Biomedical subjects

B Schwilk

Publications and source records attributed to B Schwilk.

At least 19 recordsLinked to original sources

PubMed2000

Building a large-scale perioperative anaesthesia outcome-tracking database: methodology, implementation, and experiences from one provider within the German quality project.

The German Society of Anaesthesiology and Intensive Care Medicine evaluates voluntary, standardized, everyday, perioperative anaesthesia outcome measures. A standard minimal data set is collected for national benchmarking. This article reviews the implementation of a data acquisition system in one academic centre that has participated in this long-term nationwide project since its initiation in 1992. The population studied comprised 96,107 patients up to 1997. The overall incidence of anaesthesia-related incidents, events and complications (IEC) was 22%. Results are presented and discussed for 63 different IEC, seven functional system categories and five severity grades. The proposed methodology, using computer-readable records, was suitable for comprehensive and detailed outcome documentation. However, an extensive data validation system was necessary. IEC reporting results were largely dependent on the documentation culture. The future of outcome tracking in routine anaesthesia may lie in multicentre comparisons with multivariate-adjusted risk and comorbidity data from each provider's integrated information system.

Algorithms↗

PubMed1999

[The incidence of perioperative events with optimized documentation discipline].

AIM: The German Society of Anesthesiology and Intensive Care Medicine evaluated the standardized reporting of perioperative anaesthesia-related incidents, events, and complications (IEC). As part of the data validation efforts, the problem of variation in documentation procedure was evaluated. METHODS: A study group of particularly motivated and instructed residents and attendants was scrutinized at a University teaching hospital from April through June 96. IEC assessment was completed according to the Society's definitions. RESULTS: Out of 4242 anaesthetics during the study period 839 (19.8%) were completed by the study group. In the univariate analysis, the incidence of IECs was significantly (P < 0.001) more reported by the physicians studied (36.4%) than by the control group (18.6%). In a multivariate analysis, while adjusting for all covariables, reported incidence of IEC was 2.4-fold significantly increased (P < 0.001). CONCLUSIONS: This study is another step in validating the assessment of IECs. The results gain importance with respect to upcoming nationwide quality comparisons among anaesthesia providers. In addition, they give a better estimate of economic implications from IECs within the institution.

Analysis of Variance↗

PubMed1999

The impact of minor perioperative anesthesia-related incidents, events, and complications on postanesthesia care unit utilization.

UNLABELLED: The German Society of Anesthesiology and Intensive Care Medicine evaluates the standardized and routine reporting of perioperative anesthesia-related incidents, events, and complications (IEC). As part of the long-term project's definitions, IECs are graded according to severity and to their clinical consequence on further postanesthesia monitoring and treatment demands. The adult study population of our department comprised 37,079 patients recovering from anesthesia in a tertiary university hospital from July 1992 through June 1997. Cardiac, obstetric, craniotomy, thoracotomy, laparotomy, and emergency operations were excluded. Multivariate regression statistics were used to calibrate the impact of minor graded IECs on necessary postanesthesia care unit (PACU) utilization. Minor and severe IECs appeared in 22.1% and 0.2% of the patients. A minor IEC occurrence was a statistically significant (P < 0.001) predictor of PACU utilization in a multivariate regression model. The mean difference of PACU length of stay for patients with minor IECs was prolonged by a range of 6%-26% when adjusted for coexisting severity features such as age, gender, ASA physical status, and type and duration of anesthesia and surgery. We conclude that the IEC methodology integrates epidemiologic information about perioperative anesthesia outcome. Minor but frequently occurring IECs have an impact on PACU utilization and are thus important to measure and follow. IMPLICATIONS: It is desirable to know how anesthesia-related incidents, events, and complications influence postanesthesia care. Analyses of standardized and routine perioperative outcome data, as proposed by the German anesthesia quality project, can show that even minor events consume relevant resources and are thus important to measure and follow.

Adolescent↗

PubMed1998

A cross-validated multifactorial index of perioperative risks in adults undergoing anaesthesia for non-cardiac surgery. Analysis of perioperative events in 26907 anaesthetic procedures.

OBJECTIVE: To develop a severity index of anaesthetic risk that predicts relevant perioperative adverse events in adults. DESIGN: Prospective cross-sectional study. SETTING: Department of anaesthesiology at one university hospital. PATIENTS: 26907 consecutive anaesthetic procedures in patients over 15 years of age and a complete preoperative evaluation. Patients undergoing cardiac and obstetric surgery were excluded. MEASUREMENTS AND MAIN RESULTS: Demographic data, preoperative health status, type of anaesthesia, operative procedures, and perioperative incidents (standardised on a national basis) were acquired by means of a computerised anaesthetic record system. Occurrence of at least one perioperative event with impact on postanaesthetic care was computed by a multivariate logistic regression model against 17 variables with different characteristics representing possible risk factors. Fourteen variables proved to be independent risk factors. The weighting of the variables was expressed in scores which added up to form a simple index for each patient. Patients without major risk factors (0-10 points) had a 0.3% risk of suffering from a relevant incident. Patients with more than 60 points had a 28.6% risk. The results were well demonstrated by cross-validation. CONCLUSIONS: The index seems to reflect the risk of relevant perioperative incidents. It can be used for audit purposes. In daily routine, the index could focus our attention on patients with increased perioperative risk. However, it is limited in detecting particular constellations of factors which interact on each other with regard to perioperative risk.

Adolescent↗

PubMed1998

Validation of routine incidence reporting of one anaesthesia provider institution within a nation-wide quality of process assessment program.

In 1992, a long-term project was launched by the German Society for Anaesthesiology and Intensive Care Medicine to render quality comparisons between anaesthesia providers. As one of the first volunteer centres, we established the standardised reporting of perioperative anaesthesia related incidents, events, and complications (IEC) in any routine anaesthetic procedure performed. This present study is aimed to explore the longitudinal stability of IEC recordings in one institution, which should be a prerequisite for valid external comparisons. Methods. The analyses were completed on an adult population of 49945 consecutive anaesthetic procedures with peripheral surgery from July 1992 until December 1996. Attribute quality control charts with monthly samples of an average of 954 anaesthetics were used to assess statistical variability of specific IEC incidences. Results. Average proportions were 20% for moderate IEC, 2.7% for severe IEC, 13% for moderate cardio-vascular IEC, 1.3% for severe cardio-vascular IEC, and 2.4% for respiratory IEC. Moderate IEC proportions showed considerable variability during the study period. A series of excess proportions was probably due to educational activities on documentation discipline. In contrast, clinically severe IEC proportions were rather stable. Stability of cardio-vascular IEC proportions resembled the picture of the overall IEC assessment. Monthly respiratory IEC proportions showed smallest variability during the study period. Discussion. Use of the quality control statistics is suitable to distinguish random from systematic influence on quality indicators. IEC recordings that are not specific in pathophysiologic type or are of low grade of clinical severity, are heavily dependent on systematic documentation features. We assume that peak values, such as in times of optimised documentation discipline, better reflect reality than average values because missing reporting is much more likely than false positives.

Adult↗

PubMed1997

Epidemiology of acute renal failure and outcome of haemodiafiltration in intensive care.

OBJECTIVE: To examine the epidemiology of acute renal failure (ARF) and to identify predictors of mortality in patients treated by continuous venovenous haemodiafiltration (CVVHDF). DESIGN: Uncontrolled observational study. SETTING: One intensive care unit (ICU) at a surgical and trauma centre. PATIENTS: A consecutive sample of 3591 ICU treatments. MEASUREMENTS AND RESULTS: Demographic data, indications for ICU admission, severity scores and organ system failure at the beginning of CVVHDF were set against the occurrence of ARF and ICU mortality. 154 (4.3% of ICU patients and 0.6% of the hospital population) developed ARF and were treated with CVVHDF. Higher American Society of Anaesthesiologists (ASA) status and higher Apache II score were associated with ICU incidence of ARF. However, these criteria were not able to predict outcome in ARF. A simplified predictive model was derived using multivariate logistic regression modelling. The mortality rates were 12% with one failing organ system (OSF), 38% with two OSF, 72% with three OSF, 90% with four OSF and 100% with five OSF. The adjusted odds ratio (OR) of death was 7.7 for cardiovascular failure, 6.3 for hepatic failure, 3.6 for respiratory failure, 3.0 for neurologic failure, 5.3 for massive transfusion and 3.7 for age of 60 years or more. CONCLUSION: General measures of severity are not useful in predicting the outcome of ARF. Only the nature and number of dysfunctioning organ systems and massive transfusion at the beginning of CVVHDF and the age of the patients gave a reliable prognosis in this group of patients.

Acute Kidney Injury↗

PubMed1997

Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia.

BACKGROUND: The prevalence of respiratory diseases in smokers and nonsmokers and the incidence of perioperative respiratory events (PREs) were investigated for patients undergoing general anaesthesia. The aim was to quantify well-known problems and to identify possible new associations between smoking and PREs. METHODS: From July 1992 to December 1994, risk factors, demographic data, and PREs were documented by an automatically readable anaesthetic record (ARAR). PREs were used as defined by the German Society of Anaesthesiology and Intensive Care. RESULTS: Of 26961 subsequent anaesthesias in adults, 7122 (26.4%) were performed in smokers with a prevalence of chronic bronchitis of 23.3% (4.8% in nonsmokers). 1573 PREs occurred in 1397 (5.2%) of all anaesthetics. 459 events concerned intubation problems and problems in technical airway management. 1114 specific respiratory events (SPREs) like re-intubation, laryngospasm, bronchospasm, aspiration, hypoventilation/hypoxaemia and others had a total incidence of 5.5% in smokers and 3.1% in nonsmokers. The relative risk (RR) of SPREs was 1.8 in all smokers, 2.3 in young (16-39 years) smokers, and 6.3 in obese young smokers. The RR of perioperative bronchospasm was 25.7 in young smokers with chronic bronchitis. CONCLUSION: The impact of smoking on perioperative respiratory problems should make anaesthetists take this widespread preoperative condition seriously, particularly in young adults. The presented method of incident reporting (based on a national classification) could contribute to future research in anaesthetic epidemiology.

Adolescent↗

PubMed1997

Events which will influence intensive care units in future. A Delphi study.

OBJECTIVE: To find out and analyse the events which are expected to influence the future of Intensive Care Units (ICU). DESIGN: Three round Delphi study. SETTING: In a first preparation round 9 events were defined. In the two rating rounds an international panel of 60 experts heads of ICUs) estimated the time when the events may come true and whether they are desired or not. RESULTS: Computer tools are desired and expected in the near future (before the year 2000) for audit, quality assurance, record keeping and telecommunication; complex closed loops and nursing robots will not be used in clinical routine before 2005, they are not desired.

Delphi Technique↗

PubMed1996

[Perioperative monitoring of the course of anesthesia, the postanesthesia visit and inquiry of patient satisfaction. A prospective study of parameters in process and outcome quality in anesthesia].

PURPOSE: This study is an investigation into the results of reporting on incidents during and after anaesthesia, to reveal any possible associations between intra-procedural and final outcome. The study contributes to the quality assurance project of the German Society of Anaesthesiology and Intensive Care (DGAI). We adjusted and tabulated our data for preoperative risk and for different methods of anaesthesia. This nation-wide DGAI project was launched to compare clinical institutions in accordance with German social legislation. METHOD: DGAI recommends standardised documentation of parameters representing quality of process (QP) defined by a 63-items list, during every anaesthesia course. Additionally, quality of outcome parameters (QO) defined by a 64-items list should be assessed by an anaesthetist during a standardised postoperative ward round by means of spot checks. A questionnaire covering subjective complaints (SC) and patient satisfaction, is optional. The combination of these tools was evaluated during a 5-month period in every patient (n = 282) on a traumatological surgery ward. RESULTS: QP and QO showed a significant association (p < 0.0001). The incidence of both parameters increases according to risk factors like age and ASA physical status. This was not significant in respect of the type of anaesthesia (p = 0.20). Whereas perioperative QP parameters were less frequent in regional versus general anaesthesia (p < 0.0001), there was no postoperative difference in QO as seen by the anaesthetist (p = 0.20). However, postoperative SC were less frequent with regional anaesthesia (p < 0.0001). The association of QO and SC was mot significant (p = 0.24). There was comparable preoperative morbidity (p = 0.74) for both anaesthetic procedures. 96.5% of all patients expressed overall satisfaction. Despite this fact, nausea (25%), vomiting (29%), thurst (29%) and particularly wound pain (33%) were frequent. CONCLUSIONS: Quality parameters assessed by anaesthetists and patients are independent in respect to their frequency. For this purpose, anaesthesiological quality assurance must focus on both the anaesthetist and the patient. As clinical consequence, we suggest establishing an interdisciplinary post-anaesthesia service. Acceptance by, and collaboration between, the surgical disciplines are indispensable especially for a successful application of effective pain and antiemetic therapy.

Adult↗

PubMed1995

[Quality control in anesthesiology. Results of a prospective study following the recommendations of the German Society of Anesthesiology and Intensive Care].

The German Social Law has required quality assurance (QA) procedures since 1989. The measures must be suitable to allow "comparing investigations". In 1992 the German Society of Anaesthesiology and Intensive Care Medicine published recommendations for QA in anaesthesia: most problems during an anaesthetic should be documented in a standardised manner, and thus, a list of 63 pitfalls, events, and complications (PECs) and five degrees of severity were defined. The goal of this study was to determine the frequency of PECs in anaesthesia and to correlate PECs with procedures and preoperative health status. MATERIALS AND METHODS. Demographic data, preoperative findings, type and duration of anaesthesia and operation, and kind and severity of PECs were integrated in an automatically readable anaesthetic data record (ARADR). During 12 months all anaesthetics in our department were documented by the ARADR; the records were read by a reading device and the data stored in a modern SQL database (Informix). Degrees of severity: I. PEC leads to reaction of anaesthetist, no impact for recovery room (RR); II. impact for RR, no impact on transfer to ward; III. significant prolongation of RR stay or additional monitoring on ward; IV. PEC leads to intensive care unit admission; V. disabling damage or death. RESULTS. In all, 18350 anaesthetics were recorded (9055 male, 9295 female); the median age was 41 years (1 day-99 years). In 4251 (23.2%) anaesthetics 5927 PECs occurred, 3412 of them involving the cardiovascular and 949 the respiratory system, the latter with a tendency to higher degrees of severity. PECs caused by technical equipment (126) or lesions caused by anaesthesists (342) had no fatal outcomes and were less severe. Patients in ASA class I had 12.3% anaesthetics with PECs, ASA II 23.3%, ASA III 33.8%, ASA IV 34.9%, and ASA V 58.5%. PECs of degrees IV and V showed a higher incidence in the higher ASA classes. There was no fatal PEC in an ASA class I patient and only one (of 13615) in an elective procedure. Emergency cases had more frequent and more severe PECs: 16 of 19 PECs of degree V were in ASA class IV and V patients and 15 in emergency situations, all of them in surgical patients. Patients with cardiovascular disease had a more frequent incidence of PECs by a factor of 1.39 to 5.93 than those without such disease. CONCLUSIONS. Standardised incident reporting by defined PECs seems a good way to describe problems in anaesthesia. The types of PECs in our study had a similar distribution to those in other investigations, but there was a tendency to less frequent fatal PECs in ASA classes I to IV and more frequent ones in ASA class V. We expect better comparability when multicenter studies are done using identical methods in the next few years. Perhaps different patients collectives with special risks will be detected; efforts in quality improvement could focus on these patients.

Adolescent↗

PubMed1995

[Incidents, events and complications in the perioperative period in normal and malnurished patients--results of 23,056 patients].

AIM: Prevalence of cardiovascular risk factors in anaesthetic patients and perioperative pitfalls, events and complications (PECs) in different nutritional states were examined. The results should contribute to a current project of the German Society of Anaesthesiology and Intensive Care, established for quality assurance. METHOD: Preoperative data (age, sex, defined preexisting diseases, nutritional state, grade of urgency and ASA-class) were integrated in an automatically readable paper record, as well as the perioperative interventions and events, type of anaesthesia, and kind of operation. The records were routinely in use for every patient. After control and correction the data were stored in a modern data base. Data of patients under 16 years of age and incomplete sets of data were excluded from analysis. MAIN RESULTS: From July 1, 1992 to December 31, 1993 23,056 anaesthesias were recorded, 5,852 (25.4%) of them with a total of 8,107 PECs. 17,255 patients had normal body weight and 23% of them PECs. 4,484 obese (but not extremely) patients had a PEC rate of 31.2%, 330 extremely obese patients had a PEC rate of 38.2%, 966 patients with underweight (but not extremely) had a PEC rate of 36.1% and 21 with extreme underweight had a PEC rate of 38.1%. Obese patients had a higher prevalence of preexisting cardiovascular disturbances (angina pectoris, myocardial infarction and hypertension) and tended to a higher incidence of perioperative hypertensive, bronchospastic and hypoxic events as well as more difficulties in application of regional anaesthesia. Young adult patients (16-39 years) had a PEC rate of 14% in case of normal nutritional state but of 20% in case of obesity. The incidence of respiratory PECs and of PECs of higher severity was almost double in obese young patients compared to normal weight patients of the same age. When preoperative cardiovascular disease was known there was little difference between the different states of nutrition in respect of perioperative PECs. CONCLUSIONS: Nutritional disorder is an important epidemiological factor in anaesthesia. Particularly in younger patients without defined preoperative cardiovascular disturbance but with obesity the anaesthesist may be surprised by a remarkable incidence of relevant problems during and immediately after anaesthesia. We should consider the possible phenomenon that we are underestimating the anaesthetic challenge in young obese patients in a "healthy" cardiovascular state.

Adolescent↗

PubMed1995

[Clinical randomized controlled studies in anesthesiology according to the quality guidelines of good clinical practice. 1: Basic trial design].

This article was written to give researchers and clinicians a short synopsis of ethical and thorough design, conduct, analysis, publication, and interpretation of randomised controlled clinical trials according to the European quality standards of Good Clinical Practice (GCP). The paper consists of two parts. In the first part we introduce important elements of study design, especially study hypothesis, criteria of inclusion and study population, sample size calculation, validity considerations, bias and confounding, randomisation, stratification, and masking of treatment assignment. Different treatment allocation like multiple parallel groups, factorial experiment, cross-over, and sequential design are presented. Requirements of ethical standards according to the Declaration of Helsinki are discussed for their necessity in any experimentation in humans. Principles of informed consent are demonstrated with emphasis on special conditions in anaesthesia, emergency medicine, and intensive care research. In the second part of this article we explain issues of baseline assessment, experimental intervention, data recording, and data monitoring, particularly of negative or hazardous treatment effects. Topics of data analysis and reporting of trial results in publications are illustrated with regard to their influence on subsequent interpretation.

Anesthesiology↗

PubMed1995

[Clinical randomized controlled studies in anesthesiology according to quality guidelines of good clinical practice. 2: Principles of implementation, analysis, publication and evaluation].

Anesthesiology↗

PubMed1995

Effect of 7.2% hypertonic saline/6% hetastarch on left ventricular contractility in anesthetized humans.

BACKGROUND: Although a positive inotropic effect of hypertonic saline has been demonstrated in isolated cardiac tissue as well as in animal preparations, no information exists about a possible positive inotropic action of hypertonic saline in humans. The aim of this investigation was to determine whether a clinically relevant positive inotropic effect can be demonstrated in humans. METHODS: Twenty-six patients without cardiovascular disease were randomized to receive 4 ml/kg of either 7.2% hypertonic saline/6% hetastarch or 6% hetastarch (control) at a rate of 1 ml.kg-1.min-1 while under general endotracheal anesthesia. Transesophageal echocardiography was used to evaluate left ventricular function. Arterial pressure, heart rate, and left ventricular end-systolic and end-diastolic diameter, area, and wall thickness were measured immediately before and after administration of either solution. Fractional area change, end-systolic wall stress, and the area under the end-systolic pressure-length relationship curve (ESPLRarea) were calculated. ESPLRarea was used to assess left ventricular contractility. RESULTS: Administration of hypertonic saline/hetastarch resulted in a significant decrease of mean arterial pressure and end-systolic wall stress from 77 +/- 14 (mean +/- SD) to 64 +/- 17 mmHg (P < 0.01) and from 52 +/- 14 to 32 +/- 11 10(3) dyne/cm2 (P > 0.01), respectively. End-diastolic area and fractional area change increased from 16.5 +/- 2.9 to 21.7 +/- 3.3 cm2 (P < 0.01) and from 0.53 +/- 0.07 to 0.70 +/- 0.06 (P < 0.01), respectively, whereas there was only a minor change of ESPLRarea from 38 +/- 13 to 44 +/- 13 mmHg.cm (P < 0.05). CONCLUSIONS: The apparent improvement of left ventricular systolic function in response to hypertonic saline/hetastarch is caused mainly by the combined effect of increased left ventricular preload and reduced left ventricular afterload. A possible positive inotropic action of hypertonic saline/hetastarch is not likely to be clinically relevant.

Adult↗

PubMed1994

Postoperative information transfer: a study comparing two university hospitals.

Several studies have addressed the processing of anesthetic information by paper anesthetic data records or by the electronic storage and transfer of anesthetic data. Our purpose was to analyze the oral transfer of information in the postoperative period. We investigated 198 post-operative transfer situations with 120 patients in a U.S. hospital to compare the results with those of a former study in a German hospital. A great number of parameters were used in both hospitals, but there were remarkable differences. In the U.S. hospital numeric values of current vital functions, including oxygen saturation, were more common during information transfer, whereas in the German hospital the emphasis was on case history and chronic health status. The data from the U.S. hospital and those of the German hospital show that in spite of complete anesthetic records, a short (112.3 +/- 104 sec in the U.S. and 94.1 +/- 83.6 sec in Germany) oral information transfer is inevitable when the patient is transferred from the OR to the recovery room, and from the recovery room to the ward (122.7 +/- 61.4 sec in the U.S. and and 88.0 +/- 73.0 in Germany). Software developers of patient data management systems could learn from this study that in some situations it is necessary and possible to create a small set of data which will reflect the patients status quite well.

Anesthesiology↗

PubMed1994

Lessons learned while building an integrated ICU workstation.

The project LUCY (Linked Ulm Care sYstem) is described. The goal of this project was to build a research workstation in an Intensive Care Unit which enables evaluation of data/information processing and presentation concepts. Also evaluation of new devices and functions considering not only one device but the workplace as an entirety was an aim of the project. We describe the complete process of building from the stage of design until its testing in clinical routine. LUCY includes a patient monitor, a ventilator, 4 infusion pumps and 8 syringe pumps. All devices are connected to a preprocessing computer via serial interfaces. A high performance graphic workstation is used for central display of physiological and therapeutic variables. A versatile user interface provides touch screen, keyboard and mouse interaction. For fluid administration a bar code based control and documentation facility was included. While our scheduled development efforts were below 4 man-years, the overall man-power needed until the first routine test amounts to 8 man-years. Costs of devices and software sum up to 160,000 US$. First experiences in clinical routine show good general acceptance of the workplace concept. Analysing the recorded data we found 90% of the items to be redundant: individual filtering algorithms are necessary for each of nowaday's devices. The flexibility of the system concerning the implementation of new features is far from our expectations. Technical maintenance of the system during clinical operation requires continuous effort which we cannot afford in the current situation.

Algorithms↗

PubMed1994

Data quality of bedside monitoring in an intensive care unit.

Computerized record keeping promises complete, accurate and legible documentation. Reliable measurements are a prerequisite to fulfill these expectations. We analyzed the physiological variables provided by bedside monitoring devices in 657 bedside visits performed by an experienced Intensive Care nurse during 75 Intensive Care rounds. We registered which variables were displayed. If a variable was displayed, we assessed whether it could be used for documentation or should be rejected. If a value was rejected the reason was registered as: the measurement was not intended (superfluous display), the current clinical situation did not allow proper measurement, or other reasons. Basic variables (vital signs and respiration related variables) were displayed in more then 90%, specific variables (e.g. intracranial pressure) were displayed in less than 50% of the situations. Displayed variables were superfluous on an average of 11% because measurement was not intended. Variables like heart rate, temperature, airway pressure, minute volume of ventilation, arrhythmia, pulmonary arterial pressure, non-invasive blood pressure, and intracranial pressure provide high quality measured values (acceptance of more than 90%). Invasive arterial pressure, central venous pressure, respiration rate and oxygen saturation (via pulse oximetry) provided lower quality values with a rejection rate higher than 10%. Inappropriate sensor technology to match the clinical environment seems to be the root cause. In future the request for automatic documentation will increase. In order to avoid additional staff workload and to ensure reliable documentation, sensor technology especially related to respiration rate, blood pressure measurements, and pulse oximetry should be improved.

Data Collection↗

PubMed1994

System ergonomic analysis of the morning ward round in an intensive care unit.

OBJECTIVE: Our objective was to find out what is discussed during a bedside morning ward round (MWR), whether there are any weak points, and if a standard work process structure can be recommended. METHODS: An intensive care unit (ICU) consultant recorded in a predefined form the topics that were discussed in 225 bedside discussions. RESULTS: The median length of discussions was 5 min. In more than 60% of the discussions, items were considered related to the respiratory, neurological, and cardiovascular systems, as well as to surgical and nursing problems. Specific variables relating to organ system conditions were seldom used (e.g., inspired O2 concentration, 35%; temperature, 28%; ventilation mode, 25%). We recorded two interruptions per MWR; only 17% of them were related to urgent decisions. Information that could not be found in the patient's file usually concerned microbiology findings (10%) or surgical procedures (6%). CONCLUSIONS: We recommend the following structure: (1) Addressing the patient by saying "hello"; (2) presentation of information related to case history, acute status (findings and strategy) (including the function of the main organ systems), infection status, and nursing problems; (3) patient-related discussion; and (4) discussion of general treatment rules, triggered by individual patient condition.

Communication↗