Walter Schaffartzik

Wettbewerb zwischen Krankenhäusern – aus Sicht des ärztlichen Leiters

On the basis of a model calculation the Federal Statistical Office--despite a decreasing overall population--predicts a rise in the number of patients requiring inpatient healthcare of approximately 12% because of the ageing of our society. The comparative publication of data about the range, the character, the quality and the success of medical treatment allows more transparency of the medical achievements of a hospital, and the patients have learned to expect a high quality of medical treatment and its outcomes. Therefore hospitals have to find ways to present themselves to the patient as a suitable and desirable institution. In the inter-hospital competition for patients an individual hospital can only be successful by recruiting excellent professional (both medical and nursing) staff. Hospitals seeking to secure their existence will have to develop strategies that allow them to succeed in the competition for patients and staff. This includes a verifiably high quality of their medical treatment while striving for an efficient way of managing the costs. At the same time a realistic approach to the recruitment and motivation of the medical staff is essential, which is especially true of physicians.

Anästhesiezwischenfälle – Atemwegsmanagement und Schäden in der Anästhesie – „closed claims“ der Norddeutschen Schlichtungsstelle

Injuries related to the airway management belong to the most often observed anaesthesia-related complications. Injuries of the trachea and the oesophagus possibly require surgical treatment. The most severe injuries caused by the airway management are the hypoxic brain damage and the patients death. Tracheal injuries happen foremost as a result of tracheal intubation. Symptoms like subcutaneous emphysema and dyspnea are likely a sign of a tracheal lesion and need to be examined by Thorax-CT and endoscopy of the airways. In order to avoid injuries, medical treatment has to be applied with the appropriate care and strict adherence to the manufacturers requirements regarding the use of the assisting devices necessary for the tracheal intubation. While some of he cases presented have to be assessed as of fateful origin, others are clearly the results of medical errors.

Schwerpunkt IIIWettbewerb zwischen Krankenhäusern – aus Sicht des ärztlichen LeitersInter-hospital competition – from a medical director's perspective

On the basis of a model calculation the Federal Statistical Office--despite a decreasing overall population--predicts a rise in the number of patients requiring inpatient healthcare of approximately 12% because of the ageing of our society. The comparative publication of data about the range, the character, the quality and the success of medical treatment allows more transparency of the medical achievements of a hospital, and the patients have learned to expect a high quality of medical treatment and its outcomes. Therefore hospitals have to find ways to present themselves to the patient as a suitable and desirable institution. In the inter-hospital competition for patients an individual hospital can only be successful by recruiting excellent professional (both medical and nursing) staff. Hospitals seeking to secure their existence will have to develop strategies that allow them to succeed in the competition for patients and staff. This includes a verifiably high quality of their medical treatment while striving for an efficient way of managing the costs. At the same time a realistic approach to the recruitment and motivation of the medical staff is essential, which is especially true of physicians.

Gutachtenfälle – Juristische Besonderheiten bei der Begutachtung anästhesiologischer Fälle der Norddeutschen Schlichtungsstelle

Die Schlichtungsstelle fur Arzthaftpflichtfragen der norddeutschen Arztekammern Hannover (Norddeutsche Schlichtungsstelle) fuhrt im Gebiet Anasthesiologie etwa 100 Verfahren im Jahr durch. In Arzthaftpflichtverfahren liegt die Beweislast grundsatzlich auf der Patientenseite: Der Patient muss beweisen, dass der von ihm geklagte Gesundheitsschaden durch einen Behandlungsfehler verursacht worden ist. Allerdings kann unter bestimmten Voraussetzungen eine Beweislasterleichterung zugunsten der Patientenseite eintreten. In diesem Artikel werden beispielhaft Entscheidungen der Norddeutschen Schlichtungsstelle vorgestellt, bei denen Beweislasterleichterungen zur Feststellung eines Schadensersatzanspruchs fuhrten.

Qualität anästhesiologischer Gutachten bei medizinischen Schadensfällen@@@Quality of anesthesiological expert opinion in medical claims cases

Expert opinions have an important place for expert testimony in medical disputes. The report should contain a summary about facts and causality between the damage and the medical treatment in question as well as describe the current medical standard. The fulfillment of scientific criteria was investigated in 179 anesthesiological expert opinions from 150 arbitration cases. Anesthesiological expert reports (2005-2007) of the Arbitration Board of the North German Medical Associations were analyzed in terms of structure, general form of assessment and scientific substantiation of statements. Patient damage was confirmed in 76%, treatment failure in 29% and negligent malpractice in 17% of the reports. In 78% of the reports the facts were presented correctly and in 64% the question was answered whether the incident would have occurred even during adequate and professional action. Conclusive statements about the causality between the damage and the medical treatment in question were available only in 60% of the reports. The study findings suggest that anesthesia expert reports present a high incidence of non-scientific claims. The development of guidelines for expert witnesses by the medical societies is urgently recommended.

Quality of anesthesiological expert opinion in medical claims cases

Expert opinions have an important place for expert testimony in medical disputes. The report should contain a summary about facts and causality between the damage and the medical treatment in question as well as describe the current medical standard. The fulfillment of scientific criteria was investigated in 179 anesthesiological expert opinions from 150 arbitration cases. Anesthesiological expert reports (2005-2007) of the Arbitration Board of the North German Medical Associations were analyzed in terms of structure, general form of assessment and scientific substantiation of statements. Patient damage was confirmed in 76%, treatment failure in 29% and negligent malpractice in 17% of the reports. In 78% of the reports the facts were presented correctly and in 64% the question was answered whether the incident would have occurred even during adequate and professional action. Conclusive statements about the causality between the damage and the medical treatment in question were available only in 60% of the reports. The study findings suggest that anesthesia expert reports present a high incidence of non-scientific claims. The development of guidelines for expert witnesses by the medical societies is urgently recommended.

Qualität anästhesiologischer Gutachten bei medizinischen Schadensfällen

Expert opinions have an important place for expert testimony in medical disputes. The report should contain a summary about facts and causality between the damage and the medical treatment in question as well as describe the current medical standard. The fulfillment of scientific criteria was investigated in 179 anesthesiological expert opinions from 150 arbitration cases. Anesthesiological expert reports (2005-2007) of the Arbitration Board of the North German Medical Associations were analyzed in terms of structure, general form of assessment and scientific substantiation of statements. Patient damage was confirmed in 76%, treatment failure in 29% and negligent malpractice in 17% of the reports. In 78% of the reports the facts were presented correctly and in 64% the question was answered whether the incident would have occurred even during adequate and professional action. Conclusive statements about the causality between the damage and the medical treatment in question were available only in 60% of the reports. The study findings suggest that anesthesia expert reports present a high incidence of non-scientific claims. The development of guidelines for expert witnesses by the medical societies is urgently recommended.

Zahnschäden in der Anästhesiologie – Risikogruppen und Haftungsfragen

Dental injury is one of the most anaesthesia-related complications. It can cause a patients functional, esthetic, financial, and emotional annoyance. The incidence of dental injury is said to range from 1:6000 to 1:1000. The upper incisors are by far the most often injured teeth. Removable dentures should be taken out prior to anaesthesia. A tooth guard can be used as a prophylactic measure. However, with that tracheal intubation can be complicated because of the reduced view at the epiglottis and the vocal cords. If a dental injury occurred, the patient should be seen by a dentist as soon as possible to undergo appropriate treatment with no delay.Dental injury is one of the most anaesthesia-related complications. It can cause a patients functional, esthetic, financial, and emotional annoyance. The incidence of dental injury is said to range from 1:6000 to 1:1000. The upper incisors are by far the most often injured teeth. Removable dentures should be taken out prior to anaesthesia. A tooth guard can be used as a prophylactic measure. However, with that tracheal intubation can be complicated because of the reduced view at the epiglottis and the vocal cords. If a dental injury occurred, the patient should be seen by a dentist as soon as possible to undergo appropriate treatment with no delay.