Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Questionnaire
2.4. Inclusion and Exclusion Criteria
2.5. Ethics Approval
2.6. Declaration of Generative AI in the Writing Process
2.7. Statistical Analysis
3. Results
3.1. Background Characteristics
3.2. Comparison between Basic/Regular Care and Central/Maximum Care
3.3. Transfers
3.4. Communication and Quality
3.5. Proposals for Optimization
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Borchers, H. Ambulant statt stationär—Warum jetzt so eilig? Uro-News 2023, 27, 10–13. (In German) [Google Scholar] [CrossRef]
- Krankenhausreform. Available online: https://www.bundesgesundheitsministerium.de/themen/gesundheitswesen/krankenhausreform.html (accessed on 15 April 2023). (In German).
- Minz, R.; Grüttner, D.; von Heusinger-Lender, M. Krankenhaus 2030—Was sich ändern muss. Gefässchirurgie 2023, 28, 98–107. (In German) [Google Scholar] [CrossRef] [PubMed]
- Walker, M.; Schell, F.J. Patienten in den Mittelpunkt stellen und Potenziale nutzen: Sieben Thesen über das deutsche Gesundheitssystem im Jahr 2030. In Zukunft der Gesundheitsversorgung; Simon, B., Krämer, N., Eds.; Springer Fachmedien Wiesbaden: Wiesbaden, Germany, 2021; pp. 27–39. ISBN 978-3-658-33006-4. (In German) [Google Scholar]
- Petzold, T.; Haase, E.; Niethard, F.U.; Schmitt, J. Orthopädisch-unfallchirurgische Versorgung bis 2050: Analyse des Inanspruchnahmeverhaltens bei relevanten Erkrankungen und Ableitung der Häufigkeit ärztlicher Leistungserbringer. Orthopäde 2016, 45, 167–173. (In German) [Google Scholar] [CrossRef] [PubMed]
- Distler, L. Es kommt anders—Wenn man denkt! Schmerzmed 2022, 38, 54–55. (In German) [Google Scholar] [CrossRef]
- Braun, B. Das Innenleben des Krankenhauses—Zwischen Bedarfsorientierung, Überversorgung, Personalmangel, professionellen Logiken und Strukturdefiziten. In Geld im Krankenhaus; Dieterich, A., Braun, B., Gerlinger, T., Simon, M., Eds.; Springer Fachmedien Wiesbaden: Wiesbaden, Germany, 2019; pp. 69–105. ISBN 978-3-658-24806-2. (In German) [Google Scholar]
- Krankenhausfinanzierung. Available online: https://www.bundesgesundheitsministerium.de/krankenhausfinanzierung.html (accessed on 15 April 2023). (In German).
- Hebler, U.; Müther, M.; Muhr, G.; Gekle, C. Ist unfallchirurgische Intensivmedizin noch bezahlbar: Eine Kostenanalyse. Trauma Berufskrankh 2007, 9, 163–166. (In German) [Google Scholar] [CrossRef]
- Köther, H.L.; Gorschlüter, P.; Milz, H.-P. Interhospitaltransfer und Krankenhausfinanzierung: Effekte der Einführung von DRG-Fallpauschalen auf den Rettungsdienst. Notf. Rettungsmed 2009, 12, 372–378. (In German) [Google Scholar] [CrossRef]
- Traumanetzwerk Berlin; Matthes, G.; Schaser, K.D.; Otto, V.; Arens, S. TraumaNetzwerk DGU®: Am Beispiel des Traumanetzwerk Berlin. Trauma Berufskrankh 2014, 16, 187–189. (In German) [Google Scholar] [CrossRef]
- Weißbuch Schwerverletzten-Versorgung. Available online: https://www.dgu-online.de/versorgung-wissenschaft/qualitaet-und-sicherheit/schwerverletzte/weissbuch-schwerverletztenversorgung (accessed on 15 April 2023). (In German).
- Haas, H.; Heller, K.D. Anforderungskatalog Erhebungsbogen für EndoProthetikZentren zur Zertifizierung von EndoProthetikZentren als Qualitätssichernde Maßnahme in der Behandlung von Gelenkerkrankungen: EndoProthetikZentrum der Maximalversorgung (EndoCert). Available online: https://www.clarcert.com/_Resources/Persistent/0/f/b/f/0fbf2b7c56911a9bd63967007a3aaae6408e3aad/_ausfu%CC%88llhinweise-N1%20(220802).pdf (accessed on 15 April 2023). (In German).
- Koval, K.J. Are Patients Being Transferred to Level-I Trauma Centers for Reasons Other Than Medical Necessity? J. Bone Jt. Surg. 2006, 88, 2124–2132. [Google Scholar] [CrossRef]
- Roos, J.; Loy, T.; Ploeger, M.M.; Weinhold, L.; Schmid, M.; Mewes, M.; Prangenberg, C.; Gathen, M. It is (not) always on Friday: Inter-hospital patient transfers in orthopedic and trauma surgery. Eur. J. Trauma Emerg. Surg. 2023, 49, 2605–2613. [Google Scholar] [CrossRef]
- Iwashyna, T.J. The incomplete infrastructure for interhospital patient transfer. Crit. Care Med. 2012, 40, 2470–2478. [Google Scholar] [CrossRef]
- Mueller, S.K.; Fiskio, J.; Schnipper, J. Interhospital Transfer: Transfer Processes and Patient Outcomes. J. Hosp. Med. 2019, 14, 486–491. [Google Scholar] [CrossRef] [PubMed]
- Reichheld, A.; Yang, J.; Sokol-Hessner, L.; Quinn, G. Defining Best Practices for Interhospital Transfers. J. Healthc. Qual. 2021, 43, 214–224. [Google Scholar] [CrossRef] [PubMed]
- Johnson, C.; Hernandez, C.; Bacak, C.; Sandler, A.B.; Childs, B.; Eckhoff, M.D.; Parnes, N. A High Proportion of Orthopaedic Hand Trauma Transfers are Unnecessary: A Systematic Review. J. Orthop. Bus. 2024, 4. [Google Scholar] [CrossRef]
- Crichlow, R.J.; Zeni, A.; Reveal, G.; Kuhl, M.; Heisler, J.; Kaehr, D.; Vijay, P.; Musapatika, D.L. Appropriateness of patient transfer with associated orthopaedic injuries to a Level I trauma center. J. Orthop. Trauma 2010, 24, 331–335. [Google Scholar] [CrossRef] [PubMed]
- SoSci Survey—Professionelle Onlinebefragung Made in Germany. Available online: https://www.soscisurvey.de/ (accessed on 16 July 2023). (In German).
- Introducing ChatGPT. Available online: https://openai.com/blog/chatgpt (accessed on 13 August 2023).
- On behalf of the British Sarcoma Group; Gerrand, C.; Athanasou, N.; Brennan, B.; Grimer, R.; Judson, I.; Morland, B.; Peake, D.; Seddon, B.; Whelan, J. UK guidelines for the management of bone sarcomas. Clin. Sarcoma Res. 2016, 6, 7. [Google Scholar] [CrossRef] [PubMed]
- Malik, A.T.; Alexander, J.H.; Khan, S.N.; Scharschmidt, T.J. Is Treatment at a High-volume Center Associated with an Improved Survival for Primary Malignant Bone Tumors? Clin. Orthop. Relat. Res. 2020, 478, 631–642. [Google Scholar] [CrossRef] [PubMed]
- Hischebeth, G.T.R.; Gravius, S.; Buhr, J.K.; Molitor, E.; Wimmer, M.D.; Hoerauf, A.; Bekeredjian-Ding, I.; Randau, T.M. Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction. J. Vis. Exp. 2017, e55147. [Google Scholar] [CrossRef] [PubMed]
- Roof, M.A.; Sharan, M.; Merkow, D.; Feng, J.E.; Long, W.J.; Schwarzkopf, R.S. High-volume revision surgeons have better outcomes following revision total knee arthroplasty. Bone Jt. J. 2021, 103-B, 131–136. [Google Scholar] [CrossRef] [PubMed]
- Wirtz, D.C.; Jaenisch, M.; Osterhaus, T.A.; Gathen, M.; Wimmer, M.; Randau, T.M.; Schildberg, F.A.; Rössler, P.P. Acetabular defects in revision hip arthroplasty: A therapy-oriented classification. Arch. Orthop. Trauma Surg. 2020, 140, 815–825. [Google Scholar] [CrossRef]
- Pilz, V.; Hanstein, T. Revisionsendoprothetik des Hüftgelenks in Deutschland: Erwartete Fallzahlen bis zum Jahr 2040. Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Available online: https://www.egms.de/static/en/meetings/dkou2018/18dkou439.shtml (accessed on 27 July 2023). (In German).
- Lang, P.; Schwabe, K.; Riesner, H.-J.; Friemert, B.; Stuby, F.; Palm, H.-G.; AG Becken III der Deutschen Gesellschaft für Unfallchirurgie. Epidemiological and Therapeutic Developments in Pelvic Ring Fractures Type C from 2004 to 2014—A Retrospective Data Analysis of 2,042 Patients in the German Pelvic Register (DGU). Z. Orthop. Unfall. 2022, 160, 172–182. (In German) [Google Scholar] [CrossRef]
- Hd, I.; Mf, L.; Yp, D. The Outcome of Complex Pelvic Fracture after Internal Fixation Surgery. Malays. Orthop. J. 2016, 10, 16–21. [Google Scholar] [CrossRef] [PubMed]
- Martin, A.; McMaster, J.; Bretherton, C.; Noyes, D. Pelvic and acetabular fracture care in England: Current workload and future directions. Ann. R. Coll. Surg. Engl. 2021, 103, 420–425. [Google Scholar] [CrossRef] [PubMed]
- Fritz, T.; Veith, N.; Braun, B.; Pohlemann, T.; Herath, S. Beckenchirurgie—Akutversorgung. OP-J. 2018, 34, 26–32. (In German) [Google Scholar] [CrossRef]
- BOAST—The Management of Patients with Pelvic Fractures. Available online: https://www.boa.ac.uk/resource/boast-3-pdf.html (accessed on 27 July 2023).
- Buecking, B.; Hoffmann, R.; Riem, S.; Sturm, J.; Schmucker, U.; Friess, T.; Liener, U.; Hartwig, E. AltersTraumaZentrum DGU®. Unfallchirurg 2014, 117, 842–848. (In German) [Google Scholar] [CrossRef]
- Chang, C.-H.; Lee, S.-H.; Lin, Y.-C.; Wang, Y.-C.; Chang, C.-J.; Hsieh, P.-H. Increased periprosthetic hip and knee infection projected from 2014 to 2035 in Taiwan. J. Infect. Public Health 2020, 13, 1768–1773. [Google Scholar] [CrossRef]
BRC (n = 56) | CMC (n = 96) | Total | ||
---|---|---|---|---|
Chief physicians | N (%) | 17 (30.4%) | 17 (17.7%) | 34 (22.4%) |
Senior doctors in a leading position | N (%) | 13 (23.2%)) | 21 (21.9%) | 34 (22.4%) |
Senior doctors | N (%) | 13 (23.2%) | 27 (28.1%) | 40 (26.3%) |
Specialists | N (%) | 2 (3.6%) | 10 (10.4%) | 12 (7.9%) |
Residents | N (%) | 11 (19.6%) | 21 (21.9%) | 32 (21.1%) |
Rural community | N (%) | 4 (7.1%) | 1 (1.0%) | 5 (3.3%) |
Small town | N (%) | 10 (17.9%) | 3 (3.1%) | 13 (8.6%) |
Medium-sized city | N (%) | 21 (37.5%) | 23 (24.0%) | 44 (28.9%) |
Large city | N (%) | 21 (37.5%) | 69 (71.9%) | 90 (59.2%) |
BRC | CMC | Total | p-Value | ||
---|---|---|---|---|---|
Beds | Median | 50.0 | 78.0 | 60.0 | <0.001 |
[Min, Max] | [5.00, 465] | [5.00, 1000] | [5.00, 1000] | ||
95% CI | (40, 50) | (64, 80) | (56, 70) | ||
Intensive care beds | Median | 12.0 | 30.0 | 20.0 | <0.001 |
[Min, Max] | [3.00, 465] | [0, 200] | [0, 465] | ||
95% CI | (11, 15) | (20, 38) | (15, 22) | ||
CT—Diagnostic | Yes | 1.000 | |||
N | 48 | 71 | 119 | ||
(%, 95% CI) | (85.7%, 74–94) | (74.0%, 64–82) | (78.3%, 71–85) | ||
Missing answers | 7 (12.5%) | 23 (24.0%) | |||
MRI—Diagnostic | Yes | <0.001 | |||
N | 13 | 61 | 74 | ||
(%, 95% CI) | (23.2%, 13–36) | (63.5%, 53–73) | (48.7%, 41–57) | ||
Missing answers | 7 (12.5%) | 23 (24.0%) |
BRC | CMC | Total | p-Value | ||
---|---|---|---|---|---|
Number of specializations | Median | 2 | 4 | 4 | <0.001 |
[Min, Max] | [1, 9] | [1, 13] | [1, 13] | ||
95% CI | (1, 2) | (4, 5) | (3, 4) | ||
Hand surgery | N | 22 | 77 | 99 | <0.001 |
(%, 95% CI) | (39.3%, 26–53) | (80.2%, 71–88) | (65.1%, 57–73) | ||
Severe injury procedure | N | 7 | 70 | 77 | <0.001 |
(%, 95% CI) | (12.5%, 5–24) | (72.9%, 63–81) | (50.7%, 42–59) | ||
EndoProthetikZentrum (EPZ) | N | 25 | 41 | 66 | 1.000 |
(%, 95% CI) | (44.6%, 31–59) | (42.7%, 33–53) | (43.4%, 35–52) | ||
EndoProthetikZentrum of maximum care (EPZMAX) | N | 6 | 33 | 39 | 0.016 |
(%, 95% CI) | (10.7%, 4–22) | (34.4%, 25–45) | (25.7%, 19–33) | ||
Spine center of maximum care of the DWG | N | 1 | 41 | 42 | <0.001 |
(%, 95% CI) | (1.8%, 0–10) | (42.7%, 33–53) | (27.6%, 21–35) | ||
Spine specialist center of the DWG | N | 12 | 9 | 21 | 0.763 |
(%, 95% CI) | (21.4%, 12–34) | (9.4%, 4–17) | (13.8%, 9–20) | ||
Spine facility of the DWG | N | 15 | 13 | 28 | 0.778 |
(%, 95% CI) | (26.8%, 16–40) | (13.5%, 7–22) | (18.4%, 13–26) | ||
Center for foot surgery | N | 12 | 22 | 34 | 1.000 |
(%, 95% CI) | (21.4%, 12–34) | (22.9%, 15–33) | (22.4%, 16–30) | ||
Rheumatological orthopedics | N | 1 | 8 | 9 | 1.000 |
(%, 95% CI) | (1.8%, 0–10) | (8.3%, 4–16) | (5.9%, 3–11) | ||
Hemophilia center | N | 1 | 13 | 14 | 0.271 |
(%, 95% CI) | (1.8%, 0–10) | (13.5%, 7–22) | (9.2%, 5–15) | ||
Tumor orthopedics | N | 5 | 46 | 51 | <0.001 |
(%, 95% CI) | (8.9%, 3–20) | (47.9%, 38–58) | (33.6%, 26–42) | ||
Pediatric- and neuro-orthopedics | N | 1 | 37 | 38 | <0.001 |
(%, 95% CI) | (1.8%, 0–10) | (38.5%, 29–49) | (25%, 18–33) | ||
Plastic reconstructive surgery | N | 13 | 51 | 64 | 0.005 |
(%, 95% CI) | (23.2%, 13–36) | (53.1%, 43–63) | (42.1%, 34–50) | ||
Other | N | 8 | 9 | 17 | 1.000 |
(%, 95% CI) | (14.8%, 6–26) | (9.4%, 4–17) | (11.3%, 7–17) |
BRC | CMC | Total | p-Value | ||
---|---|---|---|---|---|
Contact person | 33.9% (CI: 22–48) | 32.3% (CI: 23–43) | 32.9% (CI: 25–41) | 1.000 | |
Quality of communication | Very good | 8.9% | 7.3% | 7.9% | 1.000 |
Good | 25.0% | 28.1% | 27.0% | ||
Satisfactory | 33.9% | 29.2% | 30.9% | ||
Sufficient | 14.3% | 10.4% | 11.8% | ||
Insufficient | 7.1% | 5.2% | 5.9% |
BRC | CMC |
---|---|
For cases of limited admission capacities (especially in intensive care), assistance in bed searches. | From the perspective of the receiving clinic: Transferring hospitals often withhold crucial information that could jeopardize the possible acceptance of the patient, for example, mandatory isolation due to infectious diseases, misrepresentation of the urgency for transfer, lack of patient consent to possible therapies, exaggeration of clinical symptoms. |
Improved accessibility of senior physicians. | Improved patient documentation. Opportunity for subsequent transmission of findings (e.g., Mibi). |
Better feedback and increased willingness to accept. | Improved telemedicine/digital networking between hospitals. |
Direct contact with a senior physician/decision-maker. | Database displaying available beds. |
A single phone number with 24/7 availability with a knowledgeable and authorized contact person. If a conversation is currently being held, an automatic callback should be triggered. | Direct contact/availability of a decision maker. |
A central phone number/contact person (on-duty senior physician) who is easier to reach. | Dedicated contacts, insufficient willingness to accept web-based image transfer (“better send a CD…”). |
A designated contact person for transfers in each specialty; urgent training for the reception staff is necessary. | Release of an electronic file. A common data standard is required for this. |
Dedicated contact persons, increased emergency capacity of maximum care providers. | Capacities, especially for emergencies during the night, should be distributed within the network. |
Fixed and known uniform phone number for transfers; Clear acceptance criteria. | Clear levels of care. |
Better management of transport capacities. | Clarification of possible readmissions. |
Standardized transfer request. | Optimization of the distribution of emergency patients already by the emergency services. |
Further possibilities to improve digital data traffic. | Specific phone numbers dedicated solely to the topic of patient transfers. Comprehensive teleradiology, use of data protection compliant modern communication media. Mutual transferability. Better compensation for patients who have been accepted to finance/compensate for the increased logistical effort. |
Central communication network with the ability to query capacities. | Central “bed exchange” for specialty-specific peripheral hospitals. |
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Roos, J.; Ben Amar, S.; Weinhold, L.; Zellner, A.A.; Touet, A.; Prangenberg, C.; Loy, T.; Gathen, M. Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany. Clin. Pract. 2024, 14, 789-800. https://doi.org/10.3390/clinpract14030063
Roos J, Ben Amar S, Weinhold L, Zellner AA, Touet A, Prangenberg C, Loy T, Gathen M. Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany. Clinics and Practice. 2024; 14(3):789-800. https://doi.org/10.3390/clinpract14030063
Chicago/Turabian StyleRoos, Jonas, Soufian Ben Amar, Leonie Weinhold, Alberto Alfieri Zellner, Amadeo Touet, Christian Prangenberg, Thomas Loy, and Martin Gathen. 2024. "Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany" Clinics and Practice 14, no. 3: 789-800. https://doi.org/10.3390/clinpract14030063