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Biomedical subjects

A Schleppers

Publications and source records attributed to A Schleppers.

11 recordsLinked to original sources
PubMed2007

[Analysis of personnel costs after reorganization of intensive care using calculated diagnosis-related groups comparative data. An investigation at the Charité Berlin].

BACKGROUND: In an extensive project intensive care units (ICUs) of the Charité University Hospital were reorganized. The aim of this investigation was to determine if staff costs after this reorganization are financed by modular profits of diagnosis-related groups (DRGs). METHODS: Staff costs of all non-pediatric intensive care units, including ICUs, intermediate care units and post-anaesthesia care units (PACUs) in the Charité University Hospital were compared with the modular profits of all DRGs of patients older than 14 years in 2005. These DRGs were converted into the German refined DRG (GDRG) system 4.0 from 2006 with calculations based on actual income for medical doctors and nurses in 2006. Due to changed wage agreements for the incomes of physicians in 2006 there was an increase of costs. For the other professional groups an increase in income is expected, which cannot be estimated at present. RESULTS: The calculation revealed that staff costs of the ICUs at the Charité University Hospital based on a current German mean base rate of 2,836 EUR were 4.2% above the modular profits of the DRGs. As a result of a structural reorganization of the ICUs, the costs of staff could be adapted to the modular profits. Under the conditions of the actual reduced base rate of Berlin of 2,955 EUR the costs and profits were nearly equal. As the financial impact of the reorganization of the ICUs will take full effect in the coming years, it can be anticipated that with an expected base rate of 2,949 EUR in 2010 the intensive care medicine of a University hospital in Germany can become profitable. DISCUSSION: The spectrum of intensive care medicine at the Charité University Hospital covers the maximum range of operative and non-operative medicine. After an extensive reorganization of the ICUs under the aspect of staff costs, intensive care medicine can become profitable under the 4.0 G-DRG system. With consequent reorganization the cost efficiency of staff can be optimized, particularly in the setting of high-end intensive care medicine.

Adolescent↗
PubMed2006

[Operative management in axillary brachial plexus blocks: comparison of ultrasound and nerve stimulation].

Given a case-by-case accounting system, the analysis of medical performance becomes increasingly important. Quality of treatment and the time effort attached play an important role. Anaesthesia procedures require a high level of quality and safety. Moreover, they are personnel intensive. In the area of regional anaesthesia, new procedures such as the use of high definition ultrasonography for nerve blocks, allow a possible time gain as well as improved quality. The aim of this investigation was to analyze the impact on time and results when using ultrasonography or nerve stimulation for axillary brachial plexus blocks. Therefore, over a time period of 9 months, the ultrasound-guided plexus anaesthesia (Sono) and the neurostimulation methods (NStim) were investigated based upon the anaesthesia documentation of patients undergoing hand surgery. Only those cases were included where an axillary brachial plexus block had been performed, incomplete protocols were excluded and 1.5% mepivacaine was used as medication. Overall, a total of 130 cases fulfilled these criteria. The success rates, time consumption and timelines were evaluated. All data was stored on an Excel-sheet and statistically evaluated. The results revealed a significant increase in the success rate for the patient group where ultrasound was used (98.2% Sono vs 83.1% NStim) and the operation could begin 15 min earlier in the Sono group (5 min vs. 20 min, p<0.001). Furthermore, the duration of anaesthesia was significantly shorter (85 min vs. 120 min, p<0.001) and the necessity for post-operative observation was less (5.4% vs. 32.4%, p<0.001). The data provided in the study indicate that the use of ultrasound for the identification of the nerves can clearly improve quality and time-scales of axillary brachial plexus blocks.

Adult↗
PubMed2005

[Pharmacological peculiarities and problems with older patients].

Because of demographic developments, the fraction of the German population over 65 years of age in the year 2025 will have risen to 20% and will continue to rise so that in 2030 this number will have doubled compared to today's numbers. This has a huge impact on the requirements for anaesthesiologic procedures. In addition to the frequent multi-morbidity in this age group, physiologic changes also occur in the elderly which have to be taken into consideration during the entire perioperative management of these patients. Renal, cardiovascular and hepatic function are impaired in many elderly patients. A major concern in addition to cardiovascular and operative complications is the postoperative cognitive dysfunction (POCD), not only because of its implications for the patient but also because of economical consequences. Regional anaesthesia has some benefits when compared to general anaesthesia as it leads to a reduction in thromboembolic and respiratory complications.

Aged↗
PubMed2005

[Controlling systems for operating room managers].

Management means developing, shaping and controlling of complex, productive and social systems. Therefore, operating room managers also need to develop basic skills in financial and managerial accounting as a basis for operative and strategic controlling which is an essential part of their work. A good measurement system should include financial and strategic concepts for market position, innovation performance, productivity, attractiveness, liquidity/cash flow and profitability. Since hospitals need to implement a strategy to reach their business objectives, the performance measurement system has to be individually adapted to the strategy of the hospital. In this respect the navigation system developed by Gälweiler is compared to the "balanced score card" system of Kaplan and Norton.

Cost Control↗
PubMed2005

[Organized pain management in the DRG reimbursement system].

Multidisciplinary pain management in pain centers can only be guaranteed if the DRG reimbursement system takes into account the multiple risk factors. The German pain associations prospectively analyzed clinical and administrative (DRG-related) data sets (n=3943) of inpatient and day care pain treatment facilities. The index diagnoses of 84% of the patient sample were grouped into nine basic DRGs. The most frequent pain procedure code was 8-918 ("multimodal pain management"). The minimal length of stay for this code set to 7 days was 17.2 days for the study sample. The DRG grouper software 2003 categorized 68.6% of the patients into PCCL 0 despite the proven complexity of risks and secondary diseases. The mean case weight in the sample was set at about 1. The pain-related data set analyzing pain severity, chronicity, and its influence on various functions emphasizes the total severity and burden of disease and thus the necessity for multimodal pain management. The German pain societies carried the motion that a new complex ICD code for chronic pain (with biopsychosocial consequences) should be established in the German Modification of the ICD. The new ICD code F62.80 and the procedure code 8-918 had not yet been implemented into the German DRG algorithm. Due to modifications in DRG systematics and the DRG algorithm, to be activated in 2005, the procedure code 8-918 will now automatically trigger into four special basic pain DRGs corresponding to the index pain diagnosis.

Combined Modality Therapy↗
PubMed2004

[Procedure optimization in hospital management].

Starting January 1st 2004 the German diagnosis-related group (DRG) system was established for in-patient cases. Consequently, the detection and realization of cost-saving potentials are becoming more and more important. For a successful future, efficient allocation of resources is essential. Economically, anaesthesia-related time delays during perioperative work-flow should be minimized. Since numerous entities contribute to perioperative care, it is extremely complex to analyze and optimize this process flow. In this publication single steps leading to an optimized perioperative process flow will be presented: documentation of predefined time points, calculation of relevant time intervals and analysis of key numbers for complex settings. Single steps of the given process analysis will be demonstrated using data from surgical patients at the University Hospital Schleswig-Holstein, Campus Kiel. The attached data collection sheets can be used by interested hospital departments and are meant to serve as a template for further process analyses. Based on the shown analysis, an example will be given to develop an optimized work-flow as a standard operating procedure (SOP). The implementation of the SOP module in an interdisciplinary clinical pathway (CP), which defines efficient medical care from admission to discharge, is mainly responsible for decreased process costs but increased quality of care.

Anesthesia Department, Hospital↗
PubMed2003

[Preoperative fasting. An update].

In Germany the predominant standard of preoperative care for elective surgery is fasting after midnight, with the aim of reducing the risk of pulmonary aspiration. However, for the past several years the scientific evidence supporting such a practice has been challenged. Experimental and clinical studies prove a reliable gastric emptying within 2 h suggesting that, particularly for limited intake of clear fluids up to 2 h preoperatively, there would be no increased risk for the patient. In addition, the general incidence of pulmonary aspiration during general anaesthesia (before induction, during surgery and during recovery) is extremely low, has a good prognosis and is more a consequence of insufficient airway protection and/or inadequate anaesthetic depth rather than due to the patient's fasting state. Therefore, primarily to decrease perioperative discomfort for patients, several national anaesthesia societies have changed their guidelines for preoperative fasting. They recommend a more liberal policy regarding per os intake of both liquid and solid food, with consideration of certain conditions and contraindications. The following article reviews the literature and gives an overview of the scientific background on which the national guidelines are based. The intention of this review is to propose recommendations for preoperative fasting regarding clear fluids for Germany as well.

Fasting↗