[Availability of patient information in the emergency department : Wish and reality]. / Verfügbarkeit von Patienteninformationen in der Notaufnahme : Wunsch und Wirklichkeit.

BACKGROUND: Fast access to information from other healthcare service providers is particularly important in emergency medicine, as the patients are often unknown and treatment decisions have to be made promptly. OBJECTIVES: The study aims to identify the challenges that emergency departments face in obtaining information on patient history, the expected benefits of easier access to information and which information is most urgently needed. MATERIALS AND METHODS: An online survey throughout Germany was carried out among medical staff working in emergency departments. In all, 181 questionnaires were fully completed and could be included in the data analysis. RESULTS: Of the respondents, 77.9% said it was difficult or very difficult to receive external data at the point of patient care. The survey participants estimate that they need an average of around 47 min to obtain information about one patient. 99.4% believe that patient care would benefit from an easier and faster information exchange. Medication lists, discharge letters, information on previous illnesses and allergies were classified as the most important data elements. CONCLUSIONS: There is an urgent need for action with regard to the considerable effort involved in obtaining information on emergency patients. Digital solutions such as the recently introduced emergency data set can offer additional value for clinical emergency care if they are widely used.

[Pedelec users get more severely injured compared to conventional cyclists]. / Pedelec-Fahrer werden bei Unfällen schwerer verletzt als konventionelle Radfahrer.

BACKGROUND: For years e­bike (Pedelec) sales have been steadily increasing. Therefore, the incidence of e­bike-related injuries and deaths has been growing. Due to clinical experience, emergency personnel are suspecting that e­bikers might be injured more severely compared to conventional bicyclists suffering from an accident. This topic has not yet been analyzed for Germany. OBJECTIVE: Analysis of injury severity and mortality following e­bike and conventional bicycle accidents in a level I trauma center in Germany. MATERIAL AND METHODS: Data of patients treated after a bicycle accident at the accident and emergency department as well as the clinic for traumatology and orthopedics of the Evangelical Hospital (Evangelisches Krankenhaus) Oldenburg were gathered from 1 March 2017 to 1 March 2019. RESULTS: In this study 59 electric bicycle users (e-bikers) and 164 conventional cyclists were included. The average age of e­bikers was 62 years compared to 48 years in the group of conventional cyclists. Comorbidities were significantly more frequent in the e­bike group compared to classical cyclists. The e­bikers were found to be significantly more severely injured than conventional bicyclists, the mean injury severity scores (ISS) were 5.2 and 3.4, respectively. E­bikers were admitted to the hospital more often and for longer periods than the control group. There was no significant difference in mortality. CONCLUSION: E­bikers are more severely injured in accidents compared to conventional cyclists. Due to older age and comorbidity they form a sensitive trauma subgroup. Based on demographics, an increase of old age, more frail cyclists and a growing incidence of serious e­bike accidents is to be expected. Preventive measures, such as helmet usage and riding lessons should be introduced, especially in e­bikers. E­bikers in the emergency department should be examined and treated with special care and aggressive diagnostics. A low threshold for an initial interdisciplinary assessment (shock room management) is advised.

[Information on medical history in the emergency department : Influence on therapy and diagnostic decisions]. / Informationen zur medizinischen Vorgeschichte in der Notaufnahme : Einfluss auf Therapie- und Diagnostikentscheidungen.

BACKGROUND: The introduction of an electronic health record (EHR) or an emergency care data set (ECDS), as well as reforms in emergency medical care, is currently part of political debate in Germany. Currently, no data are available of how emergency departments could benefit from an ePA or NFD in Germany. The aim of this study was to determine if a patient's medical history has an influence on diagnostic and therapeutic decisions in the emergency department. METHODOLOGY: To answer this question, a descriptive observational study was conducted in an interdisciplinary emergency department with a study population of n = 96. RESULTS: For 55 patients (59%) neither a doctor's letter nor a drug list was found. However, in 48% of the patients who were admitted to the hospital via the emergency department, additions to the anamnesis record could be identified. Eight (9%) patients showed that therapy and/or diagnostic decisions should have been discussed or changed if the supplemented anamnestic information had been available in the emergency room. In addition, the study revealed that the duration of the anamnesis was prolonged in case of missing medical history (mean: 10-15 min, standard deviation: ±<5 min). In contrast to the patients with a medical history (mean: 5-10 min, standard deviation: ±<5 min). CONCLUSION: Based on the data stored in EHR and ECDS, therapy and diagnostic decisions could be made more reliably. In the absence of a medical history, the time required for medical history taking in emergency departments is significantly longer, which could be reduced by introducing EHR or ECDS.

[Increasing Number of Road Traffic Fatalities in Germany - Turnaround or Snap-Shot]. / Warum wieder mehr Menschen im Straßenverkehr sterben ­ Trendwende oder Ausreißer?

Introduction: For the first time since 20 years, the number of road accident fatalities in 2011 increased on German roads compared to earlier periods. Methods and Results: The presented paper submitted by the expert group for accident prevention investigates and discusses possible reasons for the observed increase in road traffic fatalities. Results: Climate changes as well as changes in economic environment, and technological progress in car and passenger safety are identified as possible reasons for the observed increase. Discussion: Mentioning the "Decade of Action for Road Safety" initiated by the UNO and coordinated by the WHO, the overall goal is a worldwide reduction of accident related road fatalities. But prognostic calculations predict an asymptotic approximation to a limit of road fatalities. To achieve a reduction by half until 2020 intense collaboration and disproportional expenditure are necessary. Conclusion: From the authors' point of view the current increase of traffic fatalities in Germany is rated as a snapshot rather than a turnaround.

[Comparison of ICD 10 and AIS with the Development of a Method for Automated Conversion]. / Vergleich von ICD-10 und AIS mit der Entwicklung einer Methode zur automatisierten Umwandlung.

BACKGROUND: Most of the current scores and outcome prediction calculations in traumatology are based on the Abbreviated Injury Scale (AIS). However, this is not routinely used for documentation and coding of injuries in many countries, including Germany. Instead of the AIS, the International Classification of Diseases (ICD) is used. While the ICD functions as the basis for automated calculating of the diagnosis-related groups (DRG), no possibility of simple conversion of the 10th version of the ICD into AIS is available so far. OBJECTIVES: The aim of this work is to develop and apply a methodology for simple conversion from ICD 10 to current AIS. MATERIALS AND METHODS: The developed mapping procedure was based on a 1 : n relationship between trauma codes of ICD-10-GM and the codes of the AIS2005. Calculated ISS from the conversion codes were then compared with the actual ISS coding available from the clinical trauma documentation. RESULTS: It can be shown that, despite the considerable differences in the structure and systematic of both classification systems, an automated translation is technically possible. CONCLUSIONS: The preliminary result of the mapping suggests, however, that despite the technical feasibility of a reliable conversion and comparability of ICD 10 and AIS in the required quality is still questionable. An automated conversion is still possible and quality would possibly improve by inclusion of additional information.

Bicycle accidents - do we only see the tip of the iceberg? A prospective multi-centre study in a large German city combining medical and police data.

INTRODUCTION: Bicycles are becoming increasingly popular. In Münster, a German town with a population of 273,000, bicycles were the main method of transportation in 2009, used more often (37.8%) than cars (36.4%). Each day in Münster, bicycles are used around 450,000 times. In 1982, they were only used around 270,000 times a day. However, the increased use of bicycles has also led to an increased number of bicycle accidents. METHODS: Between February 2009 and January 2010, data on bicycle-accidents leading to injuries were collected by the Police of Münster and in all emergency units of the six hospitals in Münster. A systematic acquisition of technical data from the police and the medical data from the hospitals were combined anonymously. None of the forms contained personal data of patients involved, except for patient age and sex as well as time and place of bicycle accidents to match the questionnaires. The data were entered into a central database (MS Access for input/MySQL for data retrieval). RESULTS: 2250 patients were included in this study. For each of these patients either a patient record or a hospital record or a police record or a combination of any of these different records existed in our database. In total, 1767 patients received medical treatment at a hospital and 484 people included in the study did not go to a hospital. Three fatalities occurred as a result of bicycle accidents. Considering reasons for hospital admission, traumatic brain injuries were the leading cause (25.7%). However, the largest resource consumption was attributed to fractures of the upper extremities (36.8%) and lower extremities (29.9%) with major surgery. DISCUSSION: Bicycle accidents occur more frequently than indicated by police records. The results of the Münster Bicycle Study have shown that the actual number of bicycle accidents exceeds the officially reported number by nearly two times. Since bicycle helmets cannot prevent accidents it is recommended not only to focus on helmet use as the only injury prevention method. Other factors, such as weather, pavement and default of traffic, roadworthiness of the bicycles or alcohol/drug abuse also affect the accident rates.

[Prevention of road accidents involving non-motorized traffic participants (pedestrians and cyclists) in Germany]. / Prävention von Verkehrsunfällen äußerer Verkehrsteilnehmer (Fußgänger und Fahrradfahrer) in Deutschland.

During a 1-day workshop organized by the German Society of Orthopaedics and Traumatology (DGOU) 15 German accident researchers used different approaches to improve the effectiveness of accident prevention for pedestrians and bicyclists on German roads. The main results of this analysis show: Fatal injuries of pedestrians have been significantly reduced by 82% between 1970 (n=6.056) and 2007 (n=695). Similarly, fatalities of bicyclists have been reduced during the same time period from 1,835 to 425 which amount to almost 80%. However, the total number of injured cyclists increased almost twice, i.e. from 40,531 (in 1979) to 78,579 (in 2007) a fact that needs to be analyzed in more detail. Although scientifically proven to provide protection against severe head injuries, helmets are worn less frequently by adolescents and women as compared to younger children and men. Fatalities of bicyclists might be reduced by using Dobli mirrors which allow the truck driver to see the bicyclist when turning right. Recently developed sensors are able to detect pedestrians walking closely (<2.5 m) and warn the truck driver acoustically. Bicycle lanes should be planned for one direction only, separated from the pedestrian way and large enough (2.0 m are safer than 1.6 m). Traffic education for school beginners and younger children should be repeated to be effective. Training for elderly bicyclists in cities with heavy traffic would also be reasonable. Active security systems in cars like ESP (electronic stability program), BAS (brake assist system), special light systems for curves, and night vision utilities are most effective to prevent collision with pedestrians and bicyclists. TV spots for bicyclists could help to point out dangerous situations and the proven benefits of wearing a helmet in the same way as previous campaigns, e.g."The 7th Sense" for car drivers.

Telematics in acute trauma care.

Each year, 20,000 people in Germany die because of a traffic accident. Altogether, yearly productivity loss caused by these injuries is estimated to be around 5 billion Euros. International and national studies revealed the trauma center level of the primary hospital as the major predictor for trauma related mortality. In 2006 the German Society for Trauma Surgery (DGU) called its members to form regionally based networks for the exchange of data among hospitals engaged in trauma care. In April 2008 the north-west region of Germany with 49 hospitals, three hospitals in the Netherlands, and local emergency services founded the "TraumaNetwork NorthWest (TNNW). The major goals of the TNNW are: 1) to shorten the time between accident and admission to the appropriate hospital, 2) to create effective means of communication, and 3) to implement common pre- and in-hospital standards for trauma care. Since the needed application software is not commercially available, a team of computer and medical specialists has been formed for its development. Once the software is in place, a pre- and post-analysis will be performed to study the consequences of the application on transportation time and injury-related mortality within the region. The project is recognized as a pilot project by the DGU and if it is successful is meant to be adapted across Germany.

[Classification of severely injured patients in the G-DRG System 2008]. / Abbildung des schwer verletzten Patienten im G-DRG-System 2008.

BACKGROUND: Since the introduction of a per-case reimbursement system in Germany (German Diagnosis-Related Groups, G-DRG), the correct reimbursement for the treatment of severely injured patients has been much debated. While the classification of a patient in a polytrauma DRG follows different rules than the usual clinical definition, leading to a high number of patients not grouped as severely injured by the system, the system was also criticized in 2005 for its shortcomings in financing the treatment of severely injured patients. The development of financial reimbursement will be discussed in this paper. METHOD: 167 patients treated in 2006 and 2007 due to a severe injury at the University-Hospital Münster and grouped into a polytrauma-DRG were included in this study. For each patient, cost-equivalents were estimated. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK cost-calculation method. The reimbursement was calculated using the G-DRG-Systems of 2007, 2008 and 2009. Cost-equivalents/costs and clinical parameters were correlated. RESULTS: A total of 167 patients treated in 2006 and 2007 for a severe injury at the Münster University Hospital and grouped into a polytrauma DRG were included in this study. Cost equivalents were estimated for each patient. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK (Institute for the Hospital Remuneration System) cost calculation method. Reimbursement was calculated using the G-DRG systems of 2007, 2008 and 2009. Cost equivalents/costs and clinical parameters were correlated. DISCUSSION: With the ongoing development of the G-DRG system, reimbursement for the treatment of severely injured patient has improved, but the amount of underfinancing remains substantial. As treatment of severely injured patients must be reimbursed using the G-DRG system, this system must be further adapted to better meet the needs of severely injured patients. Parameters such as total surgery time, injury severity score (ISS) and LOS in ICU could be used for this purpose. In future, data obtained in trauma networks can help optimize reimbursement for the treatment of these patients.

[Transfer of severely injured patients under DRG terms]. / Verlegen von Schwerverletzten unter DRG-Bedingungen.

The aim of trauma networks is the transfer of severely injured patients to the next suitable hospital according to different trauma center levels. Under the terms of DRG-based payment, we must pay attention to conditions of reimbursement.

[Internal quality management: use of a patient questionnaire in a urological university clinic. Results of a pilot project]. / Internes Qualitätsmanagement: Patientenbefragung in einer urologischen Universitätsklinik. Ergebnisse eines Pilotprojektes.

INTRODUCTION AND OBJECTIVE: In order to support the introduction of quality management, a systematic patient questionnaire was used in the Urology Clinic of the University Hospital of Münster and in another comparable clinic. The aim was to distinguish between well established areas and areas needing improvement. METHODS: A multidimensional questionnaire with emphasis on items involving patient satisfaction was developed and handed out to the patients before they left the clinic. The questionnaire could be sent back with an enclosed envelop free of charge. RESULTS: Hospital hygiene was rated as most important factor by the patients, followed by professionalism of the physicians and nurses. Patients were dissatisfied with hospital hygiene, making this an issue for improvement. Physicians and nurses were rated positively in both clinics. Furthermore, a high proportion of patients (82%) said that they had no pain after surgery. Overall, patients were very satisfied with their hospital stay in both clinics. CONCLUSIONS: After analyzing the questionnaires, we could identify areas in need of improvement and areas of high performance. In particular, hospital hygiene needs to be improved. In order to reach more patients, the inquiries need to be performed in all departments of the University Hospital of Münster.

Empirical comparison of DRG variants using cardiovascular surgery data: initial results of a project at 18 German hospitals.

In 2000, the responsibility for selecting a DRG variant for use in Germany was assigned to a body comprising representatives of hospitals and insurers called the Self-Administration Board (or Board in this paper). To help the Board, we applied cardiac surgery data from 18 German hospitals to eight different DRG variants. The error caused by bad coding quality could be minimized this way, since all diagnoses and procedures in cardiac surgery must be recorded for quality assurance purposes. To match the German code to the appropriate code required by the DRG variant, we created mapping tables whenever needed. As far as cardiac surgery is concerned, the Australian AR-DRG and the French GHM variants provided the best medical relevance, while the AR-DRG variant considered the level of severity better. Other variants would have to be updated to better reflect the level of medical complexity. Three main causes for wrong grouping could be identified for all systems: incomplete mapping, not enough reference to multidisciplinary treatments, and system construction problems.