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Fallvolumen und Ergebnis („Volume-Outcome-Beziehung“)

Zusammenfassung

Die European Surgical Association (ESA) hat in einem Konsensuspapier die Notwendigkeit der Zentralisierung von bestimmten gastrointestinalen Eingriffen für Europa und Nordamerika begründet. Sie stellte fest, dass in nur sehr wenigen der befragten Länder Anforderungen an Mindestfallzahlen (Resektionen/Jahr) existieren, fast ausschließlich nur für das Krankenhausfallaufkommen . Die Autoren betonten, dass drei Faktoren (Krankenhausfallaufkommen, Fallaufkommen des Chirurgen und seine Spezialisierung) die Ergebnisse beeinflussen, dass aber der Mechanismus dieses Einflusses umstritten sei. So mögen Volumen und Spezialisierung nicht automatisch zu besserer Leistung führen, aber sie können als Annäherungsmaßstäbe dienen, um bestimmte Charakteristika der Prozessqualität und Qualität der Leistungserbringung zu beschreiben. Bei der Qualität der Leistungserbringung sei speziell die Versagerrate nach Auftreten einer Komplikation („Failure-to-rescue “) zu bewerten. Selbst wenn Nieder(NV)- und Hochvolumen(HV)-Krankenhäuser die gleiche Komplikationsrate aufweisen, so sterben doch in der Regel mehr Patienten im Niedervolumenkrankenhaus, da Komplikationen im Hochvolumenkrankenhaus aufgrund seiner Infrastruktur besser beherrscht werden (können). Dies kann an der Ausstattung der Intensivstation und dem Personalschlüssel insgesamt liegen, aber auch an der besseren Verfügbarkeit von Spezialisten rund um die Uhr und am Wochenende.

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Abb. 2.1

(Nach Hemschemeier et al. 2019)

Abb. 2.2
Abb. 2.3

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Abschnitt 2.2

Abschnitt 2.3

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Grundmann, R.T., Thomsen, J. (2020). Fallvolumen und Ergebnis („Volume-Outcome-Beziehung“). In: Debus, E., Grundmann, R. (eds) Versorgungsqualität in der operativen Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-60423-6_2

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