Der IT-gestützte Behandlungspfad als Routinearbeitsinstrument in der Unfallchirurgie

Homagk, L.; Deml, O.; Hofmann, Gunther O.

doi:10.1007/s00113-011-1996-8

Cited by 10 publications

(11 citation statements)

References 18 publications

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“…This allows about half of the paralyzed patients to expect an improvement of the initial symptoms [20]. The therapy is according to standardized treatment approach followed a clinical pathway is recommended [18,19].…”

Section: Discussionmentioning

confidence: 99%

Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis

Homagk

Klauss

et al. 2015

Eur Spine J

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The main localization of spondylodiscitis was the lumbar spine (55%) followed by the thoracic spine (34%). The classification of patients into 3 grades of severity depends on clinical and laboratory parameters, the morphological vertebral destruction seen in radiological examinations and the current neurological status. Therapies are adapted according to severity and they include a specific surgical management, systemic antibiotic therapy according to culture and sensitivity tests, physiotherapy and initiation of post-hospital follow-up. 40.6% of patients are associated with neurological deficits, classified as severity grade 3 and treated surgically with spinal stabilization and decompression. 46.9% of patients corresponded to severity grade 2, with concomitant vertebral destruction were dorsoventrally stabilized. The 31 patients of severity Grade 1 were treated surgically with dorsal stabilization. From 1998 to 2013, the time from the onset of symptoms to the first surgical treatment was about 69.4 days and has not changed significantly. However, the time from admission to surgical treatment had been reduced to less than 2 days. Also the time of hospitalization was reduced and we see positive effects regarding the sensation of pain. 270 patients underwent surgery. We treated 89% dorsally and 21% dorsoventrally. With the spondylodiscitis severity code, a classification of the severity of spondylodiscitis could be established and used for a severity-based treatment. In addition, specific parameters for the treatment of individual grades of severity can be determined in a clinical pathway.

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Section: Discussionmentioning

confidence: 99%

Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis

Homagk

Klauss

et al. 2015

Eur Spine J

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“…The spondylodiscitis pathway was electronically translated into the IT-system, which allows intern workstations data-protected access. [6] The practical application of the clinical pathway starts with admission of the patient. It then shows which work steps are completed and which are still to be carried out by whom (see Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…[5] In our hospital of maximum care, information technology (IT)supported clinical pathways have been established since 2009 for numerous surgical, traumatological and endoprothetic treatments, with a focus on optimising processes and documentation. [6] Spondylodiscitis, an infectious disease of the vertebral bodies, intervertebral discs and adjacent structures, occurs in one out of 125,000 people, and three times more often in men than in women. The spectrum of the infectious agent is broad, but there is a predominance of Staphylococcus aureus.…”

Section: Introductionmentioning

confidence: 99%

Advantages of IT-based clinical pathways in surgical treatment of non-specific spondylodiscitis

Homagk

Jarmuzek

Meisel

et al. 2016

JHA

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Objective: The German health care system increasingly incorporates clinical pathways as a tool to organize surgical, intervention or conservative therapies. Does a computerized clinical pathway offer advantages in severity-based surgical therapy of spondylodiscitis?Methods: A hospital has adopted a computerized system based on three severity grades of spondylodiscitis. From 01/01/2012 to 12/31/2013, 32 patients with spondylodiscitis were randomly chosen at admission and prospectively analysed with regard to duration, costs of treatment, pain level and inflammatory markers.Results: Of the 32 patients treated for spondylodiscitis who had not been transferred from another facility, 17 (53%) were treated according to a clinical pathway based on three well-established treatment regimens dependent on severity. The SponDT, as a parameter for the course of disease, was initially slightly higher in the pathway patient’s group (6.82) than in the control group (6.2). Compared to a control group (n = 15) there were differences in the total duration of stay (17.2 vs. 26.0) and the number of blood samples taken (7 vs. 10). No differences could be shown for the extent of documentation, the physical and neurological outcome, the level of pain and or the course of inflammatory markers. The most prevalent germ was Staphylococcus aureus (18.8%). In 43.8% of the patients, no infectious agent could be detected. Material costs and personnel-costs were significantly reduced in the pathway group (12,076 €) compared to 21,341 € in the control group.Conclusions: An IT-based clinical pathway is preferable for surgical therapy of spondylodiscitis based on three grades of severity and offers various advantages as a clinical and administrative regulative mechanism. The cost-effective treatment particularly stands out.

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“…Der elektronisch basierte Behandlungspfad zur Behandlung der Spondylodiszitis ist als Routineprozess im KIS einzusetzen und als umfassendes klinisch-administratives Steuerungsinstrument anzusehen. Es zeigten sich durch die Standardisierung wichtiger Behandlungsschritte eine signifikante Steigerung der Qualität und Dokumentationshäufigkeit relevanter Behandlungsschritte [35]. Der SponDT kann sowohl in der Diagnostik einer Spondylodiszitis als auch zur Verlaufskontrolle eingesetzt werden und lässt sich gemeinsam mit dem SSC in einem elektronischen Behandlungspfad abbilden.…”

Section: Diskussionunclassified

“…2). Damit stehen dem Behandler Diagnose-und Therapietools der Spondylodiszitis zur Verfügung, die sich ferner in einem elektronischen Behandlungspfad implementieren lassen.Diese Integrierung von Behandlungsalgorithmen in das Krankenhausinformationssystem (KIS) führt zu einer Verbesserung der Behandlungsqualität und Dokumentation[35,36]. Ziel dieser Arbeit ist die Implementierung einer schweregradbasierten Spondylodiszitistherapie anhand des bereits etablierten Spondylodiscitis Severity Codes (SSC) sowie des Spondylodiszitis-Scoring-Systems SponDT in einem elektronisch basierten Behandlungspfad.Material und MethodenIm Rahmen der Reevaluierungen erfolgte eine regelmäßige Anpassung der Schweregradeinteilung.…”

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Die schweregradorientierte Therapie der Spondylodiszitis – eine prospektive Betrachtung anhand von elektronisch basierten Behandlungspfaden

et al. 2017

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Spondylodiscitis is a rare but serious infection of the spine. Recognised methods of treatment include immobilisation and systemic antibiotics. However, available data for specific and recommendations for continuing treatment are also rare. The aim of the present study is the optimisation of the therapy of spondylodiscitis using a clinical pathway that depends on a classification of spondylodiscitis. From 1 October 1998 to 31 December 2013, a classification of the severity of spondylodiscitis was established, including specific treatment recommendations. As part of the re-evaluation, the classification of severity was adapted. On this basis, electronically based clinical pathways were developed. A total of 296 cases were included. With a steadily increasing number of treatments, the mean age of the patients increased to 67.3 years. In 34.3% of these patients, spondylodiscitis developed spontaneously and 68.6% of patients did not receive treatment until the diagnosis. In the context of the specific treatment, pain intensity decreased from 6.0 to 3.1 NRS (numeric rating scale). The inflammatory values (CRP) decreased from 119.2 to 46.7 mg/dl. The time from the onset of symptoms to the surgical treatment was almost 65.6 days and has not changed significantly. Nevertheless, the time from admission to surgical treatment could be reduced to less than 3 days. The classification of patients into 3 degrees of severity of spondylodiscitis (SSC) depends on the SponDT: spondylodiscitis diagnosis and treatment. The SponDT describes vertebral destruction and the current neurological status. The severity-adapted therapy was mapped electronically and includes specific surgical care, systemic antibiotic therapy and physical therapy.

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Der IT-gestützte Behandlungspfad als Routinearbeitsinstrument in der Unfallchirurgie

Cited by 10 publications

References 18 publications

Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis

Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis

Advantages of IT-based clinical pathways in surgical treatment of non-specific spondylodiscitis

Die schweregradorientierte Therapie der Spondylodiszitis – eine prospektive Betrachtung anhand von elektronisch basierten Behandlungspfaden

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