Nurse-to-patient ratio as risk factor for nosocomial infections - prospective cohort study in the endemic situation and review

Titelblatt und Inhaltsverzeichnis Einleitung und Aufgabenstellung Material und Methoden Ergebnisse Diskussion Zusammenfassung LiteraturIn dieser Studie konnte anhand der Beobachtungen, die innerhalb eines Krankenhauses gemacht wurden, nachgewiesen werden, dass die Stationsbesetzung einen Einfluss auf die endemische Rate primärer Sepsis besitzt. Die Ergebnisse der vorliegenden Studie untermauern, wie wichtig die ausreichende Besetzung mit Pflegepersonal für die Infektionshygiene in Krankenhäusern ist. Das Pflege-Patienten-Verhältnis auf den von uns untersuchten Intensivstationen war, verglichen mit denen anderer Intensivstationen in Deutschland, noch gut. Die gefundenen Risiken werden also auf anderen, schlechter besetzten Stationen, mutmaßlich in noch stärkerem Ausmaße zu finden sein. Es ist allgemein erforderlich, dass in Zukunft die Besetzungsrate der Stationen mit Pflegepersonal nicht von krankenhauspolitischen Entscheidungen abhängig gemacht wird, sondern dass sich an solchen empirischen Untersuchungen orientiert wird, die zeigen, welches Verhältnis von Stationsbesetzung zu Patientendichte notwendig ist, um die optimale Betreuung der Patienten zu gewährleisten.In the present prospective cohort study the effect of nurse-to-patient-ratio in the adult intensive care unit on nosocomial bloodstream infections could be demonstrated. In a systemic review the results were evaluated and discussed with a total of 30 studies regarding patient outcomes in relation to the nurse-to-patient-ratio. The observations support the concept of the importance of adequate staffing levels on hospital hygiene and patient outcome. In times of cuts on nursing staff levels, due to cost concerns, hospital administrators should be aware that these savings are likely to pale in comparison to the costs related to worsened patient outcomes

Comparative evaluation of 64-slice CT angiography and digital subtraction angiography in assessing the cervicocranial vasculature

Randolf Klingebiel1, Max Kentenich3, Hans-Christian Bauknecht3, Florian Masuhr2, Eberhard Siebert1, Markus Busch2, Georg Bohner11Department of Neuroradiology, 2Department of Neurology, 3Department of Radiology, Charité Universitary Medicine Berlin, GermanyBackground: Noninvasive 64-slice computed tomography angiography (64-MSCTA) closely approximates conventional catheter angiography (DSA) in terms of detail resolution. Objective: Retrospective evaluation of cervicocranial (cc) 64-MSCTA in comparison with DSA in patients with presumptive cc vascular disorders.Material and methods: Twenty-four 64-MSCTA studies (32 mm detector width, slice thickness 0.5 mm, 120 kv, 150 mAs, pitch 0.75) of patients with presumptive cc vascular pathology (13 men, 11 women, mean age 38.3 ± 11.3 yrs, range 19–54 yrs) were assessed in comparison with DSA studies without abnormal findings in age-matched patients (11 men, 13 women, mean age 39.7 ± 11.9 yrs, range 18–54 yrs). Study readings were performed in a blinded manner by two neuroradiologists with respect to image quality and assessibility of various cc vascular segments by using a five-point scale. Radiation exposure was calculated for 64-MSCTA.Results: Each reader assessed 384/528 different vessel segments (64-MSCTA/DSA). Superior image quality was attributed to DSA with respect to the C1 ICA–C6 ICA, A3 ACA, and P3 PCA segments as well the AICA and SCA. 64-MSCTA was scored superior for C7 ICA and V4 VA segments. A significantly increased number of nonassessable V2- and V3 VA segments in DSA studies was noted. The effective dose for 64-MSCTA amounted to 2.2 mSv.Conclusions: 64-MSCTA provides near-equivalent diagnostic information of the cc vasculature as compared with DSA. According to our results, DSA should be considered primarily when peripheral vessels (A3/P3) or ICA segments close to the skull base (C2-5) are of interest, such as in primary angiitis or stenoocclusive ICA disease, respectively.Keywords: CT-angiography, CNS, angiograph

Process mapping of PTA and stent placement in a university hospital interventional radiology department

Abstract Objective To apply the process mapping technique in an interdisciplinary approach in order to visualize, better understand, and efficiently organize percutaneous transluminal angioplasty (PTA) and stent placement procedures in a university hospital’s interventional radiology department. Methods After providing an overview of seven established mapping techniques for medical professionals, the process mapping technique was chosen and applied in an interdisciplinary approach including referrers (physicians, nurses, and other staff in referring departments, e.g., vascular surgery), providers (interventional radiologists, nurses, technicians, and staff of the angiography suite), and specialists of the hospital’s controlling department. Results A generally binding and standardized process map was created, describing the entire procedure for a patient in whom the radiological intervention of PTA or stent treatment is contemplated from admission to the department of vascular surgery until discharge after successful treatment. This visualization tool assists in better understanding (especially given natural staff fluctuation over time) and efficiently organizing PTA and stent procedures. Conclusion Process mapping can be applied for streamlining workflow in healthcare, especially in interdisciplinary settings. By defining exactly what a business entity does, who is responsible, to what standard a process should be completed, and how the success can be assessed, this technique can be used to eliminate waste and inefficiencies from the workplace while providing high-quality goods and services easily, quickly, and inexpensively. Main Messages • Process mapping can be used in a university hospital’s interventional radiology department. • Process mapping can describe the patient’s entire process from admission to PTA/stent placement until discharge. • Process mapping can be used in interdisciplinary teams (e.g., referrers, providers, and controlling specialists). • Process mapping can be used in order to more efficiently organize PTA and stent placement procedures. • Process mapping can assist in better understanding and efficiently organizing procedures in standardized fashion