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Quality benchmarks for chest pain units and stroke units in Germany

Qualitätskriterien für Chest Pain Units und Stroke Units in Deutschland

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Abstract

Background

Chest pain units (CPUs) and stroke units (SUs) provide specialized multidisciplinary in-hospital management for acute chest pain and ischemic stroke. We analyzed exemplary equivalent quality benchmarks in both concepts.

Material and methods

Data from the German CPU registry (2012–2015; 45 certified CPUs, 5881 patients) were compared with data from the SU registry of Rhineland-Palatinate (2011–2015; 29 SUs; 40,380 patients). Parameters comprised demographics, symptoms, diagnosis, medication, critical time intervals, therapeutics, and in-unit outcome.

Results

Non-ST-segment elevation myocardial infarction (47.4%) and ischemic stroke (63.0%) were the most frequent entities. An electrocardiogram was performed on average within 7 min in CPUs, cranial imaging within 49 min in SUs. The mean time interval from admission until coronary intervention or lysis was 42 min or 57 min, respectively. Rates of antiplatelet therapy (90.1% vs. 96.0%), brain imaging, and coronary angiography were high (99.3% vs. 81.1%) and the mortality was low (0.8% for CPUs vs. 3.6% for SUs). The length of stay was shorter in CPUs (1.5 days vs. 4.4 days).

Conclusion

As reimbursement for emergency medicine in Germany was recently rearranged, quality benchmarking has gained incremental importance. Mandatory joint quality measurement in both concepts ensuring gap analysis and process improvement is encouraged.

Zusammenfassung

Hintergrund

Chest Pain Units (CPU) und Stroke Units (SU) bieten eine spezialisierte, multidisziplinäre stationäre Versorgung bei akutem Brustschmerz bzw. ischämischem Schlaganfall. Die Autoren untersuchten in der vorliegenden Studie exemplarisch korrespondierende Qualitätsmarker für beide Konzepte.

Material und Methoden

Daten aus dem deutschen CPU-Register (2012–2015; 45 zertifizierte CPU, 5881 Patienten) wurden mit Daten aus dem Qualitätssicherungsprojekt Schlaganfallversorgung Rheinland-Pfalz (2011–2015; 29 SU; 40.380 Patienten) verglichen. Zu den untersuchten Parametern zählten Demografie, Symptome, Diagnosen, Medikation, kritische Zeitintervalle, therapeutische Maßnahmen sowie das innerklinische Outcome.

Ergebnisse

Der Nicht-ST-Strecken-Hebungs-Infarkt (47,4 %) und der ischämische Schlaganfall (63,0 %) waren die häufigsten Entitäten. Ein EKG wurde im Mittel binnen 7 min geschrieben, die zerebrale Bildgebung innerhalb von 49 min durchgeführt. Die mittlere Dauer zwischen Aufnahme und Herzkatheteruntersuchung bzw. Lysetherapie betrug 42 bzw. 57 min. Die Raten für Therapie mittels Plättchenhemmung (90,1 vs. 96,0 %), Herzkatheteruntersuchung (81,1 %) und zerebrale Bildgebung (99,3 %) waren hoch, wohingegen die Mortalität niedrig war (0,8 % in den CPU vs. 3,6 % in den SU). Die Dauer des Aufenthalts in den SU war mit 4,4 Tagen länger als in den CPU (1,5 Tage).

Schlussfolgerung

Nicht zuletzt infolge der Neuregelung zur Vergütung in der Notfallmedizin in Deutschland gewinnt die strukturierte Qualitätskontrolle zunehmend an Bedeutung. Ein verpflichtendes, gemeinsames Benchmarking zur Lückenanalyse und Prozessoptimierung sollte forciert werden.

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Author information

Correspondence to Frank Breuckmann.

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Conflict of interest

F. Breuckmann, M. Hochadel, A.J. Grau, T. Münzel, and J. Senges declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their interpretation.

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Breuckmann, F., Hochadel, M., Grau, A.J. et al. Quality benchmarks for chest pain units and stroke units in Germany. Herz (2020). https://doi.org/10.1007/s00059-019-04881-3

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Keywords

  • Coronary angiography
  • Brain ischemia
  • Non-ST elevated myocardial infarction
  • Emergency medicine
  • Acute coronary syndrome

Schlüsselwörter

  • Koronarangiographie
  • Hirnischämie
  • Nicht-ST-Strecken-Hebungs-Infarkt
  • Notfallmedizin
  • Akutes Koronarsyndrom