Analyse von notfallmedizinischen Routinedaten aus Präklinik und Klinik

Background: In the 2018 advisory opinion concerning the realignment of healthcare, it is advocated that in order to relieve pressure on emergency departments (ED) prehospital medical emergency services should be given the option to directly transport suitable patients to doctors' offices. Objectives: To determine the prevalence of patients treated by prehospital emergency services that have the potential to be directly allocated to a primary care provider. Materials and methods: Preclinical and clinical data of adult patients who in a 2-month period were transported to the ED of a university hospital by an ambulance were evaluated. To determine a safe and meaningful transport directly to a doctor's office, a stepwise assessment was carried out: patients were categorized on the basis of the prehospital assessment of urgency as "urgent" (contact to doctor necessary within a maximum time of 30 min) and "less urgent" (contact to doctor not necessary within 30 min, maximum 120 min). "Less urgent" patients were further divided and those treated as outpatients were identified. This group was further restricted to cases whose administrative reception in the ED was documented Monday-Friday between 8 am and 7 pm. In addition, these cases were further differentiated with regard to medical content and compared with the triage results in the ED (Manchester Triage, MTS). Results: In all, 1260 patients were brought to the ED by ambulance within the study period (total number of patients treated in this time period n = 11,506); 894 cases had a documented prehospital level of urgency and could therefore be included. Of these n = 477 (53.4%) were categorized as "less urgent"; 317 (66.5%) of these "less urgent" cases were treated as outpatients in the ED, and n = 114 (23.9%) in a time frame potentially suitable for direct transport to doctors' offices, which is 1% of all patients treated in the ED in the time period examined. However, 70 of the cases suitable for doctors' office (63.6% of n = 110 with documented MTS) were rated more urgent in the ED. With regards to prehospital complaints and documented diagnosis we assume employment of a relevant amount of resources in the treatment of these cases. Conclusions: EDs could be relieved from every tenth patient brought in by prehospital emergency services (1% of all patients treated) during normal offices hours by direct allocation to doctors' offices. Regarding patient's safety this process however has to be seen critically as > 60% of these cases were potentially undertriaged. Necessary resources for diagnostics and treatment have to be available in the doctors' offices and known to prehospital emergency services. Primary assignment of patients to doctors' offices by prehospital emergency can only relieve urban EDs to a negligible extent, is potentially dangerous and linked to a tremendous logistic effort

Job requirements compared to medical school education: differences between graduates from problem-based learning and conventional curricula

Background: Problem-based Learning (PBL) has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements. Methods: Graduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke) and conventional curricula. Results: Three schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female) and the conventional curricula (n = 4720, 49% female) were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p < 0.001), except for "Medical knowledge" and "Research competence". Comparing competencies required at work and taught in medical school, PBL was associated with benefits in "Interdisciplinary thinking" (Δ + 0.88), "Independent learning/working" (Δ + 0.57), "Psycho-social competence" (Δ + 0.56), "Teamwork" (Δ + 0.39) and "Problem-solving skills" (Δ + 0.36), whereas "Research competence" (Δ - 1.23) and "Business competence" (Δ - 1.44) in the PBL-based curriculum needed improvement. Conclusion: Among medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development

Mit dem Rettungsdienst direkt in die Arztpraxis – eine wirkungsvolle Entlastung der Notaufnahmen?

Background!#!In the 2018 advisory opinion concerning the realignment of healthcare, it is advocated that in order to relieve pressure on emergency departments (ED) prehospital medical emergency services should be given the option to directly transport suitable patients to doctors' offices.!##!Objectives!#!To determine the prevalence of patients treated by prehospital emergency services that have the potential to be directly allocated to a primary care provider.!##!Materials and methods!#!Preclinical and clinical data of adult patients who in a 2-month period were transported to the ED of a university hospital by an ambulance were evaluated. To determine a safe and meaningful transport directly to a doctor's office, a stepwise assessment was carried out: patients were categorized on the basis of the prehospital assessment of urgency as 'urgent' (contact to doctor necessary within a maximum time of 30 min) and 'less urgent' (contact to doctor not necessary within 30 min, maximum 120 min). 'Less urgent' patients were further divided and those treated as outpatients were identified. This group was further restricted to cases whose administrative reception in the ED was documented Monday-Friday between 8 am and 7 pm. In addition, these cases were further differentiated with regard to medical content and compared with the triage results in the ED (Manchester Triage, MTS).!##!Results!#!In all, 1260 patients were brought to the ED by ambulance within the study period (total number of patients treated in this time period n = 11,506); 894 cases had a documented prehospital level of urgency and could therefore be included. Of these n = 477 (53.4%) were categorized as 'less urgent'; 317 (66.5%) of these 'less urgent' cases were treated as outpatients in the ED, and n = 114 (23.9%) in a time frame potentially suitable for direct transport to doctors' offices, which is 1% of all patients treated in the ED in the time period examined. However, 70 of the cases suitable for doctors' office (63.6% of n = 110 with documented MTS) were rated more urgent in the ED. With regards to prehospital complaints and documented diagnosis we assume employment of a relevant amount of resources in the treatment of these cases.!##!Conclusions!#!EDs could be relieved from every tenth patient brought in by prehospital emergency services (1% of all patients treated) during normal offices hours by direct allocation to doctors' offices. Regarding patient's safety this process however has to be seen critically as &amp;gt; 60% of these cases were potentially undertriaged. Necessary resources for diagnostics and treatment have to be available in the doctors' offices and known to prehospital emergency services. Primary assignment of patients to doctors' offices by prehospital emergency can only relieve urban EDs to a negligible extent, is potentially dangerous and linked to a tremendous logistic effort

„Warum wird der Notruf 112 gewählt?“ – Befragung zum Notrufverhalten der Berliner Bevölkerung

&lt;jats:title&gt;Zusammenfassung&lt;/jats:title&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Hintergrund&lt;/jats:title&gt; &lt;jats:p&gt;Steigende Notrufzahlen und vermehrte Inanspruchnahme notfallmedizinischer Versorgungsstrukturen sind derzeit Gegenstand umfassender gesundheitspolitischer Debatten in Deutschland. Die vorliegende Arbeit untersucht in einer repräsentativen Befragung die Kenntnisse, das Verhalten und mögliche Ursachen in Zusammenhang mit dem Notruf 112 im Land Berlin.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Methode&lt;/jats:title&gt; &lt;jats:p&gt;In Zusammenarbeit mit Infratest dimap wurde eine Telefonumfrage nach dem Random-digit-dialing(RDD)-Verfahren mit einer repräsentativen Zufallsstichprobe von 1002 Personen der deutschsprachigen Berliner Wohnbevölkerung zu Kenntnissen und dem Umgang mit dem Notruf 112 durchgeführt. Eingeschlossen wurden Menschen im Land Berlin, die zum Befragungszeitraum mindestens 14 Jahre alt waren und über einen Festnetzanschluss verfügten. In 12 Fragen wurden Informationen zum Wissensstand über den Notruf 112, alternative Versorgungsstrukturen, das Nutzungsverhalten der Befragten und alternative Hilfsangebote einschließlich standardisierter Fallbeispiele abgefragt. Experteninterviews wurden ebenfalls durchgeführt.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Ergebnisse&lt;/jats:title&gt; &lt;jats:p&gt;58 % der Befragten gaben an, den Notruf 112 für medizinische Notfälle, 74 % für Notfälle der Brandbekämpfung zu kennen. 91 % der Befragten gaben an, dass sie den Notruf 112 nur bei lebensbedrohlichen medizinischen Situationen wählen würden. Befragte männlichen Geschlechts, ältere Menschen und Befragte mit einem niedrigeren Bildungsstand gaben häufiger an, den Notruf 112 auch bei nicht lebensbedrohlichen medizinischen Problemen in Anspruch zu nehmen. Alternativen zum Notruf kannten 56 % der Befragten, wobei insbesondere die hausärztliche Versorgung kaum eine Rolle spielte. Experten sehen die fehlende Verfügbarkeit von Alternativen als ursächlich für die zunehmende Frequenz von Notrufen.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Schlussfolgerung&lt;/jats:title&gt; &lt;jats:p&gt;Fehlende suffiziente Alternativen in der Notfallversorgung könnten bei der vermehrten Inanspruchnahme des Notrufs eine Rolle spielen. Dennoch scheint die Berliner Bevölkerung durchaus mit der richtigen Nutzung des Notrufs vertraut zu sein. Die Gesundheitskompetenz von vulnerablen Gruppen sollte in Bezug auf das Wissen zum Notruf 112 gestärkt werden. Eine Bevölkerungskampagne könnte einen sinnvollen Ansatz darstellen. Weiterhin muss die Verfügbarkeit alternativer Versorgungsformen verbessert werden.&lt;/jats:p&gt; &lt;/jats:sec&gt

Rescue Operations Lead to Increased Cardiovascular Stress in HEMS Crew Members: A Prospective Pilot Study of a German HEMS Cohort

Helicopter emergency medical service (HEMS) is an essential part of prehospital emergency medicine. The working conditions lead to high physical stress, especially in rescue operations. The study aimed to determine the cardiovascular stress profile during rescue situations in HEMS crew members. Twenty-one HEMS crew members (male n = 20) participated in the prospective study. Heart rate, blood pressure and long-term ECG measurements were recorded during the whole operation day. The changes of measurements during rescue operation (52 operations in total) were compared to these of standby time. Rescue operations lead to increased load on the cardiovascular system, as expressed by significantly higher blood pressure, heart rate values and rate of cardiac events compared to standby time. Of special note, the difference in systolic blood pressure mean was 7.4 ± 9.0 mmHg (CI [5.1; 9.7], p < 0.001). Maximal heart rate was on average 33.7 bpm higher during rescue operation than in the standby time (CI [26.2; 40.8], p < 0.001). Cardiac events occurred significantly more frequently during the period of rescue operation than in standby time hours (p = 0.02). The results reported a significant load on the cardiovascular system during rescue operations in HEMS crew members. Therefore, it is necessary to carry out a risk stratification of the HEMS crew members to prevent cardiovascular risk and events

Job requirements compared to medical school education: differences between graduates from problem-based learning and conventional curricula

Abstract Background Problem-based Learning (PBL) has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements. Methods Graduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke) and conventional curricula. Results Three schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female) and the conventional curricula (n = 4720, 49% female) were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p Conclusion Among medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development.</p