Waeschle Rm

The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability.

IntroductionThe purpose of this study was to assess the relation between glycaemic control and the severity of sepsis in a cohort of patients treated with intensive insulin therapy (IIT).MethodsIn a prospective, observational study, all patients in the intensive care unit (ICU) (n = 191) with sepsis, severe sepsis or septic shock were treated with IIT (target blood glucose (BG) level 80 to 140 mg/dl instead of strict normoglycaemia). BG values were analysed by calculating mean values, rate of BG values within different ranges, rate of patients experiencing BG values within different levels and standard deviation (SD) of BG values as an index of glycaemic variability.ResultsThe number of patients with hypoglycaemia and hyperglycaemia was highly dependent on the severity of sepsis (critical hypoglycaemia ≤ 40 mg/dl: sepsis: 2.1%, severe sepsis: 6.0%, septic shock: 11.5%, p = 0.1497; hyperglycaemia: >140 mg/dl: sepsis: 76.6%, severe sepsis: 88.0%, septic shock: 100%, p = 0.0006; >179 mg/dl: sepsis: 55.3%, severe sepsis: 73.5%, septic shock: 88.5%, p = 0.0005; >240 mg/dl: sepsis: 17.0%, severe sepsis: 48.2%, septic shock: 45.9%, p = 0.0011). Multivariate analyses showed a significant association of SD levels with critical hypoglycaemia especially for patients in septic shock (p = 0.0197). In addition, SD levels above 20 mg/dl were associated with a significantly higher mortality rate relative to those with SD levels below 20 mg/dl (24% versus 2.5%, p = 0.0195).ConclusionsPatients with severe sepsis and septic shock who were given IIT had a high risk of hypoglycaemia and hyperglycaemia. Among these patients even with a higher target BG level, IIT mandates an increased awareness of the occurrence of critical hypoglycaemia, which is related to the severity of the septic episode.

Hypoglycaemia and predisposing factors among clinical subgroups treated with intensive insulin therapy.

In previous studies, conflicting intensive insulin therapy (IIT) results have been observed, whereby IIT‐related mortality seems to be lower in specific clinical subgroups. The aim of this study was to assess differences in glycaemic control, the risk of critical hypoglycaemia (≤ 2.2 mmol/l), the associated predisposing factors, and the in‐hospital mortality in different clinical subgroups treated with IIT.

[Errors in medicine. Causes, impact and improvement measures to improve patient safety].

The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing information on dosage, pharmacological interactions, side effects and contraindications of medications.The major challenges for quality and risk management, for the heads of departments and the executive board is the implementation and support of the described actions and a sustained guidance of the staff involved in the modification management process. The global trigger tool is suitable for improving transparency and objectifying the frequency of medical errors.

End‐tidal control vs. manually controlled minimal‐flow anesthesia: a prospective comparative trial

To ensure safe general anesthesia, manually controlled anesthesia requires constant monitoring and numerous manual adjustments of the gas dosage, especially for low‐ and minimal‐flow anesthesia. Oxygen flow‐rate and administration of volatile anesthetics can also be controlled automatically by anesthesia machines using the end‐tidal control technique, which ensures constant end‐tidal concentrations of oxygen and anesthetic gas via feedback and continuous adjustment mechanisms. We investigated the hypothesis that end‐tidal control is superior to manually controlled minimal‐flow anesthesia (0.5 l/min).

Implementation of a rational standard of hygiene for preparation of operating rooms

ZusammenfassungHintergrundDie Anforderungen an deutsche Krankenhäuser hinsichtlich Sicherung der Versorgungsqualität bei gleichzeitiger Kosteneinsparung bzw. effizienter Ressourcennutzung sind hoch. Diese Anforderungen spielen besonders im Hochrisiko- und Hochkostenbereich Operationssaal (OP) mit den vielfältigen Prozessschritten eine zentrale Rolle. Die Saalzwischenreinigung trägt wesentlich zur Patientensicherheit bei und beansprucht sowohl zeitliche als auch personelle Ressourcen. Aufgrund nicht eindeutig definierter Vorgaben hinsichtlich Verantwortlichkeiten und notwendigem Ressourceneinsatz sowie verlängerter Prozesszeiten und erhöhter Personalbindung wurde der Hygienestandard zur Aufbereitung von OP-Sälen in mehreren Prozessschritten nach dem Plan-Do-Check-Act-Prinzip optimiert.MethodenIm Prozessschritt „Plan“ wurde 2012 der Ist-Zustand erfasst. Das nachfolgende „Do“ umfasste ein Expertensymposium mit externen Referenten, interdisziplinäre Konsensgespräche mit Aktualisierung des Hygienestandards und den Umsetzungsprozess. Dabei wurden die beteiligten Mitarbeiter aktiv in den Veränderungsprozess eingebunden. Zur Kontrolle „Check“ wurde der Durchdringungsgrad der Schulungs- und Informationsmaßnahmen sowie die Akzeptanz und Einhaltung des neuen Hygienestandards überprüft. Zur Qualitätskontrolle wurden die Raten positiver Abstriche, auffälliger Luftkeimzahlmessungen sowie postoperativer Wundinfektionen überprüft. Dabei fanden sich keine Hinweise auf eine verringerte Wirksamkeit des neuen Hygienestandards. Nach erfolgreicher Implementierung dieser Maßnahmen erfolgte 2014 ein weiterer Verbesserungszyklus („Act“), der durch eine Reduktion der Anzahl vorgegebener Reinigungs- und Desinfektionsprogramme für die Saalaufbereitung zu einer Vereinfachung des Hygienestandards führte.ErgebnisseDie beschriebenen Reorganisationsmaßnahmen führten zu einer umfassenden Verbindlichkeit des Hygienestandards durch eindeutige Vorgaben bezüglich der Verantwortlichkeiten, der Vorgehensweise und des Ressourceneinsatzes. Weiterhin konnten eine Vereinfachung der Reinigungs- und Desinfektionsprogramme sowie ein rationaler Personaleinsatz und verkürzte Prozesszeiten bei der Saalaufbereitung erreicht werden. Außerdem wurde das bestehende Konfliktpotenzial aufgrund mangelnden evidenzbasierten Wissens bei den Mitarbeitern reduziert.SchlussfolgerungDie vorliegende Projektbeschreibung kann anderen Krankenhäusern als Leitfaden für vergleichbare Veränderungsprozesse dienen.AbstractBackgroundThe assurance of high standards of care is a major requirement in German hospitals while cost reduction and efficient use of resources are mandatory. These requirements are particularly evident in the high-risk and cost-intensive operating theatre field with multiple process steps. The cleaning of operating rooms (OR) between surgical procedures is of major relevance for patient safety and requires time and human resources. The hygiene procedure plan for OR cleaning between operations at the university hospital in Göttingen was revised and optimized according to the plan-do-check-act principle due to not clearly defined specifications of responsibilities, use of resources, prolonged process times and increased staff engagement.MethodsThe current status was evaluated in 2012 as part of the first step “plan”. The subsequent step “do” included an expert symposium with external consultants, interdisciplinary consensus conferences with an actualization of the former hygiene procedure plan and the implementation process. All staff members involved were integrated into this management change process. The penetration rate of the training and information measures as well as the acceptance and compliance with the new hygiene procedure plan were reviewed within step “check”. The rates of positive swabs and air sampling as well as of postoperative wound infections were analyzed for quality control and no evidence for a reduced effectiveness of the new hygiene plan was found. After the successful implementation of these measures the next improvement cycle (“act”) was performed in 2014 which led to a simplification of the hygiene plan by reduction of the number of defined cleaning and disinfection programs for preparation of the OR.ResultsThe reorganization measures described led to a comprehensive commitment of the hygiene procedure plan by distinct specifications for responsibilities, for the course of action and for the use of resources. Furthermore, a simplification of the plan, a rational staff assignment and reduced process times were accomplished. Finally, potential conflicts due to an insufficient evidence-based knowledge of personnel was reduced.ConclusionThis present project description can be used by other hospitals as a guideline for similar changes in management processes.

Implementierung eines rationalen Hygienestandards zur Aufbereitung von Operationssälen@@@Implementation of a rational standard of hygiene for preparation of operating rooms

ZusammenfassungHintergrundDie Anforderungen an deutsche Krankenhäuser hinsichtlich Sicherung der Versorgungsqualität bei gleichzeitiger Kosteneinsparung bzw. effizienter Ressourcennutzung sind hoch. Diese Anforderungen spielen besonders im Hochrisiko- und Hochkostenbereich Operationssaal (OP) mit den vielfältigen Prozessschritten eine zentrale Rolle. Die Saalzwischenreinigung trägt wesentlich zur Patientensicherheit bei und beansprucht sowohl zeitliche als auch personelle Ressourcen. Aufgrund nicht eindeutig definierter Vorgaben hinsichtlich Verantwortlichkeiten und notwendigem Ressourceneinsatz sowie verlängerter Prozesszeiten und erhöhter Personalbindung wurde der Hygienestandard zur Aufbereitung von OP-Sälen in mehreren Prozessschritten nach dem Plan-Do-Check-Act-Prinzip optimiert.MethodenIm Prozessschritt „Plan“ wurde 2012 der Ist-Zustand erfasst. Das nachfolgende „Do“ umfasste ein Expertensymposium mit externen Referenten, interdisziplinäre Konsensgespräche mit Aktualisierung des Hygienestandards und den Umsetzungsprozess. Dabei wurden die beteiligten Mitarbeiter aktiv in den Veränderungsprozess eingebunden. Zur Kontrolle „Check“ wurde der Durchdringungsgrad der Schulungs- und Informationsmaßnahmen sowie die Akzeptanz und Einhaltung des neuen Hygienestandards überprüft. Zur Qualitätskontrolle wurden die Raten positiver Abstriche, auffälliger Luftkeimzahlmessungen sowie postoperativer Wundinfektionen überprüft. Dabei fanden sich keine Hinweise auf eine verringerte Wirksamkeit des neuen Hygienestandards. Nach erfolgreicher Implementierung dieser Maßnahmen erfolgte 2014 ein weiterer Verbesserungszyklus („Act“), der durch eine Reduktion der Anzahl vorgegebener Reinigungs- und Desinfektionsprogramme für die Saalaufbereitung zu einer Vereinfachung des Hygienestandards führte.ErgebnisseDie beschriebenen Reorganisationsmaßnahmen führten zu einer umfassenden Verbindlichkeit des Hygienestandards durch eindeutige Vorgaben bezüglich der Verantwortlichkeiten, der Vorgehensweise und des Ressourceneinsatzes. Weiterhin konnten eine Vereinfachung der Reinigungs- und Desinfektionsprogramme sowie ein rationaler Personaleinsatz und verkürzte Prozesszeiten bei der Saalaufbereitung erreicht werden. Außerdem wurde das bestehende Konfliktpotenzial aufgrund mangelnden evidenzbasierten Wissens bei den Mitarbeitern reduziert.SchlussfolgerungDie vorliegende Projektbeschreibung kann anderen Krankenhäusern als Leitfaden für vergleichbare Veränderungsprozesse dienen.AbstractBackgroundThe assurance of high standards of care is a major requirement in German hospitals while cost reduction and efficient use of resources are mandatory. These requirements are particularly evident in the high-risk and cost-intensive operating theatre field with multiple process steps. The cleaning of operating rooms (OR) between surgical procedures is of major relevance for patient safety and requires time and human resources. The hygiene procedure plan for OR cleaning between operations at the university hospital in Göttingen was revised and optimized according to the plan-do-check-act principle due to not clearly defined specifications of responsibilities, use of resources, prolonged process times and increased staff engagement.MethodsThe current status was evaluated in 2012 as part of the first step “plan”. The subsequent step “do” included an expert symposium with external consultants, interdisciplinary consensus conferences with an actualization of the former hygiene procedure plan and the implementation process. All staff members involved were integrated into this management change process. The penetration rate of the training and information measures as well as the acceptance and compliance with the new hygiene procedure plan were reviewed within step “check”. The rates of positive swabs and air sampling as well as of postoperative wound infections were analyzed for quality control and no evidence for a reduced effectiveness of the new hygiene plan was found. After the successful implementation of these measures the next improvement cycle (“act”) was performed in 2014 which led to a simplification of the hygiene plan by reduction of the number of defined cleaning and disinfection programs for preparation of the OR.ResultsThe reorganization measures described led to a comprehensive commitment of the hygiene procedure plan by distinct specifications for responsibilities, for the course of action and for the use of resources. Furthermore, a simplification of the plan, a rational staff assignment and reduced process times were accomplished. Finally, potential conflicts due to an insufficient evidence-based knowledge of personnel was reduced.ConclusionThis present project description can be used by other hospitals as a guideline for similar changes in management processes.

Fehler in der Medizin@@@Errors in medicine: Ursachen, Auswirkungen und Maßnahmen zur Verbesserung der Patientensicherheit@@@Causes, impact and improvement measures to improve patient safety

The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing information on dosage, pharmacological interactions, side effects and contraindications of medications.The major challenges for quality and risk management, for the heads of departments and the executive board is the implementation and support of the described actions and a sustained guidance of the staff involved in the modification management process. The global trigger tool is suitable for improving transparency and objectifying the frequency of medical errors.

[Advantages and disadvantages of different methods for the implementation and the support of standard operating procedures: From PDF files to an app- and webbased SOP management system].

BACKGROUND The quality assurance of care and patient safety, with increasing cost pressure and performance levels is of major importance in the high-risk and high cost area of the operating room (OR). Standard operating procedures (SOP) are an established tool for structuring and standardization of the clinical treatment pathways and show multiple benefits for quality assurance and process optimization. OBJECTIVES An internal project was initiated in the department of anesthesiology and a continuous improvement process was carried out to build up a comprehensive SOP library. MATERIAL AND METHODS In the first step the spectrum of procedures in anesthesiology was transferred to PDF-based SOPs. The further development to an app-based SOP library (Aesculapp) was due to the high resource expenditure for the administration and maintenance of the large PDF-based SOP collection and to deficits in the mobile availability. The next developmental stage, the SOP healthcare information assistant (SOPHIA) included a simplified and advanced update feature, an archive feature previously missing and notably the possibility to share the SOP library with other departments including the option to adapt each SOP to the individual situation. A survey of the personnel showed that the app-based allocation of SOPs (Aesculapp, SOPHIA) had a higher acceptance than the PDF-based developmental stage SOP form. CONCLUSION The SOP management system SOPHIA combines the benefits of the forerunner version Aesculapp with improved options for intradepartmental maintenance and administration of the SOPs and the possibility of an export and editing function for interinstitutional exchange of SOPs.ZusammenfassungHintergrundDie Sicherung von Versorgungsqualität und Patientensicherheit hat bei zunehmendem Kostendruck und Leistungsverdichtung eine besondere Bedeutung im Hochrisiko- und Hochkostenbereich OP. Zur Strukturierung und zur Standardisierung der Versorgungspfade haben sich Standard Operating Procedures (SOP) etabliert und zeigen einen vielfältigen Nutzen bei der Qualitätssicherung und Prozessoptimierung.Ziel der ArbeitZum Aufbau einer umfassenden SOP-Sammlung in der Anästhesiologie wurde ein abteilungsinternes Projekt initiiert und im Sinne eines kontinuierlichen Verbesserungsprozesses durchgeführt.Material und MethodenIm ersten Schritt wurde das Leistungsspektrum der Klinik über PDF-basierte SOP abgebildet. Aufgrund des hohen Ressourcenaufwands bei der Verwaltung und Pflege dieser umfangreichen SOP-Bibliothek sowie Defiziten in der mobilen Verfügbarkeit erfolgte die Weiterentwicklung zu einer App-gestützten SOP-Sammlung (Aesculapp). In der folgenden Entwicklungsstufe, dem SOP Healthcare Information Assistent (SOPHIA), wurde die Aktualisierungsfunktion weiter vereinfacht, eine bislang fehlende Archivierungsfunktion eingeführt und insbesondere die Möglichkeit geschaffen, die SOP-Sammlung anderen Abteilungen über einen Bearbeitungsmodus adaptierbar zur Verfügung zu stellen.Eine Mitarbeiterbefragung zeigte, dass die App-gestützte Bereitstellung von SOP (Aesculapp, SOPHIA) eine höhere Akzeptanz als die PDF-basierte SOP-Entwicklungsstufe aufwies.SchlussfolgerungDas SOP-Management-System SOPHIA kombiniert die Vorteile der Vorversion Aesculapp mit verbesserten Möglichkeiten in der abteilungsinternen Pflege und Verwaltung der SOP sowie der Option einer Export- und Editierfunktion zum einrichtungsübergreifenden SOP-Austausch.AbstractBackgroundThe quality assurance of care and patient safety, with increasing cost pressure and performance levels is of major importance in the high-risk and high cost area of the operating room (OR). Standard operating procedures (SOP) are an established tool for structuring and standardization of the clinical treatment pathways and show multiple benefits for quality assurance and process optimization.ObjectivesAn internal project was initiated in the department of anesthesiology and a continuous improvement process was carried out to build up a comprehensive SOP library.Material and methodsIn the first step the spectrum of procedures in anesthesiology was transferred to PDF-based SOPs. The further development to an app-based SOP library (Aesculapp) was due to the high resource expenditure for the administration and maintenance of the large PDF-based SOP collection and to deficits in the mobile availability. The next developmental stage, the SOP healthcare information assistant (SOPHIA) included a simplified and advanced update feature, an archive feature previously missing and notably the possibility to share the SOP library with other departments including the option to adapt each SOP to the individual situation.A survey of the personnel showed that the app-based allocation of SOPs (Aesculapp, SOPHIA) had a higher acceptance than the PDF-based developmental stage SOP form.ConclusionThe SOP management system SOPHIA combines the benefits of the forerunner version Aesculapp with improved options for intradepartmental maintenance and administration of the SOPs and the possibility of an export and editing function for interinstitutional exchange of SOPs.

Vor- und Nachteile verschiedener Techniken zur Bereitstellung und Pflege von Standard Operating Procedures@@@Advantages and disadvantages of different methods for the implementation and the support of standard operating procedures: Von der PDF-Datei zum App- und webbasierten SOP-Management-System@@@From PDF files to an app- and webbased SOP management system

BACKGROUND The quality assurance of care and patient safety, with increasing cost pressure and performance levels is of major importance in the high-risk and high cost area of the operating room (OR). Standard operating procedures (SOP) are an established tool for structuring and standardization of the clinical treatment pathways and show multiple benefits for quality assurance and process optimization. OBJECTIVES An internal project was initiated in the department of anesthesiology and a continuous improvement process was carried out to build up a comprehensive SOP library. MATERIAL AND METHODS In the first step the spectrum of procedures in anesthesiology was transferred to PDF-based SOPs. The further development to an app-based SOP library (Aesculapp) was due to the high resource expenditure for the administration and maintenance of the large PDF-based SOP collection and to deficits in the mobile availability. The next developmental stage, the SOP healthcare information assistant (SOPHIA) included a simplified and advanced update feature, an archive feature previously missing and notably the possibility to share the SOP library with other departments including the option to adapt each SOP to the individual situation. A survey of the personnel showed that the app-based allocation of SOPs (Aesculapp, SOPHIA) had a higher acceptance than the PDF-based developmental stage SOP form. CONCLUSION The SOP management system SOPHIA combines the benefits of the forerunner version Aesculapp with improved options for intradepartmental maintenance and administration of the SOPs and the possibility of an export and editing function for interinstitutional exchange of SOPs.ZusammenfassungHintergrundDie Sicherung von Versorgungsqualität und Patientensicherheit hat bei zunehmendem Kostendruck und Leistungsverdichtung eine besondere Bedeutung im Hochrisiko- und Hochkostenbereich OP. Zur Strukturierung und zur Standardisierung der Versorgungspfade haben sich Standard Operating Procedures (SOP) etabliert und zeigen einen vielfältigen Nutzen bei der Qualitätssicherung und Prozessoptimierung.Ziel der ArbeitZum Aufbau einer umfassenden SOP-Sammlung in der Anästhesiologie wurde ein abteilungsinternes Projekt initiiert und im Sinne eines kontinuierlichen Verbesserungsprozesses durchgeführt.Material und MethodenIm ersten Schritt wurde das Leistungsspektrum der Klinik über PDF-basierte SOP abgebildet. Aufgrund des hohen Ressourcenaufwands bei der Verwaltung und Pflege dieser umfangreichen SOP-Bibliothek sowie Defiziten in der mobilen Verfügbarkeit erfolgte die Weiterentwicklung zu einer App-gestützten SOP-Sammlung (Aesculapp). In der folgenden Entwicklungsstufe, dem SOP Healthcare Information Assistent (SOPHIA), wurde die Aktualisierungsfunktion weiter vereinfacht, eine bislang fehlende Archivierungsfunktion eingeführt und insbesondere die Möglichkeit geschaffen, die SOP-Sammlung anderen Abteilungen über einen Bearbeitungsmodus adaptierbar zur Verfügung zu stellen.Eine Mitarbeiterbefragung zeigte, dass die App-gestützte Bereitstellung von SOP (Aesculapp, SOPHIA) eine höhere Akzeptanz als die PDF-basierte SOP-Entwicklungsstufe aufwies.SchlussfolgerungDas SOP-Management-System SOPHIA kombiniert die Vorteile der Vorversion Aesculapp mit verbesserten Möglichkeiten in der abteilungsinternen Pflege und Verwaltung der SOP sowie der Option einer Export- und Editierfunktion zum einrichtungsübergreifenden SOP-Austausch.AbstractBackgroundThe quality assurance of care and patient safety, with increasing cost pressure and performance levels is of major importance in the high-risk and high cost area of the operating room (OR). Standard operating procedures (SOP) are an established tool for structuring and standardization of the clinical treatment pathways and show multiple benefits for quality assurance and process optimization.ObjectivesAn internal project was initiated in the department of anesthesiology and a continuous improvement process was carried out to build up a comprehensive SOP library.Material and methodsIn the first step the spectrum of procedures in anesthesiology was transferred to PDF-based SOPs. The further development to an app-based SOP library (Aesculapp) was due to the high resource expenditure for the administration and maintenance of the large PDF-based SOP collection and to deficits in the mobile availability. The next developmental stage, the SOP healthcare information assistant (SOPHIA) included a simplified and advanced update feature, an archive feature previously missing and notably the possibility to share the SOP library with other departments including the option to adapt each SOP to the individual situation.A survey of the personnel showed that the app-based allocation of SOPs (Aesculapp, SOPHIA) had a higher acceptance than the PDF-based developmental stage SOP form.ConclusionThe SOP management system SOPHIA combines the benefits of the forerunner version Aesculapp with improved options for intradepartmental maintenance and administration of the SOPs and the possibility of an export and editing function for interinstitutional exchange of SOPs.

Perioperatives Wärmemanagement in Abhängigkeit von der Krankenhausgröße in Deutschland@@@Perioperative thermal management in Germany varies depending on the hospital size

BACKGROUND Improvement of quality of care and patient safety while decreasing costs are major challenges in healthcare systems. This challenge includes the avoidance of perioperative hypothermia to reduce the associated adverse effects, length of stay and treatment costs. Due to the medical and economic relevance the national S3 guidelines for the prevention of perioperative hypothermia were recently published. AIM This study presents and analyses the reality of utilization of thermal management in German hospitals depending on the size of the hospital, which is based on the number of beds. MATERIAL AND METHODS Based on the data of an online survey among all members of the German Society of Anesthesiology and Intensive Care Medicine about perioperative thermal management, a subgroup analysis differentiating between the size of hospitals was performed. The survey included questions about the structural and organizational conditions, the practical implementation of temperature measurement and warming therapy and the developmental status of clinical standard operating procedures (SOP) and educational training. RESULTS Comparing the structural quality, major differences were found with respect to the availability of core body temperature measurement and the provision of warming devices especially at different peripheral anesthesia workplaces as well as the existence of SOPs and educational training. The availability increased with hospital size. With respect to process quality, the frequency of prewarming increased with hospital size as well as the frequency of intraoperative temperature measurements during different anesthesia procedures. CONCLUSION Major differences were found in several aspects of perioperative thermal management depending on the hospital size. The main potential for improvement was found in smaller hospitals. Developmental needs primarily exist in the configuration of peripheral anesthesia workplaces, educational training, implementation of SOPs and prewarming of patients.