[The German Thorax Registry: Implementation of an Established Tool of Perioperative Health Care Research].

The collection of clinical treatment data in registry databases is an important aspect of health services research. It allows for a critical evaluation of the safety, efficacy and cost-effectiveness of clinical treatment concepts in large patient populations. The findings of registry research represent real-world patients and treatment structures as they are not limited by strict inclusion criteria or unrealistic conditions as applied in prospective clinical trials.

Major incidents and complications in otherwise healthy patients undergoing elective procedures: results based on 1.37 million anaesthetic procedures.

Background: Improved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS).

Methods: Cases from 1999 to 2010 were filtered from the CDS database.

The German Critical Incident Reporting System for Anesthesiology: CIRSains.

Background: In June 2010, the Helsinki Declaration was passed. As a result, an online nationwide critical incident reporting system named CIRSmedical Anaesthesiology (CIRSains) was implemented in Germany. The aim of the article is to evaluate CIRSains for practicability and to provide solutions to the problems detected during evaluation.

[Professional image of anesthetists in the general public. Influence of provision of information and previous experience with the discipline].

Background: The profession of the anesthetist in Germany includes the disciplines anesthesia, intensive care, emergency and pain medicine. Despite the versatility and competence of the profession, patients do not appear to have recognized anesthesiology as a medical discipline or anesthetists as medical doctors.

Aim: This study was conducted with the aim of estimating how previous experience and information gathered before contact with the anesthetist for premedication have influenced and changed the perception of patients with regards to the professional fields and the characteristics of anesthetists.

National critical incident reporting systems relevant to anaesthesia: a European survey.

Background: Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia.

Methods: We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure.

Results: Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach.

Success of commonly used operating room management tools in reducing tardiness of first case of the day starts: evidence from German hospitals.

Background: One of the declared objectives of surgical suite management in Germany is to increase operating room (OR) efficiency by reducing tardiness of first case of the day starts. We analyzed whether the introduction of OR management tools by German hospitals in response to increasing economic pressure was successful in achieving this objective. The OR management tools we considered were the appointment of an OR manager and the development and adoption of a surgical suite governance document (OR charter).

Helsinki Declaration on patient safety in anaesthesiology: putting words into practice - experience in Germany.

For years now, the German Society of Anaesthesiology and Intensive Care Medicine and the Professional Association of German Anaesthesiologists have been actively involved in efforts to improve patient safety. To this end, a whole range of activities have been initiated in recent years and, since February 2011, collected together on our home page 'PATSI' (www.patientensicherheit-ains.

ROSC after cardiac arrest--the RACA score to predict outcome after out-of-hospital cardiac arrest.

Aims: Return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation from cardiac arrest (CA) depends on numerous variables. The aim of this study was to develop a score to predict the initial resuscitation outcome-the RACA (ROSC after cardiac arrest) score.

Methods And Results: Based on 5471 prospectively registered out-of-hospital CAs patients between 1998 and 2008 within the German Resuscitation Registry, calculation of the RACA score was performed by multivariate logistic regression analysis with ROSC as the outcome variable.

[Workflow management in the operating room. Analysis of potentials for optimizing efficiency at a university hospital].

Background: The introduction of the diagnosis-related groups reimbursement system has increased cost pressures. Due to the interaction of many different professional groups, analysis and optimization of internal coordination and scheduling in the operating room (OR) is mandatory. The aim of this study was to analyze the processes at a university hospital in order to optimize strategies by identifying potential weak points.

Status quo and current trends of operating room management in Germany.

Purpose Of Review: Ongoing healthcare reforms in Germany have required strenuous efforts to adapt hospital and operating room organizations to the needs of patients, new technological developments, and social and economic demands. This review addresses the major developments in German operating room management research and current practice.

Recent Findings: The introduction of the diagnosis-related group system in 2003 has changed the incentive structure of German hospitals to redesign their operating room units.

How work context affects operating room processes: using data mining and computer simulation to analyze facility and process design.

The complexity of the operating room (OR) requires that both structural (eg, department layout) and behavioral (eg, staff interactions) patterns of work be considered when developing quality improvement strategies. In our study, we investigated how these contextual factors influence outpatient OR processes and the quality of care delivered. The study setting was a German university-affiliated hospital performing approximately 6000 outpatient surgeries annually.

Pre-operative fasting: a nationwide survey of German anaesthesia departments.

Background: Shorter pre-operative fasting improves clinical outcome without an increased risk. Since October 2004, German Anaesthesiology Societies have officially recommended a fast of 2 h for clear fluids and 6 h for solid food before elective surgery. We conducted a nationwide survey to evaluate the current clinical practice in Germany.

[Evidence-based anti-infective program "ABx" - Online-program for anti-infective therapy broadens functions for local adaptations].

National and international evidence based recommendations for anti-infective therapies in the intensive care unit are difficult to implement into daily clinical work. However, adequate and early applications of anti-infective therapies are important outcome factors for the clinical course of severe infections. With support of the German Society of Anaesthesiology and Intensive Care Medicine and the Association of German Anaesthesiologists (DGAI/BDA) a web based anti-infective program was developed to address these issues.

Quality improvement in postoperative pain management: results from the QUIPS project.

Introduction: Acute postoperative pain management is still far from satisfactory despite the availability of high-quality guidelines and advanced pain management techniques.

Methods: An outcome-oriented project called QUIPS (Quality Improvement in Postoperative Pain Management) was developed, consisting of standardized data acquisition and an analysis of quality and process indicators.

Results: After validation of the questionnaire, a total of 12 389 data sets were collected from 30 departments in six participating hospitals.

[Simulation-based analysis of novel therapy principles. Effects on the efficiency of operating room processes].

Background: The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization.

Methods: To analyze the effects of medical innovations, computer simulation was used as an experimental frame.

Operating room management and operating room productivity: the case of Germany.

We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals.

[Incident reporting systems in anesthesiology--methods and benefits using the example of PaSOS].

Preventing patient harm is one of the main tasks for the field of anesthesiology from early on. With the introduction of the national German incident reporting system PaSOS, which is hosted by the German anesthesia society, anesthesiology is again leading the field of patient safety. Important elements, success factors and background information for the introduction of successful incident reporting systems in an organization are given.

[Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix].

Objective: The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed.

Methods: On the ICU of a German focused-care hospital (896 beds, 12 anesthesiology ICU beds), cost per treatment day was calculated with or without mechanical ventilation from the perspective of the hospital.

[Controlling and reporting in operating room management: analysis of the state of development].

The operating room (OR) is one of the most expensive facilities in most hospitals. The demands on a professional and process-oriented controlling and reporting in the OR are increased due to the increasingly more limited financial margins at the end of the diagnosis related groups (DRG) convergence phase. This study gives an overview of the current situation for cost calculation, controlling and reporting in OR management in German hospitals in 2007.

[The optimization of a medicinal process and the organization of work in an operating-room].

In most hospitals, the operating-room is a most expensive therapeutic subdivision. A clear and understandable concept of organization of the management of a medical process in an operating room should be introduced into all clinics in order to satisfy increasing needs for professional and technological management. Within the framework of a promising management program to optimize a medical process and to organize work in the operating-room, the surgeons are provided with surgical equipment intended for an operating-room in accordance with their assessed needs and with their participation in budgeting, which made it possible to evaluate the efficiency of a medical process and the work of each user of an operating-room.