Coordination of Hospitals in the Corona Pandemic

Abstract BackgroundThe second wave of Corona-Pandemic posed the German Healthcare system to a major challenge. Due to the fast and wide spreading of SARS-CoV-2 in November 2020, the number of COVID-19-patients needing intensive care treatment was rapidly growing. Transferring patients between hospitals was necessary to prevent an overflow of treatment capacities within the ambulance district of Augsburg. This project aimed to create a coordination structure that ensures an efficient guiding of all hospitals within the ambulance district Augsburg.Material and methodsAn executive order of the Bavarian ministries of health and internal affairs 1 lead to the appointment of a Medical Director of Hospital Coordination (MDHC) within each ambulance district. Each hospital had to nominate a pandemic officer (PO). Based on the executive order and the “disaster management manual 100” we established a hospital coordination structure for the ambulance district Augsburg.ResultsBetween October 18th, 2020, and February 14th, 2021, the staff of the MDHC coordinated 407 transfers of patients. 223 patients were treated on a general ward, 184 on intensive care units. The transfers prevented several impending triage situations. Using the coordination structure, the urgent reduction of a COVID-19 intensive care unit of a level 1 hospital from 7 to 2 beds was managed within 4 hours after an alarm. ConclusionsBased on the “disaster management manual 100”2 we were able to establish a hospital coordination structure that can withstand high pressure and ensured that impending triage situations were prevented. Urgent shortages of treatment capacities were balanced through the transfer of patients. The major problem was the lack of intensive care personnel.

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Prolonged intensive care treatment of octogenarians after cardiac surgery: Is the economic burden justified?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297792 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

H Deschka ◽

L Vöhringer ◽

J Neufeld ◽

G Wimmer-Greinecker

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Economic Burden ◽

Intensive Care Treatment ◽

Care Treatment

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The presence of liver cirrhosis is a strong negative predictor of survival for patients admitted to the intensive care unit – Cirrhosis in intensive care patients

Zeitschrift für Gastroenterologie ◽

10.1055/a-1401-2387 ◽

2021 ◽

Author(s):

Jörg Bojunga ◽

Mireen Friedrich-Rust ◽

Alica Kubesch ◽

Kai Henrik Peiffer ◽

Hannes Abramowski ◽

...

Keyword(s):

Intensive Care Unit ◽

Liver Cirrhosis ◽

Intensive Care ◽

Hospital Mortality ◽

Intensive Care Treatment ◽

Matched Cohort ◽

Care Treatment ◽

Cirrhotic Patients ◽

The Impact ◽

Cirrhotic Group

Abstract Background and Aims Liver cirrhosis is a systemic disease that substantially impacts the body’s physiology, especially in advanced stages. Accordingly, the outcome of patients with cirrhosis requiring intensive care treatment is poor. We aimed to analyze the impact of cirrhosis on mortality of intensive care unit (ICU) patients compared to other frequent chronic diseases and conditions. Methods In this retrospective study, patients admitted over three years to the ICU of the Department of Medicine of the University Hospital Frankfurt were included. Patients were matched for age, gender, pre-existing conditions, simplified acute physiology score (SAPS II), and therapeutic intervention scoring system (TISS). Results A total of 567 patients admitted to the ICU were included in the study; 99 (17.5 %) patients had liver cirrhosis. A total of 129 patients were included in the matched cohort for the sensitivity analysis. In-hospital mortality was higher in cirrhotic patients than non-cirrhotic patients (p < 0.0001) in the entire and matched cohort. Liver cirrhosis remained one of the strongest independent predictors of in-hospital mortality (entire cohort p = 0.001; matched cohort p = 0.03) along with dialysis and need for transfusion in the multivariate logistic regression analysis. Furthermore, in the cirrhotic group, the need for kidney replacement therapy (p < 0.001) and blood transfusion (p < 0.001) was significantly higher than in the non-cirrhotic group. Conclusions In the presented study, liver cirrhosis was one of the strongest predictors of in-hospital mortality in patients needing intensive care treatment along with dialysis and the need for ventilation. Therefore, concerted efforts are needed to improve cirrhotic patients’ outcomes, prevent disease progression, and avoid complications with the need for ICU treatment in the early stages of the disease.

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Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix

Burns ◽

10.1016/j.burns.2019.02.005 ◽

2019 ◽

Vol 45 (5) ◽

pp. 1057-1065

Author(s):

Rolf K. Gigengack ◽

Margriet E. van Baar ◽

Berry I. Cleffken ◽

Jan Dokter ◽

Cornelis H. van der Vlies

Keyword(s):

Intensive Care ◽

Case Mix ◽

Intensive Care Treatment ◽

Care Treatment

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Lung ultrasound presentation of COVID-19 patients: phenotypes and correlations

Internal and Emergency Medicine ◽

10.1007/s11739-020-02620-9 ◽

2021 ◽

Author(s):

Gianmarco Secco ◽

◽

Marzia Delorenzo ◽

Francesco Salinaro ◽

Caterina Zattera ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lung Ultrasound ◽

Structure And Function ◽

General Ward ◽

Prognostic Role ◽

Interstitial Syndrome ◽

Lung Structure ◽

And Function ◽

The Relationship

AbstractBedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R2 0.68; p < 0.0001) and P/F at FiO2 = 21% (R2 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function.

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Discharge practices for the intensive care patient: A qualitative exploration in the general ward setting

Intensive and Critical Care Nursing ◽

10.1016/j.iccn.2014.04.004 ◽

2014 ◽

Vol 30 (5) ◽

pp. 292-300 ◽

Cited By ~ 10

Author(s):

Stephanie Cognet ◽

Fiona Coyer

Keyword(s):

Intensive Care ◽

Intensive Care Patient ◽

Care Patient ◽

General Ward ◽

Qualitative Exploration

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Ethical Decisions in Neonatal Intensive Care Units: The Dutch Experience

PEDIATRICS ◽

10.1542/peds.90.5.729 ◽

1992 ◽

Vol 90 (5) ◽

pp. 729-732

Author(s):

Pieter J. J. Sauer

Keyword(s):

Quality Of Life ◽

Intensive Care ◽

The Netherlands ◽

Neonatal Intensive Care ◽

Fatal Outcome ◽

Modern Technology ◽

Withholding Treatment ◽

Intensive Care Treatment ◽

Best Interest

Modern technology makes it possible to keep more sick, extremely small, and vulnerable neonates alive. Many neonatologists in the Netherlands believe they should be concerned not only about the rate of survival of their patients, but also about the way the graduates of their care do, in fact, survive beyond the neonatal period. In most cases, we use all available methods to keep newborns alive. However, in some instances there is great concern about the quality of life, if the newborn should survive; here questions do arise about continuing or withholding treatment. In this commentary, I present my impression of the opinions held by a majority of practicing neonatologists in the Netherlands, as well as some personal thoughts and ideas. Recently, a committee convened by the Ministers of Justice and Health in the Netherlands issued an official report regarding the practice of euthanasia and the rules of medical practice when treatment is withheld.1 In this report of more than 250 pages, only 2 pages focus on the newborn. The following conclusions were made in this small section of the report. In almost one half of the instances of a fatal outcome in a neonatal intensive care unit in the Netherlands, discussions about sustaining or withholding treatment did take place at some stage of the hospital stay. A consideration of the future quality of life was always included in the discussion. The committee agreed with doctors interviewed for the report that there are circumstances in which continuation of intensive care treatment is not necessarily in the best interest of a neonate.

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