Unakzeptabel hohe Letalitätsrate bei Myokardinfarktpatienten: Was tun? Der Beitrag eines integrierten Qualitätsmanagement-Ansatzes. Eine Fallstudie aus der Schweiz.

 

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Zusammenfassung

Ein integriertes Qualitätsmanagement kann ein Klinikum maßgeblich darin unterstützen, seine Mortalitätsraten auch im Kontext zunehmender Spezialisierung und fragmentierter Behandlungsprozesse zu senken. Am Beispiel des akuten Myokardinfarktes wird nachstehend gezeigt, wie mit einem Set von Interventionen (EKG-Übertragung auf Smartphones, Prozessanalysen/Prozessoptimierungen, Round Tables, Kulturentwicklung, Zertifizierung) die Myokardinfarkt-Letalität von 7,4 % auf 3,4 % gesenkt werden konnte (p = 0,02). Die einzelnen Maßnahmen werden beschrieben und die zentrale Bedeutung des Qualitätsmanagements für diesen Prozess analysiert.

Abstract

Confronted with bad outcome data, not only management attention is needed but also a clear plan of actions. Due to subspecialisation, cure and care processes in modern hospitals are fragmented with a lot of hand overs and interfaces. The processes and measures to improve an unacceptable high mortality rate for acute myocardial infarction are explained. Using several process changes (e. g. transferring the patient’s ECG tracing to the cardiologist’s smart phone, implementing process changes to shorten the door to needle time for cath-lab interventions, round tables, fulfilling the criteria’s of certification agency) the in-house mortality rate was lowered from the unacceptable high value of 7.4 % to 3.4 % for acute myocardial infarction (p = 0.02). A detailed discussion of the several steps is provided and the central role of quality management for this process is assessed.

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