Kumpf Oliver, Nothacker Monika, Dubb Rolf, Kaltwasser Arnold, Brinkmann Alexander, Greim Clemens-A, Wildenauer René
Anasthesiol Intensivmed Notfallmed Schmerzther. 2021 Jan;56(1):12-27. doi: 10.1055/a-1130-4950. Epub 2021 Jan 7.
Goal-oriented quality management in health care is an essential tool to provide good medical practice and treatment. It aims at a patient-centred case management with high transparency of structural and clinical process aspects, as well as patient outcome. An objective and comprehensive description of clinical care includes the use of quality indicators. However, the appliance of those indicators falls short, when the evaluation of quality is not followed by recommendations for improvement.As a highly specified area in health care provided in hospitals, intensive care medicine is characterized by complex interprofessional and multidisciplinary approaches. In addition, critical care units are an expensive resource. In order to provide an economic and yet high quality patient care, treatments should be evidence-based, and cost-drivers must be analysed for their effectiveness on patient-outcome.Various methods of quality assurance allow for a formative evaluation of intensive care units by peer reviews, including the use of quality indicators. This article focuses on peer review systems currently applied in German hospitals, and particularly describes quality indicators that have been established by DIVI (German Interdisciplinary Society of Intensive Care and Emergency Medicine). It also addresses the need for a professional dialogue between equal partners. This has to accompany each peer review that aims at an improvement in quality of critical patient care.
医疗保健中的目标导向质量管理是提供良好医疗实践和治疗的重要工具。它旨在以患者为中心进行病例管理,使结构和临床过程方面以及患者结局具有高度透明度。对临床护理的客观全面描述包括使用质量指标。然而,如果在质量评估之后没有改进建议,这些指标的应用就存在不足。作为医院提供的医疗保健中的一个高度专业化领域,重症医学的特点是跨专业和多学科的复杂方法。此外,重症监护病房是一种昂贵的资源。为了提供经济且高质量的患者护理,治疗应基于证据,并且必须分析成本驱动因素对患者结局的有效性。各种质量保证方法允许通过同行评审对重症监护病房进行形成性评估,包括使用质量指标。本文重点关注德国医院目前应用的同行评审系统,特别描述了由德国重症监护与急诊医学跨学科协会(DIVI)制定的质量指标。它还探讨了平等伙伴之间进行专业对话的必要性。这必须伴随旨在改善危重症患者护理质量的每次同行评审。