Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Guidelines in trauma surgery--geriatric traumatology].
The treatment of injuries in elderly patients requires thorough planning. Preexisting diseases and the current status determine the priorities and methods of treatment. ⋯ Fracture treatment aims at fast, careful and simple fixation, which is nevertheless stable and sufficient. Modern methods and implants allow acceptable results to be achieved, even under the limitations of modern health care systems.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Comparative Study["Score systems as a measure for quality assurance in polytrauma?"].
Score systems in trauma try to aggregate the severity of injury in a single number of formula. They give a common basis to standardize logistics and outcome in trauma management. This holds true only if the score is valid, reliable, and based on a meticulous documentation of data. As errors cannot be excluded, individual decisions in trauma management can never rely on scores alone.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Verifying routine preoperative diagnosis between private practice and the surgical university clinic].
In an attempt to shorten the preoperative in-patient period and to avoid unnecessary investigations, a cooperative patient management model was established for a number of surgical operations at the University Department of Surgery, Anaesthesiology and their referring Specialist and General Practitioners. The latter were requested to carry out the previously defined preoperative routine investigations, which allowed for a marked reduction in hospital diagnostics. Ambulatory preoperative patient management and a new admission routine resulted in a 57% decrease of the average preoperative in-patient stay for the observed procedures.
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Algorithms represent a graphical display of decision-making by giving clearly defined and formalized guidelines. The systematic order of decisions and consequent actions is guided by medical priority and regulates the time frame and sequence of each single step in a logical manner. With the help of clinical algorithms highly complex processes such as the management of the severely injured patient can be translated into a clearly structured, logical pathway. ⋯ The use of algorithms allows a systematic search for errors in the process of quality management. In emergency situations they suggest a structured way of problem-solving to the less experienced user. Algorithms are useful instruments in teaching medical decision-making.
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Hospital standards for the care of multiple traumatized patients include certain clinical capabilities, special logistics (appraisal of structure), and--even more important--algorithms for simultaneous activities in diagnosis and therapy (assessment of process). The main goal in the trauma system should be definitive, specialized care for the injured in the shortest possible time. Economically there is no way of creating a tight network of highly developed trauma centers close to every patient. ⋯ Trauma registers are necessary to plan for the future. Quality improvement programs (education, system evaluation) should be installed, especially for smaller hospitals bound into the trauma system. Financial support is essential for hospitals designated for care of multiple traumatized patients in rural areas.