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Nohl A, Trentzsch H, Bieler D, Peters J, Pieske O, Brune B, Dudda M, Hartensuer R. [Position of trauma surgery in emergency medicine]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:425-432. [PMID: 35829758 DOI: 10.1007/s00113-022-01206-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The decision of the Federal Joint Committee has resulted in the further development of in-hospital emergency medicine through the establishment of central emergency departments and staged emergency care. In addition, the additional training in clinical acute and emergency medicine was established. AIM The aim of this work is on the one hand to make trauma surgeons aware of these structural changes. On the other hand, we would like to evaluate an opinion and discuss the position of trauma surgery in emergency medicine. METHODS A web-based online survey was conducted at the Trauma Network and Trauma Registry Congress to collect participants' opinions on the position of trauma surgery in emergency medicine. RESULTS Of 143 congress participants, 98 (67%) responded to the survey. The majority of participants were male (n = 78, 80%), over 40 years of age (n = 62, 63%), and in a professional position with staff responsibility (n = 73, 75%). Emergency medicine (mean: 84.8; SD: 18.7) and intensive care medicine (mean: 78.3; SD: 20.4) training appears important. On the other hand, subsequent work in these areas appears less important (prehospital emergency medicine: mean: 65.1; SD: 28.0; ICU: mean: 53.7, SD: 30.3); however, activity in an emergency department is rated higher (MW: 87.0; SD: 18.7). There is high agreement that the trauma leader should be a trauma surgeon (mean 87.9; SD: 19.7). DISCUSSION A high volume of emergency trauma surgery patients and the care of severely injured patients in designated trauma centers show that trauma surgery expertise is mandatory in a central emergency department. Senior positions should also be sought to ensure high quality standards.
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Affiliation(s)
- André Nohl
- Zentrum für Notfallmedizin, BG Klinikum Duisburg, Duisburg, Deutschland.
- Ärztliche Leitung Rettungsdienst, Feuerwehr Stadt Oberhausen, Oberhausen, Deutschland.
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland.
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland.
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, LMU München, München, Deutschland
| | - Dan Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, Heinrich-Heine-Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Jan Peters
- Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland
| | - Oliver Pieske
- Klinik für Unfallchirurgie, Orthopädie & Sporttraumatologie, Evangelisches Krankenhaus Oldenburg, Oldenburg, Deutschland
| | - Bastian Brune
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
- Ärztliche Leitung Rettungsdienst, Feuerwehr Essen, Essen, Deutschland
| | - Marcel Dudda
- Zentrum für Notfallmedizin, BG Klinikum Duisburg, Duisburg, Deutschland
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
- Ärztliche Leitung Rettungsdienst, Feuerwehr Essen, Essen, Deutschland
| | - René Hartensuer
- Klinik für Unfall, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
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Junaid SB, Imam AA, Balogun AO, De Silva LC, Surakat YA, Kumar G, Abdulkarim M, Shuaibu AN, Garba A, Sahalu Y, Mohammed A, Mohammed TY, Abdulkadir BA, Abba AA, Kakumi NAI, Mahamad S. Recent Advancements in Emerging Technologies for Healthcare Management Systems: A Survey. Healthcare (Basel) 2022; 10:healthcare10101940. [PMID: 36292387 PMCID: PMC9601636 DOI: 10.3390/healthcare10101940] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
In recent times, the growth of the Internet of Things (IoT), artificial intelligence (AI), and Blockchain technologies have quickly gained pace as a new study niche in numerous collegiate and industrial sectors, notably in the healthcare sector. Recent advancements in healthcare delivery have given many patients access to advanced personalized healthcare, which has improved their well-being. The subsequent phase in healthcare is to seamlessly consolidate these emerging technologies such as IoT-assisted wearable sensor devices, AI, and Blockchain collectively. Surprisingly, owing to the rapid use of smart wearable sensors, IoT and AI-enabled technology are shifting healthcare from a conventional hub-based system to a more personalized healthcare management system (HMS). However, implementing smart sensors, advanced IoT, AI, and Blockchain technologies synchronously in HMS remains a significant challenge. Prominent and reoccurring issues such as scarcity of cost-effective and accurate smart medical sensors, unstandardized IoT system architectures, heterogeneity of connected wearable devices, the multidimensionality of data generated, and high demand for interoperability are vivid problems affecting the advancement of HMS. Hence, this survey paper presents a detailed evaluation of the application of these emerging technologies (Smart Sensor, IoT, AI, Blockchain) in HMS to better understand the progress thus far. Specifically, current studies and findings on the deployment of these emerging technologies in healthcare are investigated, as well as key enabling factors, noteworthy use cases, and successful deployments. This survey also examined essential issues that are frequently encountered by IoT-assisted wearable sensor systems, AI, and Blockchain, as well as the critical concerns that must be addressed to enhance the application of these emerging technologies in the HMS.
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Affiliation(s)
| | - Abdullahi Abubakar Imam
- School of Digital Science, Universiti Brunei Darussalam, Brunei Darussalam, Jalan Tungku Link, Gadong BE1410, Brunei
- Correspondence: (A.A.I.); or (A.O.B.)
| | - Abdullateef Oluwagbemiga Balogun
- Department of Computer Science, University of Ilorin, Ilorin 1515, Nigeria
- Department of Computer and Information Science, Universiti Teknologi PETRONAS, Sri Iskandar 32610, Malaysia
- Correspondence: (A.A.I.); or (A.O.B.)
| | | | | | - Ganesh Kumar
- Department of Computer and Information Science, Universiti Teknologi PETRONAS, Sri Iskandar 32610, Malaysia
| | - Muhammad Abdulkarim
- Department of Computer Science, Ahmadu Bello University, Zaria 810211, Nigeria
| | - Aliyu Nuhu Shuaibu
- Department of Electrical Engineering, University of Jos, Bauchi Road, Jos 930105, Nigeria
| | - Aliyu Garba
- Department of Computer Science, Ahmadu Bello University, Zaria 810211, Nigeria
| | - Yusra Sahalu
- SEHA Abu Dhabi Health Services Co., Abu Dhabi 109090, United Arab Emirates
| | - Abdullahi Mohammed
- Department of Computer Science, Ahmadu Bello University, Zaria 810211, Nigeria
| | | | | | | | - Nana Aliyu Iliyasu Kakumi
- Patient Care Department, General Ward, Saudi German Hospital Cairo, Taha Hussein Rd, Huckstep, El Nozha, Cairo Governorate 4473303, Egypt
| | - Saipunidzam Mahamad
- Department of Computer and Information Science, Universiti Teknologi PETRONAS, Sri Iskandar 32610, Malaysia
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Gries A, Marie Schrimpf A, von Dercks N. Hospital Emergency Departments—Utilization and Resource Deployment in the Hospital as a Function of the Type of Referral. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:640-646. [PMID: 35912425 PMCID: PMC9764348 DOI: 10.3238/arztebl.m2022.0276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/03/2022] [Accepted: 07/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inpatient admission rates and the resources required upon admission to the hospital were studied as a function of the type of referral to the emergency department (ED) of a university hospital. METHODS We retrospectively analyzed data concerning patients who were treated in the ED of the University of Leipzig Medical Center in 2019. The following data were recorded: process data, type of referral, hospital admission vs. discharge from the ED, and leading symptom according to classification as "trauma" or "non-trauma." For all admitted patients, the Patient Clinical Complexity Level (PCCL), length of hospital stay, and intensive care (yes/no) with or without ventilation were recorded. RESULTS Data on 34 178 patients (50.9 ± 22.2 years, 53.8% male) were analyzed; 28.8% of patients were referred because of "trauma," and the remaining 71.2% for "non trauma". The most common sources of referral were the rescue and emergency medical services (47.7%) and the patients themselves (self-referrals, 44.7%); 7.6% of the patients were referred by a resident doctor or general practitioner (physician). 62.6% were discharged from the ED after diagnosis and treatment, while 37.4% were admitted to the hospital. In comparison with self-referred patients as a baseline, the likelihood of inpatient admission was higher when the patient was referred by a physician (adjusted odds ratio [OR] 2.2), by the emergency rescue service without an emer - gency physician (OR 3.4), by an emergency physician (OR 9.3), or by the helicopter rescue service (OR 44.1). 49.1% of patients with trauma referred themselves to the ER, and 36% were referred by the emergency rescue service. Older and male patients were more likely to be admitted to the hospital, especially for non-trauma. 30.4% of the admitted patients required intensive care, and 35.5% of the patients in intensive care required ventilation. CONCLUSION Whether a patient is admitted to the hospital depends on the source of the referral and the leading symptom on arrival in the ED. One in every six self-referred patients is admitted to the hospital, particularly when the reason for presenting to the ER is non-traumatic and some of them go on to receive intensive care. The high percentage (around 95%) of self-referred trauma patients that are discharged from the ED presumably indicates that they were referred mainly for the exclusion of dangerous conditions, and/or that appropriate care options are lacking in the community setting.
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Affiliation(s)
- André Gries
- Hospital emergency department/observation unit, University of Leipzig Medical Center, Leipzig, Germany,*Zentrale Notaufnahme/Beobachtungsstation Notaufnahme Universitätsklinikum Leipzig AöR Liebigstraße 20, 04103 Leipzig, Germany
| | - Anne Marie Schrimpf
- Independent Department of General Practice, University of Leipzig, Division of Health Services Research, University of Leipzig Medical Center, Leipzig, Germany
| | - Nikolaus von Dercks
- Medical Controlling Unit, University of Leipzig Medical Center, Leipzig, Germany
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Schunk D, Malsy M, Zimmermann M. [Fellowship Training Program in Emergency Medicine]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:478-487. [PMID: 35896386 DOI: 10.1055/a-1545-2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractGerman emergency departments have experienced significant development in recent years due to changes in health care policy as well as continued professionalism in emergency department
medical care. The German Medical Association has taken this development into account and included an additional post residency fellowship training program in emergency medicine into their
2018 model training regulation guidelines. The specialized training in emergency medicine covers the initial diagnosis and treatment of patients in the emergency department as well as
medical decision making and coordination of further specialist medical care in interdisciplinary cooperation. The following article provides information about requirements, content, and
duration of the fellowship training program in emergency medicine, which has now been introduced in emergency departments throughout Germany.
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Michael M, Al Agha S, Böhm L, Bosse HM, Pohle AN, Schürmann J, Hannappel O, Tengg E, Weiß C, Bernhard M. Alters- und geschlechtsbezogene Verteilung von Zuführung, Ersteinschätzung, Entlassart und Verweildauer in der zentralen Notaufnahme. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00895-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Zusammenfassung
Einleitung
Jährlich stellen sich bundesweit zahlreiche Patienten in zentralen Notaufnahmen vor. Ziel der vorliegenden Untersuchung war es, alters- und geschlechtsabhängig Zuführung, Ersteinschätzung, Entlassart und Verweildauer an einem universitären Standort zu analysieren.
Material und Methodik
In dieser retrospektiven Studie wurden alle Patientenkontakte der zentralen Notaufnahme des Universitätsklinikums Düsseldorf des Jahres 2019 erfasst und anhand der Prozesskriterien Zuführung, Ersteinschätzung, Entlassart und Verweildauer kategorisiert und deren Verteilung untersucht.
Ergebnisse
Vom 01.01. bis 31.12.2019 wurden insgesamt 43.821 Patientenkontakte erfasst. Das durchschnittliche Alter der Patienten betrug 47 ± 24 Jahre (Median: 47, Min.–Max.: 0–106). Der Anteil weiblicher Patienten betrug 48 %. Ein Alter ≤ 17 Jahren wiesen 10 % der Patienten (♀ vs. ♂: 4 vs. 6 %, p < 0,0001) und ein Alter ≥ 70 Jahre 24 % auf (♀ vs. ♂: 13 vs. 11 %, p < 0,0001). Für beide Geschlechter nahm der Anteil der Triagekategorien „blau“ und „grün“ über die aufsteigenden Altersgruppen stetig ab. Ab der Altersgruppe der 50- bis 59-Jährigen lag für beide Geschlechter führend eine höhere Dringlichkeit („gelb“ bis „rot“) vor. Während im Alter ≤ 17 Jahren mit 84–90 % vorwiegend eine ambulante Behandlung erfolgte, reduzierte sich dieser Anteil über die weiteren Altersgruppen bis auf 22 % bei Männern und 28 % bei Frauen in der Altersgruppe der ≥ 90-Jährigen. Für die drei Entlassarten „ambulant“, „prästationär“ und „stationär“ stieg die Verweildauer bei beiden Geschlechtern mit dem Alter kontinuierlich an.
Schlussfolgerung
Es finden sich deutliche und vor allem altersabhängige Unterschiede in den Prozesskriterien Zuführung, Ersteinschätzung, Entlassart und Verweildauer. Rund 15 % der Patienten sind kritisch krank oder verletzt („orange“ und „rot“). Mit steigendem Alter nimmt der Anteil dieser Triagekategorien zu. Bei rund 30 % der Patienten besteht eine stationäre Aufnahmeindikation, entsprechende Bettenkapazitäten müssen täglich eingeplant werden.
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Behringer W, Dodt C, Eisenburger P, Laggner AN. [Aspects of intensive care medicine in emergency medicine]. Med Klin Intensivmed Notfmed 2020; 115:625-632. [PMID: 33044657 DOI: 10.1007/s00063-020-00741-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022]
Abstract
Emergency medicine and intensive care medicine have many similarities. In this review, we will first discuss the terminology of emergency medicine in a hospital in terms of a uniform designation as a department for emergency medicine or emergency department. Emergency medicine and intensive care medicine are a location-independent concept of patient care in the sense of the recognition, treatment and diagnosis of acute health disorders. Emergency medicine covers the entire range of disease severity, while intensive care medicine focuses on organ replacement and organ preservation, uses highly specialized technology for this purpose and treats only the seriously ill. The treatment of seriously ill patients in the emergency departments requires special intensive care medical knowledge both by the physicians and nursing staff. In the medical field, the curriculum for the European emergency medicine specialist takes into account all aspects necessary for the diagnosis and treatment of critically ill patients. For the nursing sector, Germany has had its own recognized specialty training program in emergency medicine for several years. However, the treatment of critically ill patients in emergency departments also requires that the emergency departments be adequately equipped. In this regard, there is an urgent need for statutory quality criteria that are concrete and structured. We know from the literature that intensive care competence in emergency departments reduces the admission rate to intensive care units and the mortality of all emergency patients. The concept of intensive care units in the emergency department is gaining popularity in the USA and should also be evaluated for implementation in the German-speaking countries.
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Affiliation(s)
- W Behringer
- Zentrum für Notfallmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07749, Jena, Deutschland.
| | - C Dodt
- Notfallzentrum, München Klinik Bogenhausen, München, Deutschland
| | - P Eisenburger
- Abteilung für Notfallmedizin, Krankenhaus Nord - Klinik Floridsdorf, Wien, Österreich
| | - A N Laggner
- Klinik für Notfallmedizin, Medizinische Universität Wien, Wien, Österreich
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Brokmann JC, Pin M, Bernhard M, Walcher F, Gries A. [Restructuring of inpatient emergency treatment : What will change?]. Anaesthesist 2020; 68:261-269. [PMID: 31025042 DOI: 10.1007/s00101-019-0588-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The resolution on the restructuring of inpatient emergency treatment was passed by the Federal Joint Committee (G-BA) on 19 April 2018 based on the Hospital Structure Act and became binding with the publication in the Bundesanzeiger on 18 May 2018. The resolution describes the future structural and qualitative prerequisites for participation of hospitals in the provision of emergency treatment in three levels: basic emergency treatment, extended emergency treatment and comprehensive emergency treatment. Furthermore, a level of nonparticipation is also planned. In addition, there are special modules, e.g. for the treatment of children and auxiliary modules for specifically equipped hospitals with highly specialized patient treatment (e.g. stroke unit). A transition regulation period of 3-5 years provides hospitals with the possibility to adjust to the new minimum requirements. The German Hospital Federation (DKG) and the National Association of Statutory Health Insurance Funds (GKV-SV) will negotiate the assessment of surcharges and deductions subsequent to the resolution.
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Affiliation(s)
- J C Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - M Pin
- Zentrale Notaufnahme, Florence Nightingale Krankenhaus, Düsseldorf, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - F Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Schaffartzik W. Die neue Zusatz-Weiterbildung Klinische Akut- und Notfallmedizin. Anaesthesist 2018; 67:893-894. [DOI: 10.1007/s00101-018-0517-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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