ABSTRACT
The initial situation of dying persons is described along the current ratio of places of death. A register of places of death is missing in Germany. It becomes clear that until today approx. 80% of all German citizens die in an inpatient setting. According to various experts, the Covid-19 pandemic has led to a loss of established quality of care. The outstanding importance of a valid patient living will for the terminal phase of life becomes apparent. In a project, the existing situation that 20-25% of dying nursing home residents are transferred to a hospital was chosen as the starting point to develop suitable solutions. Even within hospitals there are transfers of dying patients without, from the point of view of medicine, care and/or psycho-social aspects, indication. Both kinds of transfer affect approx. 150,000 patients and residents each year. 13 causal factors, some of which influence each other, were identified empirically and by factor analysis. Under the supervision of the Marburg Institute of the Association of the Scientific Medical Societies (AWMF), two structured consensus-based guidelines were developed and implemented in a nursing facility and a hospital. These were supplemented by decision-making aids, guidelines and management tools that supported the implementation. As a result, it could be demonstrated that there was not only a reduction in transfers but also an increase in labor satisfaction. The project members see the possibility of transferring the guidelines nationwide. The given project management, the adaptability of the instruments developed to regional conditions, the intersectoral, collaborative and communal approach make this possible. Copyright © 2022 MVS Medizinverlage Stuttgart. All rights reserved.