ABSTRACT
BACKGROUND: The aim of this study was to develop a valid tool for internal process analysis of stroke management in order to identify possible improvements. METHOD: 939 stroke patients were classified into DRG diagnoses. Specific parameters known to influence the length of stay were analysed. Subgroup analyses were carried out in patients with TIA regarding a) differences between the neurological sections/ wards, and b) length of stay in correlation with resident level of training and the physician staffing in the particular department/ ward over the year. RESULTS: A difference in the length of stay of 1-2 days was revealed between the neurological departments/wards. Transfer to rehabilitation centres increased the length of stay by 5 days. Length of stay correlated with the training level of residents and staffing in the department/ward. Capacity overload due to reduced staffing or high fluctuation of staff increased the length of stay significantly. CONCLUSION: TIA patients were shown to be a homogeneous subtype of stroke patients, who can be used as a valid tool to analyse internal processes. This analysis revealed that length of stay depends on resident level of training and workload.
Subject(s)
Internship and Residency , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/therapy , Neurology/education , Process Assessment, Health Care/methods , Stroke/diagnosis , Stroke/therapy , Clinical Competence , Diagnosis-Related Groups , Germany , Hospital Departments , Hospitals, Urban , Humans , Intensive Care Units/statistics & numerical data , Medical Staff, Hospital/supply & distribution , Observer Variation , Patient Transfer , Quality Improvement , Rehabilitation Centers/statistics & numerical data , WorkforceABSTRACT
Genomic variations influencing nociceptive sensitivity and susceptibility to pain conditions, as well as responses to pharmacotherapy of pain are currently under investigation. Candidate genes involved in pain perception, pain processing and pain management such as (opioid) receptors, transporters and other targets of pharmacotherapy are discussed. Drug metabolizing enzymes represent a further major target of ongoing research in order to identify associations between an individual's genetic profile and drug response (pharmacogenetics). Polymorphisms of the cytochrome P 450 enzymes influence analgesic efficacy of codeine, tramadol and tricyclic antidepressants (CYP2D6). Blood levels of some non-steroidal anti-inflammatory drugs (NSAIDs) are dependent on CYP2C9 activity, whereas opioid receptor polymorphisms are discussed with respect to differences in opioid-mediated analgesia and side-effects. Pharmacogenetics is seen as a potential diagnostic tool for improving patient therapy and care and will contribute to a more individualized drug treatment in the future.
