Zusammenfassung

     Zusammenfassung Zielsetzung In deutschen Krankenhäusern binden schlecht abgestimmte Prozesse Ressourcen und münden in Versorgungsengpässen. Negative Auswirkungen dessen und Verbesserungsmöglichkeiten sollen aufgezeigt werden. Methodik Deskriptive systematische Literaturanalyse (Jhg. 2003–2020) in den Datenbanken PubMed und EBSCOhost. Ergebnisse Von 860 Publikationen wurden 54 eingeschlossen. Lean-Management, Normalization Theory und Model for Improvement wurden beschrieben. Bedeutung eines Multi-Stakeholder Ansatzes wurde ausgeführt. Schlussfolgerung Holistische Prozessoptimierungen können zunehmende Versorgungsengpässe abmildern. Früh sollten strategische in operative Ziele übersetzt und messbar gemacht werden. Innerklinische Projektbüros sollten Prozessimplementierungen begleiten und die Ausrichtung an Patientenversorgungs- und ökonomischen Aspekten im interdisziplinären Kontext steuern. Abstract Aim In German hospitals, poorly coordinated processes tie up resources and result in care bottlenecks. Negative effects of this and possibilities for improvement should be highlighted. Method Descriptive systematic literature review (yr 2003–2020) in PubMed and EBSCOhost databases. Results Out of 860 publications, 54 were included. Lean Management, Normalization Theory and Model for Improvement were primarily described. Importance of a multi-stakeholder approach was elaborated. Conclusion Holistic process optimization can help to reduce increasing care bottlenecks. Early on, strategic goals should be translated into operational goals and being made measurable. In-house project offices should support process implementations and manage the alignment of patient care and economic aspects in an interdisciplinary context. Schlüsselwörter Versorgungsengpässe - Prozesssynchronisation - Ressourcenallokation - Patientenflusssteuerung Key words Care bottlenecks - process synchronization - resource allocation - patient-flow management Zusatzmaterial Zusätzliches Material finden Sie unter https://doi.org/10.1055/a-1676-1160 Supplementary material 13 December 2021 © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Literaturverzeichnis 1 Rutherford PA, Provost LP, Kotagal UR. et al. Achieving Hospital-wide Patient-Flow. The Right Care, in the Right Place, at the Right Time. 2017. Institute for Healthcare Improvement; Google Scholar 2 Icks A. Gesundheitsökonomie. Diabetologe 2019; 15: 502-503 CrossrefPubMedGoogle Scholar 3 Amelung V, Wolf S. Gesundheitssystem im Umbruch: Ärztenetze: Treiber für integrierte Versorgung?. Urologe 2011; 50: 1566-1572 CrossrefPubMedGoogle Scholar 4 Korzilius H. Deutsches Gesundheitssystem: Hohe Kosten, durchschnittliche Ergebnisse. Dtsch Arztebl. 2019 116. A-2283/B-1873/C-1821:7 PubMedGoogle Scholar 5 Hospital discharges and length of stay statistics [Internet]. Verfügbar unter: https://ec.europa.eu/eurostat/statistics-ex-plained/index.php?title=Hospital_discharges_and_length_of_stay_statistics#Average_length_of_hospital_stay_for_in-patients (Letzter Zugriff: 19. April 2020) PubMedGoogle Scholar 6 Eckdaten der Krankenhausstatistik [Internet]. https://www.dkgev.de/fileadmin/default/Mediapool/3_Service/3.2._Zahlen-Fakten/Eckdaten_Krankenhausstatistik.pdf Letzter Zugriff: 19. April 2020 PubMedGoogle Scholar 7 Ralfs D. Modul 10: Prozessorientierung. In: Hellmann W. (Hrsg). Medical Hospital Manager Junior kompakt: Managementwissen für Studierende im Praktischen Jahr und Neueinsteiger im Krankenhaus. 1. Aufl.. Stuttgart: Kohlhammer; 2019: 78-83 Google Scholar 8 Santos C, Pimenta CA, Nobre MRC. The PICO strategy for the research question construction and evidence search. Rev Latino-Am Enfermagem 2007; 15: 508-511 CrossrefPubMedGoogle Scholar 9 Mayring P. Qualitative Inhaltsanalyse. Grundlagen und Techniken. 12. Aufl.. Weinheim und Basel: Beltz; 2010 Google Scholar 10 Moher D, Liberati A, Tezlaff J. et al. The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Medicine 2009; 6: 1-6 CrossrefPubMedGoogle Scholar 11 Frewer W, Busch H. Internal Controlling of a Radiology Department. RöFo – Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren; 2015; 87: 990-997 PubMedGoogle Scholar 12 Lee EK, Atallah HY, Wright MD. et al. Transforming Hospital Emergency Department Workflow and Patient Care. Interfaces 2015; 45: 58-82 CrossrefPubMedGoogle Scholar 13 Vos L, Chalmers SE, Dückers MLA. et al. Towards an Organisation-Wide Process-Oriented Organisation of Care: A Literature Review. Implementation Science 2011; 6: 8 CrossrefPubMedGoogle Scholar 14 Drinhaus H, Hackl M, Hickelbein J. et al. Herausforderungen an der Schnittstelle zwischen Notaufnahme und Intensivstation. In: Böttiger B, Kuckelt W. (Hrsg). Jahrbuch Intenisvmedizin 2019. Lengrich: Pabst; 2019: 29-40 Google Scholar 15 Williams TA, Leslie GD, Brearley L. et al. Discharge delay, room for improvement?. Australian Critical Care 2010; 23: 141-149 CrossrefPubMedGoogle Scholar 16 Gabriel S, Gaddis J, Mariga NN. et al. Use of a daily discharge goals checklist for timely discharge and patient satisfaction. MedSurg Nursing 2017; 10 PubMedGoogle Scholar 17 Baig SH, Gorth DJ, Yoo EJ. Critical Care Utilization and Outcomes of Interhospital Medical Transfers at Lower Risk Death. Journal of Intensive Care Medicine. 06/2021 PubMedGoogle Scholar 18 Warner CJ, Walsh DB, Horvath AJ. et al. Lean Principles Optimize On-Time Vascular Surgery Operating Room Starts and Decrease Resident Work Hours. Journal of Vascular Surgery 2013; 58: 1417-1422 CrossrefPubMedGoogle Scholar 19 Silver SA, Harel Z, McQuillan R. et al. How to Begin a Quality Improvement Project. Clin J Am Soc Nephrol 2016; 11: 893-900 CrossrefPubMedGoogle Scholar 20 Kennedy L, Pinkney S, Suleman S. et al. Propagating Change: Using RE-FRAME to Scale and Sustain A Community-Based Childhood Obesity Prevention Initiative. International Journal of Environmental Research and Public Health 2019; 16: 736 CrossrefPubMedGoogle Scholar 21 Rotteau L, Webster F, Salkeld E. et al. Ontario’s Emergency Department Process Improvement Program: The Experience of Implementation. Academic Emergency Medicine 2015; 22: 720-729 CrossrefPubMedGoogle Scholar 22 Conn GL, McKenzie M, Pearsall EA. Successful Implementation of an Enhanced Recovery after Surgery Programme for Elective Colorectal Surgery: A Process Evaluation of Champions’ Experiences. Implementation Science 2015; 10: 99 CrossrefPubMedGoogle Scholar 23 Roberts E. Negotiated Risk and Resident Autonomy: Frontline Care Staff Perspectives on Culture Change in Long Term Care in Nova Scotia, Canada. Work 2016; 54: 837-851 CrossrefPubMedGoogle Scholar 24 Nordmark S, Zingmark K, Lindberg I. Process Evaluation of Discharge Planning Implementation in Healthcare Using Normalization Process Theory. BMC Medical Informatics and Decision Making 2016; 16: 48 CrossrefPubMedGoogle Scholar 25 Geerligs L, Rankin NM, Shepherd HL. et al. Hospital-Based Interventions: A Systematic Review of Staff-Reported Barriers and Facilitators to Implementation Processes. Implementation Science 2018; 13: 36 CrossrefPubMedGoogle Scholar 26 Collins KF, Muthusamy SK, Carr A. Toyota Production System for Healthcare Organisations: Prospects and Implementation Challenges. Total Quality Management & Business Excellence 2015; 26: 905-918 CrossrefPubMedGoogle Scholar 27 Svanström R, Andersson S, Rosén H. et al. Moving from Theory to Practice: Experience of Implementing a Learning Supporting Model Designed to Increase Patient Involvement and Autonomy in Care. BMC Research Notes 2016; 9: 361 CrossrefPubMedGoogle Scholar 28 Silver SA, McQuillan R, Harel Z. et al. How to Sustain Change and Support Continuous Quality Improvement. Clin J Am Soc Nephrol 2016; 11: 916-924 CrossrefPubMedGoogle Scholar 29 Wutzke S, Benton M, Verma R. Towards the Implementation of Large Scale Innovations in Complex Health Care Systems: Views of Managers and Frontline Personnel. BMC Research Notes 2016; 9: 327 CrossrefPubMedGoogle Scholar 30 Kim CS, Spahlinger DA, Kin JM. et al. Lean Health Care: What Can Hospitals Learn from a World-Class Automaker?. Journal of Hospital Medicine 2006; 1: 191-199 CrossrefPubMedGoogle Scholar 31 Hoffman KA, Green CA, Ford JH. et al. Improving Quality of Care in Substance Abuse Treatment Using Five Key Process Improvement Principles. The Journal of Behavioral Health Services & Research 2012; 39: 234-244 CrossrefPubMedGoogle Scholar 32 Lindholm JM, Laine I, Hippala H. et al. Improving Eye Care Services with a Lean Approach. Acta Ophthalmologica 2018; 96: 724-728 CrossrefPubMedGoogle Scholar 33 Schuster T, Kohorst J, Hassan A. Change Management: So gelingt der Wandel. Pflegez 2017; 70: 10-13 CrossrefPubMedGoogle Scholar 34 Jacobson GH, McCoin NS, Lescallette R. et al. Kaizen: A Method of Process Improvement in the Emergency Department: Kaizen Process improvement in the ED. Academic Emergency Medicine 2009; 16: 1341-1349 CrossrefPubMedGoogle Scholar 35 Schwinger A, Klauber J, Tsiasioti C. Pflegepersonal heute und morgen. In: Jacobs K, Kuhlmey A, Greß S. et al., (Hrsg). Pflege-Report 2019 Mehr Personal in der Langzeitpflege – aber woher?. Berlin: Springer Open; 2020: 3-20 Google Scholar 36 Pflegekammer Niedersachsen. (Hrsg). Bericht zur Lage der Pflegefachberufe in Niedersachsen. 2018 Google Scholar 37 Destatis – Statistisches Bundesamt. Gesundheitspersonal [Internet]. Verfügbar unter: https://www.destatis.de/DE/Themen/Gesellschaft/Umwelt/Gesundheit/Gesundheitspersonal/gesundheitspersonal.html (Letzter Zugriff: 21. April 2020) PubMedGoogle Scholar 38 Augurzky B, Beivers A. Digitalisierung und Investitionsfinanzierung. In: Klauber J, Geraedts M, Friedrich J. et al., (Hrsg). Krankenhaus-Report 2019 Das digitale Krankenhaus. Berlin: Springer Open; 2019: 67-80 Google Scholar 39 Versorgungsengpässe durch Pflegemangel. ProCare 2018; 23: 24 CrossrefPubMedGoogle Scholar 40 Spohn K, Schütte JK, Hiller M. et al. Engpass Intensivmedizin – Bedarf an Intensivbetten muss interdisziplinär gesteuert werden. In: Böttiger B, Kuckelt W. (Hrsg). Jahrbuch Intensivmedizin 2020. Lengerich: Pabst Science Publichers; 2020: 65-80 Google Scholar

Vorschau