Evaluation of new quality indicators for the TraumaRegister DGU® using the systematic QUALIFY methodology

Bieler, Dan; Hörster, A. C.; Lefering, Rolf; Franke, Axel; Waydhas, Christian; Huber‐Wagner, Stefan; Baacke, Markus; Paffrath, Thomas; Wnent, Jan; Volland, Ruth; Jakisch, Barbara; Walcher, Felix; Kulla, Martin

doi:10.1007/s00068-018-1055-z

Cited by 23 publications

(16 citation statements)

References 21 publications

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“…End-tidal capnography monitoring has an essential value of safety during HEMS transport. First, tube dislodgement may be detected reliably, second, hypocapnia or hypercapnia can be adjusted by changing mechanical ventilation parameters, and third, it provides prognostic value in highly critical patients [15][16][17][18]. Hypocapnia secondary to hyperventilation is a frequent iatrogenic complication during pre-hospital ventilation [19].…”

Section: Discussionmentioning

confidence: 99%

Mechanical ventilation of patients in helicopter emergency medical service transport: an international survey

Hilbert-Carius

Struck

Hofer

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. Method We conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20–22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Vital parameters and ventilation settings of the patients at first patient contact and at handover were compared using non-parametric statistical tests. Results Out of 215 invited HEMS bases, 53 responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all teams were physician staffed, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0–25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21–100) years and 53% male gender were analyzed. Of these, 24 were primary missions and 6 interfacility transports. At handover, oxygen saturation (p < 0.01) and positive end-expiratory pressure (p = 0.04) of the patients were significantly higher compared to first patient contact. Conclusion In this survey, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Patient conditions, training of medical crew and different technical and environmental resources are likely to influence management. Further studies are necessary to assess safety and process quality of mechanical ventilation in HEMS. Trial registration The survey was prospectively registered at Research Registry (researchregistry2925).

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Section: Discussionmentioning

confidence: 99%

Mechanical ventilation of patients in helicopter emergency medical service transport: an international survey

Hilbert-Carius

Struck

Hofer

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…Over the last decades, improvements in trauma care in the fields of prehospital care, emergency department (ED) care, operation techniques and intensive care led to a constant reduction of mortality rates [ 2 , 3 ]. Most established quality indicators focus on the initial trauma care before and during admission [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality in severely injured patients: nearly one of five non-survivors have been already discharged alive from ICU

et al. 2020

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Background Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as “failure to rescue” of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards. Methods Retrospective analysis of the TraumaRegister DGU® with data from 2015 to 2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 h but died later on. Results A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6576 patients (8.0%) died during their hospital stay. Out of those, 5481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay. Conclusions 17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may partially represent patients that died of potentially avoidable or treatable complications.

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“…(1) Over the last decades, improvements in trauma care in the fields of prehospital care, emergency department (ED) care, operation techniques and intensive care led to a constant reduction of mortality rates. (2,3) Most established quality indicators focus on the initial trauma care before and during admission (4)(5)(6) In general and elective surgery a number of studies suggested that a relevant proportion of patients decease within the hospital after discharge from their initial (post-operative) stay in the ICU. This group may represent potentially preventable deaths (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Hamsen

Drotleff

Lefering

et al. 2020

Preprint

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Background Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as "failure to rescue" of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards.Methods Retrospective analysis of the TraumaRegister DGU® with data from 2015-2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 hours but died later on.Results A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6,576 patients (8.0%) died during their hospital stay. Out of those, 5,481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay.Conclusions 17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may represent patients that died of potentially avoidable or treatable complications.

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Evaluation of new quality indicators for the TraumaRegister DGU® using the systematic QUALIFY methodology

Cited by 23 publications

References 21 publications

Mechanical ventilation of patients in helicopter emergency medical service transport: an international survey

Mechanical ventilation of patients in helicopter emergency medical service transport: an international survey

Mortality in severely injured patients: nearly one of five non-survivors have been already discharged alive from ICU

Mortality of severely injured patients after ICU discharge: An underestimated problem?

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