Wildenauer René, Hamsen Uwe
, Mainstockheim, Deutschland.
Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland.
Chirurgie (Heidelb). 2025 Jun 19. doi: 10.1007/s00104-025-02320-0.
Intensive care medicine in Germany has fundamentally developed in the context of medical progress and changed treatment requirements. Originally preceded by pioneer work in surgery, intensive medical care facilities are nowadays decisive cost drivers in patient care. Earlier models from around the 1930s were replaced by specialization and interdisciplinary cooperation. Against this background the present study investigated the current state of care, the structures for continuing education and the implementation of surgical intensive and intermediate care (IMC) wards.
Between 27 February 2023 and 8 May 2023, a representative sample of 1106 intensive care wards was pooled using an anonymous online survey on a German web server (lamapoli.de) and 181 complete replies could be evaluated. The survey incorporated 42 questions, which in addition to the demographic acquisition also requested data on the resources, leadership and continuing education modalities of personnel on independent surgical intensive care wards as well as interdisciplinary surgical intensive care wards (IOI) and IMCs.
Approximately 17% of the hospitals surveyed had their own surgical intensive care ward, predominantly in university hospitals. These units are characterized by a high presence of the specialist discipline and qualified personnel with additional qualifications in intensive care medicine. In contrast, interdisciplinary intensive care wards were used in facilities with a lower level of care, frequently managed by anesthesiology departments. The continuing education times for assistant surgeons were in most cases longer than 6 months, which promotes an intensive transfer of knowledge and interdisciplinary cooperation. The IMC wards are also an integral component of surgical care even though they are personnel intensive and more economically challenging. The study shows that surgical intensive care medicine has a well-structured, discipline-specific care and training, especially at university locations. In facilities with lower levels of care interdisciplinary models dominate, which also enable an adequate training. Nevertheless, the debate on the retention of discipline-specific knowledge in intensive care medicine remains a current topic in order to ensure a high quality of perioperative care.
德国的重症医学在医学进步和不断变化的治疗需求背景下有了根本性的发展。重症医疗设施最初是在外科先驱工作的基础上发展起来的，如今已成为患者护理中决定性的成本驱动因素。20世纪30年代左右的早期模式已被专业化和跨学科合作所取代。在此背景下，本研究调查了护理现状、继续教育结构以及外科重症和中级护理（IMC）病房的实施情况。
2023年2月27日至2023年5月8日，通过在德国网络服务器（lamapoli.de）上进行的匿名在线调查，收集了1106个重症监护病房的代表性样本，共获得181份完整回复并进行评估。该调查包含42个问题，除了收集人口统计学信息外，还要求提供独立外科重症监护病房、跨学科外科重症监护病房（IOI）和IMC的人员资源、领导情况和继续教育方式的数据。
约17%的受访医院设有自己的外科重症监护病房，主要分布在大学医院。这些病房的特点是专科和具备重症医学额外资质的合格人员比例较高。相比之下，护理水平较低的机构使用跨学科重症监护病房，通常由麻醉科管理。大多数情况下，助理外科医生的继续教育时间超过6个月，这促进了知识的密集传授和跨学科合作。IMC病房也是外科护理的一个组成部分，尽管它们人员密集且经济上更具挑战性。研究表明，外科重症医学拥有结构完善、特定学科的护理和培训体系，尤其是在大学医院。在护理水平较低的机构中，跨学科模式占主导，这也能提供充分的培训。然而，为确保围手术期护理的高质量，关于在重症医学中保留特定学科知识的争论仍是当前的一个话题。
