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      Kompetenz, Kreativität und Kommunikation: Grundlagen zur Qualitätsverbesserung in der Traumatologie : Realität und Herausforderung der Zukunft Translated title: Competence, creativity and communication: basics for quality improvement in traumatology : Reality and future challenges

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          Abstract

          Interdisziplinarität spielt in der Behandlung von Patienten mit komplexen Erkrankungen und Verletzungen eine ausschlaggebende Rolle für den Behandlungserfolg. So konnte die Unfallchirurgie durch innovative Konzepte die Qualität der Patientenversorgung nachweislich steigern: Die Einführung eines Stationsapothekers mit der täglichen Besprechung der verordneten Medikation zeigt eine Reduktion der Nebenwirkungen, Arzneimittelkosten und Verbrauch von Antibiotika. Ein Delirpräventionsteam untersucht Patienten über 65 Jahre auf Risikofaktoren für ein peri- und postoperatives Delir, passt die Medikation an und berät in der Akutbehandlung. In Anlehnung an das längst etablierte Tumorboard soll eine interdisziplinäre muskuloskelettale Konferenz zur abgestimmten Therapie der Versorgung komplexer interdisziplinärer Verletzungen des Bewegungsapparates etabliert werden. Die Herausforderung der Zukunft liegt in der digitalen Verknüpfung bereits bestehender Krankenhausnetzwerke und der Ermöglichung eines schnellen Zuganges zu diesem interdisziplinären Expertenwissen auch in der Breite.

          Translated abstract

          Interdisciplinary collaboration is one of the key factors for successful treatment of patients with complex injuries and diseases. Hence, several innovative concepts have been initiated to improve the treatment quality within the field of trauma surgery. The implementation of a ward pharmacist with the daily discussion of prescribed medications shows a reduction of side effects, costs for medicaments and the use of antibiotics. An interdisciplinary and multimodal delirium team was introduced and every patient over the age of 65 years was screened for the risk of perioperative and postoperative delirium, the medication was adjusted and expert advice was available in the case of acute delirium. Corresponding to the well-established tumor boards, an interdisciplinary musculoskeletal conference to decide on the treatment of complex interdisciplinary injuries of the musculoskeletal system should be established. The future challenges will include the digital connection of hospitals within the already existing trauma networks in order to provide rapid access to this interdisciplinary expertise also outside maximum care hospitals.

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          Most cited references26

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          Is Open Access

          The incidence and nature of in-hospital adverse events: a systematic review

          Introduction: Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general overview of the data is lacking. We performed a systematic review of the literature on in-hospital adverse events. Methods: A formal search of Embase, Cochrane and Medline was performed. Studies were reviewed independently for methodology, inclusion and exclusion criteria and endpoints. Primary endpoints were incidence of in-hospital adverse events and percentage of preventability. Secondary endpoints were adverse event outcome and subdivision by provider of care, location and type of event. Results: Eight studies including a total of 74 485 patient records were selected. The median overall incidence of in-hospital adverse events was 9.2%, with a median percentage of preventability of 43.5%. More than half (56.3%) of patients experienced no or minor disability, whereas 7.4% of events were lethal. Operation- (39.6%) and medication-related (15.1%) events constituted the majority. We present a summary of evidence-based interventions aimed at these categories of events. Conclusions: Adverse events during hospital admission affect nearly one out of 10 patients. A substantial part of these events are preventable. Since a large proportion of the in-hospital events are operation- or drug-related, interventions aimed at preventing these events have the potential to make a substantial difference.
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            Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis.

            Delirium, an acute disorder with high morbidity and mortality, is often preventable through multicomponent nonpharmacological strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies to date.
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              Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults.

              Major postoperative complications and delirium contribute independently to adverse outcomes and high resource use in patients who undergo major surgery; however, their interrelationship is not well examined.
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                Author and article information

                Contributors
                steffen.rosslenbroich@ukmuenster.de
                Journal
                Chirurg
                Chirurg
                Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
                Springer Medizin (Heidelberg )
                0009-4722
                1433-0385
                29 January 2021
                : 1-6
                Affiliations
                [1 ]GRID grid.16149.3b, ISNI 0000 0004 0551 4246, Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, , Universitätsklinikum Münster, ; Albert-Schweitzer-Campus 1, Gebäude W1, 48149 Münster, Deutschland
                [2 ]GRID grid.16149.3b, ISNI 0000 0004 0551 4246, Geschäftsbereich Apotheke, , Universitätsklinikum Münster, ; Münster, Deutschland
                Author notes
                [Redaktion]

                M. Ehrenfeld, München

                Article
                1347
                10.1007/s00104-020-01347-9
                7845268
                33512560
                1c660148-acad-4edd-841e-5b2c74abd1d3
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 21 December 2020
                Categories
                Leitthema

                delirpräventionsteam,stationsapotheker,traumanetzwerk,interdisziplinarität,krankenhausnetzwerke,delirium prevention team,ward pharmacist,trauma network,interdisciplinarity,hospital networks

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