuries/surgery , Cost Control/legislation & jurisprudence , Germany , Hospitals, University , Humans , National Health Programs/economics , Quality Assurance, Health Care/legislation & jurisprudence , Reimbursement Mechanisms/economics , Wounds and Injuries/economics
Shorter lengths of hospitalization may result in more surgical wound infections being documented after hospital discharge. The current investigation analyzed 1644 surgical procedures performed over a 3-month period, and documented surgical wound infections both before and for 1 month after hospital discharge. Physician and patient questionnaires were used. One hundred eight infections were noted, of which 50 (46%) were seen after hospital discharge by either the patient or the surgeon. Rates of infection were 5.2%, 7.5%, and 7.5% for clean, clean-contaminated, and contaminated-dirty categories, respectively. Had postdischarge surveillance not been used, rates would have appeared to be 2.5%, 6.5%, and 6.8% for the same surgical classes. Infections following clean and clean-contaminated procedures were more likely to be noticed after hospital discharge. Excluding those that were patient-documented, wound infection rates would have been 4.2% (clean), 6.3% (clean-contaminated) and 6.8% (contaminated-dirty). Postdischarge surveillance is imperative to meaningfully document true rates of surgical wound infection, inasmuch as increasing numbers are likely to occur only after patients leave the hospital.
Patient Discharge , Surgical Wound Infection/epidemiology , Follow-Up Studies , Hospital Bed Capacity, 500 and over , Humans , Massachusetts , Surveys and Questionnaires
A report on malignant fibrous histiocytoma of the mandible in a 1 6/12-year-old boy, a condition rarely seen in children. Because of inoperability radiotherapy was used resulting in complete tumour remission. The clinical course was complicated by a tracheo-oesophageal fistula and aspiration pneumonia. The spontaneous closure of the fistula occurred 5 months after tracheostomy and catheter jejunostomy. After 2 10/12 years there is no evidence of tumour disease. Possibilities and problems of therapy are discussed.
Histiocytoma, Benign Fibrous/surgery , Mandibular Neoplasms/surgery , Child , Combined Modality Therapy , Histiocytoma, Benign Fibrous/pathology , Humans , Lymphatic Metastasis , Male , Mandible/pathology , Mandibular Neoplasms/pathology , Prognosis
Infections identified between 1981 and 1983 in a hospital's medical/surgical, pediatric, neonatal, coronary care, and cardiac surgery ICUs were compared. Among 14,360 admissions, 1840 infections occurred in 1360 patients. Total infection rates ranged from 1.0% (cardiac surgery ICU) to 23.5% (medical/surgical ICU). Rates of ICU-acquired infection ranged from 0.8% (cardiac surgery ICU) to 11.2% (medical/surgical ICU), indicating that only about half of infections in the latter unit were acquired from within. Primary bacteremias comprised 14.5% of neonatal ICU infections, a rate 500% higher than in other ICUs. Meningitis and genitourinary infections were more common in pediatric and coronary care ICUs. Candida and Pseudomonas species and Klebsiella-Enterobacter-Serratia were most common in the medical/surgical ICU. Survival rate of infected patients was over 87% in pediatric and neonatal ICUs, compared with only 55.4% in the medical/surgical ICU. These differences in types and rates of infection have an important bearing on infection-control activities in the ICU, and also provide a yardstick against which similar institutions can gauge their ICU infection status.
Cross Infection/epidemiology , Intensive Care Units , Bacteria/isolation & purification , Cross Infection/microbiology , Cross Infection/mortality , Hospital Bed Capacity, 500 and over , Hospitals, Community , Hospitals, Teaching , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Massachusetts , Prospective Studies
Monitoring of poor risk cases is of decisive importance in paediatric surgery. The monitoring has to be adapted to the specific situation of the disease in question.
Monitoring, Physiologic/methods , Surgical Procedures, Operative , Age Factors , Body Temperature , Child , Heart Rate , Humans , Monitoring, Physiologic/instrumentation , Postoperative Care/methods , Risk
Child Health Services , Dermatoglyphics , Hand , Physical Examination , Adult , Age Factors , Child , Child Behavior Disorders/diagnosis , Child Development , Congenital Abnormalities/diagnosis , Developmental Disabilities/diagnosis , Evaluation Studies as Topic , Female , Genetics, Medical , Hearing Disorders/diagnosis , Humans , Intellectual Disability/diagnosis , Intelligence , Leukemia/diagnosis , Leukemia, Lymphoid/diagnosis , Male , Motor Skills , Rubella/complications , Speech Disorders/diagnosis , Vision Disorders/diagnosis
Dermatoglyphics , Hand Deformities, Acquired , Intellectual Disability/epidemiology , Abnormalities, Multiple/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Child Development , Child, Preschool , Dermatoglyphics/classification , Female , Hand/embryology , Humans , Infant , Infant, Newborn , Intellectual Disability/diagnosis , Male , Physical Examination , Pregnancy
Diet Therapy , Parent-Child Relations , Phenylketonurias , Adult , Attitude , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male
