Prokop A, Reinauer K M, Chmielnicki M
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Kliniken Sindelfingen, Klinikverbund Südwest.
Altersmedizin, Med. VI, Kliniken Sindelfingen.
Z Orthop Unfall. 2015 Jun;153(3):306-11. doi: 10.1055/s-0035-1545710. Epub 2015 Apr 30.
By 2030, 30 % of German residents will be over 70 years of age. In 2009, we conceptualised a TÜV (German Technical Inspection Authority) certified interdisciplinary centre for geriatric trauma care. All treatment pathways were agreed upon by all disciplines. Complex geriatric therapy was established, and patients were seen by trauma surgeons, geriatricians, therapists, and a pharmacist. Cases were discussed in team meetings. Morbidity and mortality conferences were conducted. In 2014, supplementary DGU (German Society for Trauma Surgery) certification was achieved.
Have these measures led to improved quality of care and have the increased costs been covered? Is the formation of such a centre worthwhile for patients and hospitals?
This interdisciplinary treatment was implemented for all patients over 70 admitted with proximal femur, proximal humerus, and vertebral fractures. In 2012, there were 208 proximal femur, 171 vertebral, and 69 humeral fractures. The following parameters were defined for quality control: admission and diagnosis completed within 90 minutes, over 80 % of operations performed within 24 hours, reoperation rate under 12 %, decubitus rate under 5 %, mobilisation within 24 hours of surgery in 75 %, discharge to the previous environment in over 80 % of cases, and minimal mortality rates.
Surgery performed within 24 hours fell just short of target in 2012 with 78 %, and 2013 with 81 %. The target time for diagnosis was reached in only 30 % of patients in 2012 and in 42 % in 2013; thus, more outpatient personnel was added. Mobilisation within 24 hours of surgery was completed in 79 % of patients in 2012. Implementation of decubitus standards reduced the rate of decubitus formation from 8 to 3.2 %. Reoperation rate was 5.2 % in 2012 and 3.1 % in 2013. In 2012, 6.4 % and in 2013, 9.3 % of discharged patients required short- and long-term care facilities for the first time, and the rest were discharged to rehabilitation or directly back home. Mortality rates for proximal femur fractures were 5.7 % in 2010, 5.1 % in 2011, 2.9 % in 2012, and 3.0 % in 2013. The implementation of complex geriatric therapy generated 103 treatments in 2012 with revenue of 912,000 €, and 160 treatments in 2013 with revenue of 1.35 million €.
Interdisciplinary geriatric-trauma therapy for older patients resulted in improved measurable outcomes. Interdisciplinary geriatric trauma care with implementation of complex therapy benefits both patients and hospitals.
到2030年，30%的德国居民年龄将超过70岁。2009年，我们构思了一个经德国技术检验局（TÜV）认证的老年创伤护理跨学科中心。所有治疗途径均得到各学科的认可。建立了复杂的老年治疗模式，创伤外科医生、老年病科医生、治疗师和药剂师共同诊治患者。病例在团队会议上进行讨论，并召开发病率和死亡率研讨会。2014年，该中心获得了德国创伤外科学会（DGU）的补充认证。
这些措施是否提高了护理质量，增加的成本是否得到了弥补？对于患者和医院而言，组建这样一个中心是否值得？
对所有70岁以上因股骨近端、肱骨近端和椎体骨折入院的患者实施这种跨学科治疗。2012年，有208例股骨近端骨折、171例椎体骨折和69例肱骨骨折。为质量控制定义了以下参数：入院和诊断在90分钟内完成，超过80%的手术在24小时内进行，再次手术率低于12%，褥疮发生率低于5%，75%的患者在术后24小时内活动，超过80%的病例出院后回到先前的生活环境，以及最低死亡率。
2012年和2013年在24小时内进行手术的比例分别为78%和81%，未达到目标。2012年仅有30%的患者在目标时间内完成诊断，2013年为42%；因此，增加了门诊工作人员。2012年79%的患者在术后24小时内进行了活动。褥疮标准的实施使褥疮发生率从8%降至3.2%。2012年再次手术率为5.2%，2013年为3.1%。2012年6.4%、2013年9.3%的出院患者首次需要短期和长期护理机构，其余患者出院后接受康复治疗或直接回家。股骨近端骨折的死亡率在2010年为5.7%，2011年为5.1%，2012年为2.9%，2013年为3.0%。2012年复杂老年治疗模式产生了103次治疗，收入91.2万欧元，2013年有160次治疗，收入135万欧元。
针对老年患者的跨学科老年创伤治疗带来了可衡量的改善结果。实施复杂治疗的跨学科老年创伤护理对患者和医院均有益处。
