Breuckmann Frank, Nabavi Darius G, Post Felix, Grau Armin J, Giannitsis Evangelos, Hochadel Matthias, Senges Jochen, Busse Otto, Münzel Thomas
Medizinische Klinik I, Herz-Jesu-Krankenhaus Dernbach, Südring 8, 56428, Dernbach, Deutschland.
Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Deutschland.
Herz. 2021 Sep;46(Suppl 2):141-150. doi: 10.1007/s00059-020-04984-2. Epub 2020 Sep 29.
Chest pain units (CPU) and stroke units (SU) have both become established as essential components of clinical emergency care. For both instances dedicated certification processes are installed. Up to summer 2020, 290 CPUs and 335 SUs have been successfully certified.
The aim of this review is to compare the structures and the current certification situation of CPUs and SUs. Also, the younger CPU certification process is compared to the long established SU certification standard.
The comparison includes the historical background, the certification process, quality benchmarking, possible additive structures, the current status of certification in Germany, the transfer of the concept to the European level as well as reimbursement issues.
Both certification concepts show clear analogies. Evidence for SUs is supported by a positive Cochrane analysis and for CPUs there are many studies from the German CPU registry. The main differences include a uniform CPU system versus a multistep SU system of certification. Furthermore, SU have obligatory elements of quality documentation but only facultative quality indicator assessment for CPUs. From an economic viewpoint operation and procedural key (OPS) numbers guarantee a better reflection of the use of resources in the complex treatment of stroke, which could not yet be established for CPUs.
The well-established CPU concept could additionally benefit from a superordinate quality control. Adequate quality benchmarking appears to be fundamental for gap analyses and for the establishment of a separate remuneration structure. In this respect the German Society for Cardiology as the certifying institution is required to establish an appropriate mechanism within the framework of regular updates of criteria.
胸痛单元（CPU）和卒中单元（SU）已成为临床急诊护理的重要组成部分。针对这两种情况都设立了专门的认证程序。截至2020年夏季，已有290个CPU和335个SU成功获得认证。
本综述的目的是比较CPU和SU的结构以及当前的认证情况。此外，还将较新的CPU认证流程与已确立的SU认证标准进行比较。
比较内容包括历史背景、认证流程、质量基准、可能的附加结构、德国的认证现状、该概念向欧洲层面的转化以及报销问题。
两种认证概念有明显的相似之处。SU的证据得到了Cochrane的积极分析支持，而CPU则有来自德国CPU登记处的许多研究。主要差异包括统一的CPU系统与多步骤的SU认证系统。此外，SU有强制性的质量文件要素，而CPU只有可选的质量指标评估。从经济角度看，手术与操作编码（OPS）编号能更好地反映卒中复杂治疗中的资源使用情况，而这一点在CPU中尚未确立。
已确立的CPU概念可能会从上级质量控制中额外受益。充分的质量基准对于差距分析和建立单独的薪酬结构似乎至关重要。在这方面，作为认证机构的德国心脏病学会需要在标准定期更新的框架内建立适当的机制。
