Leitlinienbasierte Anforderungsprofile (Order Sets) von Bildgebenden Verfahren in der Traumatologie

Medical quality improvement and evidence based medicine are catchwords within the health care system. Medical acting on a scientifically proven basis is supposed to improve the diagnostical and therapeutical results and to increase effictiveness. Health care systems worldwide set their trust in concepts of the evidence based medicine to create transparent structures for medical decision making and to keep the attainments affordable. Guidelines are an important foundation to these means. The big amount of scientifical information has been growing extremely in the last twenty years. The expenditure of time for the search and selection of information causes physicians disaffection and is hardly integrable in the daily working routine. But the implementation of evidence based medicine in clinical practice requires this search and selection of information. Medical guidelines are supposed to limit the amount of information by taking over the preselection of scientific expertise for the consumer, in this case the medical fraternety. Reasons for an insufficient use of guidelines are for example the contrariness of recommendations of different developers and an hindered orientation due to the inflation of guidelines. There is no possibility to get an overview off all current existent guidelines, because there are many developers, but no central institution which controls or documents the publication of guidelines. To gain an overview about the existent international guideline recommendations of radiological diagnostics in traumatology, all of them are brought together and compared in this dissertation. The high number and the inconsistency of the guidelines are conspicuous. They differ in structure and content, in their way of development and underlying evidence as well as in their classification-systems and documentation of the used evidence. The enormous diversity and complexity causes the user an expensive orientation, which decreases the attraction of utilization of guidelines. The high number and the inhomogeneity of the classification systems are both central problems of utilization. In fact the function of those systems is to make the scientific validity of the recommendations transparent for users. Though the guideline developers are using diversity of classification systems, which partly differ a lot in their interior division, they increase confusion instead of transparency. To achieve the mentioned overview and comparison of the guideline recommendations, it is necessary to unify the many systems of classification. With this intention each one of the systems is translated into the classification system of AWMF. To get a practical benefit from this comparison the different recommendations are evaluated and profiles for requirements for radiological diagnostics in traumatology are constructed. Within the framework of a decision support system, an algorithm of recommendations is created in cooperation with the trauma surgery clinic of the University of Marburg. This algorithm contains the profiles for requirements plus the tabularly comparison of the guidelines. The integration into the clinical intranet of the university enables the simple and fast access to the recommendation-algorithm. With this application of an intranet portal the implementation of a big number of guideline-recommendations is simplified.