Strukturqualität in deutschen Intensivstationen: Reevaluation der Strukturdatensätze des DIVI-Registers

Seitdem im Jahr 2000 im Zuge eines zunehmenden ökonomischen Drucks die Forderung zur Pflichtimplementierung von qualitätssichernden Maßnahmen in der Medizin gesetzlich verankert wurde, ist verstärkt versucht worden, Intensiveinheiten bezüglich ihrer Basisdaten zu erfassen sowie einen nationalen Re...

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Bibliographic Details
Main Author: Kofahl, Nele Verena
Contributors: Stiletto, Raphael (Dr.) (Thesis advisor)
Format: Dissertation
Published: Philipps-Universität Marburg 2012
Operative Medizin
Online Access:PDF Full Text
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Table of Contents: Since the year 2000, when due to a higher economic pressure in the Health Care System the implementation of quality measurements became mandatory by law, several independent associations tried to register the basic data set of Intensive Care Units in Germany in order to deduce a national reference concerning its quality standards. Intensive Care Units (ICU) always had been in an economic focus due to the fact that ICUs are responsible for a high percentage of the yearly expenses of the Health Care System without any proper tool to measure their efficiency. Therefore ICUs had always difficulties in justifying the high amount of financial care. Furthermore without any possibility of measuring its efficiency among each other it means that on the other hand on the long term any improvement will stagnate. One of these associations that had a major part in the evaluation of a basic data set, was the “Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin” (DIVI). The present publication revaluates the former data set to 1) update the data and 2) to analyse what effects on the ICU structure the implementation of quality measurements and the continuous economic pressure had. 119 of the former 349 ICUs participated in the revaluation of the first data set, compared to the nationwide data set containing among others the Unit size, number of treated and/or ventilated patients, number of treated/ventilated days in total, number of treated/ventilated patients, personal and technical equipment etc. both contingents were in general similar. In summary the revaluated contingent showed that despite of the economic pressure and the skills shortage ICUs in Germany expanded their technical equipment, in particular the MRI, and increased the number of medical staff per patient. On the same hand the degree of utilisation of intensive care beds increased and is meanwhile higher than the degree of utilisation of the hospital beds in total. Nevertheless despite of an increase of medical staff more than one fourth of all ICUs of General Hospitals were unable to provide a physician during the night time on ICUs. Thanks to the revaluation of the former data set it will be possible to analyse in the future the question why the percentage of ventilated patients declined whereas the total number of ventilation days increased while it was expected that the percentage of ventilated patients would increase due to the implementation of Intermediate Care Units(IMC). By comparing IMCs with ICUs using the basic data it will be furthermore possible to verify whether the implementation of IMC led to the advantages hoped for.