Zusammenfassung
Hintergrund
Die Versorgung von Patienten mit akuten Notfallsituationen innerhalb von Krankenhäusern (KH) obliegt neben dem anwesenden Personal meistens bestimmten Teams, die als Herzalarmteam, Reanimationsteam oder Notfallversorgungsteam zusätzlich alarmiert werden. Über die Ursachen und Häufigkeit von innerklinischen Notfällen, die tatsächliche Vorgehensweise bei innerklinischen Notfallsituationen und das Ergebnis der Notfallbehandlung ist wenig bekannt.
Material und Methoden
Insgesamt 28 Akutkrankenhäuser aus Mecklenburg-Vorpommern (MV) und 30 Akutkrankenhäuser aus Schleswig-Holstein (SH) erhielten einen Fragebogen mit 34 leicht zu beantwortenden Fragen.
Ergebnisse
Ein Notfallteam ist in der überwiegenden Mehrzahl der KH in MV und SH vorhanden. Es trifft in 2–3 min beim vital bedrohten Patienten ein. Klare Alarmierungskriterien für den Notfall sind in beiden Bundesländern nicht die Regel. Die Notfallausrüstung ist vorwiegend auf den Stationen vorhanden und wird zusätzlich vom Notfallteam mitgebracht. Die Forderung, dass ein Defibrillator bzw. automatisierter externer Defibrillator (AED) innerhalb von 3 min am Krankenbett sein soll, wird nicht erfüllt. Nur in einem KH in MV kommen AEDs zum Einsatz. Das Pflegepersonal wird in beiden Bundesländern regelmäßig in Basic Cardiac Life Support (BCLS) geschult. Alle Klinikärzte werden in MV nur in 15 von 20 KH in Advanced Cardiac Life Support (ACLS) geschult, in SH lediglich in 9 von 25 KH. Das Notfallereignis wird in 16 von 25 KH in SH, in MV in 19 von 20 KH nur im Krankenblatt dokumentiert.
Schlussfolgerungen
Die innerklinische Notfallversorgung ist in den Krankenhäusern MV und SH weitestgehend organisiert. Schulungen der Mitarbeiter, insbesondere der Ärzte für Notfallsituationen müssen verpflichtend werden. Eine einheitliche strukturierte Dokumentation der Notfallsituationen und deren statistische Auswertung sollte dringend durchgeführt werden.
Abstract
Background
Emergency care of hospitalized patients is, in addition to the ward personnel, provided by certain teams which are called upon as a cardiac alarm team, resuscitation team or emergency care team. There is, however, little knowledge concerning numbers and causes of such in-hospital emergencies as well as management strategies and results.
Methods
The status quo of emergency care for hospitalized patients was assessed with a structured questionnaire which was sent to 58 hospitals in the Federal States of Mecklenburg-Western Pommerania (MWP; n=28) and Schleswig-Holstein (SH; n=30). The questionnaire was anonymous and consisted of 34 simple questions.
Results
Emergency teams are established in the majority of hospitals in both Federal States and response times are 2–3 min. Clearly defined criteria for emergency conditions and actions which would facilitate early identification of critical situations by the medical personnel are not standard in either Federal Sate. Emergency equipment is available on the wards in most instances and additionally provided by the emergency team. The requirement to have a defibrillator or AED available at the bedside within 3 min is not fulfilled. AEDs are used in only one hospital (MWP) included in this survey. The nursing staff receives basic cardiac life support (BCLS) training regularly in both Federal states. All physicians receive advanced cardiac life support (ACLS) training in 15 out of 20 hospitals in MWP and in 9 out of 20 hospitals in SH. Documentation of emergency management is in the patient chart only in 19 out of 20 hospitals in MWP and in 16 out of 25 hospitals in SH. Additional documents, such as the DIVI protocol (Deutsche Interdisziplinäre Vereinigung für Intensivmedizin/German Interdisciplinary Association of Critical Care Medicine) are rarely used. The reanimation register of the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin/German Society for Anaesthesiology and Intensive Care Medicine) is well known but hardly used.
Conclusions
In-hospital emergency care is largely well organized in MWP and SH. Emergency training of medical personnel, in particular physicians needs improvement and should be made mandatory, as in Anglo-American nations. A uniform, structured means of documentation of emergency management and statistical evaluation should be introduced; this would most likely contribute to identification of shortcomings of current in-hospital emergency management.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Abella BS, Alvarado JP, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. J Am Med Assoc 293:305–310
Abella BS, Sandbo N, Vassilatos P et al (2005) Chest compression rates during cardiopulmonary resuscitation are suboptimal. A prospective study during in-hospital cardiac arrest. Circulation 111:428–434
Baker GR, Norton PG, Flintoft V et al (2004) The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ 170:1678–1686
Baskett PJ, Nolan JP, Handley A et al (2005) European resuscitation council guidelines for resuscitation 2005. Section 9. Principles of training in resuscitation. Resuscitation 67(Suppl):181–189
Berden HJ, Willems FF, Hendrick JM et al (1993) How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills? BMJ 306:1576–1577
Berlot G, Pangher A, Petrucci L et al (2004) Anticipating events of in-hospital cardiac arrest. Eur J Emerg Med 11:24–28
Buist M, Bernard S, Nguyen TV et al (2004) Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation 62:137–141
Carlsson J, Götz J, Miketic S et al (1998) Kurz- und Langzeitüberleben nach cardiopulmonaler Reanimation. Intensivmedizin 35: 34–41
Chan PS, Krumholz HM, Nichol G et al (2008) Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 358: 9–17
Dick WF (2003) Anglo-American vs. Franco-German emergency medical services system. Prehosp Disaster Med 18:29–35; discussion 35–27
Ehlenbach WJ, Barnato AE, Curtis JR et al (2009) Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 361:22–31
Eisenberg MS, Mengert T (2001) Cardiac resuscitation. N Engl J Med 344:1304–1313
Goetz AE (2004) Zeit rettet Leben! Anaesthesist 53:123–124
Gombotz H, Weh B, Mittendorfer W, Rehak P (2006) In-hospital cardiac resuscitation outside the ICU by nursing staff equipped with automated external defibrillators – the first 500 cases. Resuscitation 70:416–422
Granja C, Cabral G, Vieira A (2001) Outcome of cardiac arrests in a Portuguese hospital – evaluation of a hospital cardiopulmonary resuscitation program at one year. Rev Port Cardiol 20:943–956
Gräsner JT, Meybohm P, Fischer M et al (2009) A national resuscitation registry of out-of-hospital cardiac arrest in Germany – A pilot study. Resuscitation 80:199–203
Gräsner JT, Messelken M, Scholz J, Fischer M (2006) Das Reanimationsregister der DGAI. Anaesth Intensivmed 47:630–631
Gries A, Zink W, Bernhard M et al (2006) Realistic assessment of physician-staffed emergency services in Germany. Anaesthesist 55:1080–1086
Hillmann K, Parr M, Flabouris A et al (2001) Redefining in-hospital resuscitation: the concept of the medical emergency team. Resuscitation 48:105–110
Jacobs I, Nadkarni V, Bahr J et al (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American heart association, European resuscitation council, Australian resuscitation council, New Zealand resuscitation council, heart and stroke foundation of Canada, interAmerican heart foundation, resuscitation council of southern Africa). Resuscitation 63:233–249
Jones D, Bellomo R, Bates S et al (2005) Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 9:808–815
Matton F, Tieret L (1986) Morbidity and mortality in anesthesia. Springer, Berlin
Mohr M, Bömelburg K, Bahr J (2001) Reanimationsversuche in Senioreneinrichtungen: Lebensrettung am Lebensende? Anästhesiol Intensivmed Notfallmed Schmerzther 36:566–572
Pederdy MA, Kaye W, Ornato JP et al (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the national registry of cardiopulmonary resuscitation. Resuscitation 58:297–308
Rosolski-Jantzen T, Gräsner JT (2007) Innerklinischer Notfall. In: Scholz J, Sefrin P, Böttiger B et al (eds) Notfallmedizin. Thieme, ISBN 978-3-13-112782-2, S 501–508
Siebig S, Kues S, Klebl F et al (2009) Cardiac arrest: Composition of resuscitation teams and training techniques – Results of a hospital survey in German-speaking countries. Dtsch Arztebl 106:65–70
Trappe HJ (2009) Prä- und intrahospitaler Herz-Kreislauf-Stillstand. Häufigkeit, Ergebnisse, Perspektiven. Kardiologe 3:37–46
Vita MA de, Braithwaite RS, Mahidhara R et al (2004) Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 13:251–254
Weil HW, Fries M (2005) In-hospital cardiac arrest. Crit Care Med 33:2825–2830
Danksagung
Wir danken den beteiligten Kliniken und deren Mitarbeitern für die Unterstützung bei der Datenerhebung.
Interessenskonflikt
Der korrespondierende Autor gibt an, dass kein Interessenskonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Additional information
Hinweis
Diese Arbeit enthält wesentliche Teile der Dissertation von Katja Schikora.
Rights and permissions
About this article
Cite this article
Gräsner, JT., Schikora, K., Bernhard, M. et al. Die innerklinische Notfallversorgung in norddeutschen Krankenhäusern. Notfall Rettungsmed 13, 294–301 (2010). https://doi.org/10.1007/s10049-010-1312-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10049-010-1312-0
Schlüsselworte
- Innerklinische Notfallversorgung
- Reanimation
- Kreislaufstillstand
- Notfall-Versorgungsteam
- Reanimationsregister