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Ungeplante Aufnahmen oder Rückverlegungen auf die Intensivstation

Vermeidbar oder schicksalhaft?

Unplanned admission or readmission to the intensive care unit

Avoidable or fateful?

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Zusammenfassung

Hintergrund

Ungeplante Aufnahmen oder Rückverlegungen auf die Intensivstation haben einen negativen Einfluss auf das Behandlungsergebnis und stellen eine Klinik vor medizinische, logistische und ökonomische Herausforderungen.

Fragestellung

Wie häufig sind und warum kommt es zu Rückverlegungen auf die Intensivstation, was gibt es für Strategien und Empfehlungen, sie zu vermeiden.

Material und Methode

Analyse und Diskussion der Studienlage und der Empfehlungen von Fachgesellschaften national und international.

Ergebnisse

Viele Studien belegen, dass die Rückverlegung auf eine Intensivstation ein unabhängiger Einflussfaktor auf eine schlechte Prognose für den Patienten ist. Verschiedene Faktoren erhöhen die Wahrscheinlichkeit für eine Rückverlegung. Strukturelle Änderungen auf der Normalstation, auf der Intensivstation und bei der innerklinischen Notfallversorgung konnten in einigen Studien die Rückverlegungsrate und/oder das Patientenoutcome im jeweiligen Krankenhaus dramatisch verbessern, jedoch blieb in anderen Studien ein positiver Effekt aus.

Schlussfolgerung

Für die optimale Patientensicherheit muss eine Klinik jederzeit eine hochwertige Übergabe und Überleitung von der Intensivstation auf die Normalstation gewährleisten. Instabile Patienten auf der Normalstation müssen frühzeitig erkannt und behandelt werden, jedoch ist der Effekt durch ein standardisiertes Einsatzteam umstritten.

Abstract

Background

Unplanned admissions or readmissions to the intensive care unit lead to a poorer outcome and present medical, logistic and economic challenges for a clinic. How often and what are the reasons for readmission to the intensive care unit? Which strategies and guidelines to avoid readmission are recommended.

Material and methods

Analysis and discussion of available studies and recommendations of national and international societies.

Results

Many studies show that unplanned admissions and readmissions to the intensive care unit represent an independent risk factor for a poor outcome for patients. Different factors that increase the probability of readmission can be identified. Structural changes concerning the normal wards, intensive care unit or the clinic internal emergency service could positively effect readmission rates and/or patient outcome while other studies failed to show any effect of these arrangements.

Conclusion

Patient transition from the intensive care unit to a lower level of care is a critical point of time and has to be accompanied by a high quality handover. Unstable patients on normal wards have to be identified and treated as soon as possible but effects of standardized medical emergency teams are controversial.

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Author information

Authors and Affiliations

  1. Chirurgische Klinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland

    U. Hamsen,  C. Waydhas &  T. A. Schildhauer

  2. Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland

    C. Waydhas

  3. Mainstockheim, Deutschland

    R. Wildenauer

  4. Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Gotenstraße 1, 42653, Solingen, Deutschland

    W. Schwenk FACS

Authors
  1. U. Hamsen
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  2. C. Waydhas
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  3. R. Wildenauer
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  4. T. A. Schildhauer
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  5. W. Schwenk FACS
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Corresponding author

Correspondence to U. Hamsen.

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Interessenkonflikt

U. Hamsen, C. Waydhas, R. Wildenauer, T.A. Schildhauer und W. Schwenk geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hamsen, U., Waydhas, C., Wildenauer, R. et al. Ungeplante Aufnahmen oder Rückverlegungen auf die Intensivstation. Chirurg 89, 289–295 (2018). https://doi.org/10.1007/s00104-018-0599-0

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  • DOI: https://doi.org/10.1007/s00104-018-0599-0

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