[Frequency distribution and coordination of emergency operations in German hospitals (FACE) : Analysis in 26 hospitals depending on the level of care]. / Häufigkeitsverteilung und koordinative Umsetzung von Notfalloperationen in deutschen Krankenhäusern : Analyse in 26 Krankenhäusern in Abhängigkeit von der Versorgungsstufe.

BACKGROUND: Timely emergency surgery is vital as this often has a direct impact on morbidity and mortality. The joint recommendations of the German Associations of Anesthesiologists (BDA), Surgeons (BDC), and Operating Room Management (VOp.M) for coordinative implementation have been available since 2016: N0 (surgery immediately), N1 (surgery start in the next free operating room), N2 (surgery start ≤ 6 h), N3 (surgery at the end of the elective schedule), N4/Urgent (surgery within 12-24 h). The aim of this study was to describe the situation of care in German hospitals of different sizes for the first time using routine data. METHODS: The data were collected in 26 hospitals with different levels of care over a period of 10 days. The frequency distribution of the individual emergency categories and the duration from the notification of the operation to the start of anesthesia or surgery were examined for the hospital as a whole and for the four operating departments with a typically high ratio of emergencies: general surgery, trauma surgery, gynecology/obstetrics and urology. RESULTS: A total of 1603 emergency surgical interventions were analyzed. The number of N0 cases was very low due to the specific entity of these emergencies, N1 made up approximately 13-15% of emergencies and categories N2-N4/Urgent comprised approximately 25-32% of emergencies each. The average duration between the notification of the operation and the start of anesthesia or surgery was (min): N0 20.7 ± 14.3 and 43.6 ± 31.8, N1 61.5 ± 48.7 and 90.1 ± 56.1, N2 187.9 ± 152.0 and 220.5 ± 153.4, N3 394.5 ± 392.3 and 428.3 ± 397.9 and N4/Urgent 494.8 ± 484.4 and 519.6 ± 486.6, respectively. The distribution of the emergency categories did not differ significantly between community hospitals compared to tertiary care hospitals, including university hospitals (p = 0.731) and also the duration between notification and start of anesthesia and operation was similar. Significant differences depending on the service level were only found for N1 until the start of anesthesia and for N3 until the start of anesthesia and of surgery. General surgery classified as N3 has a significantly shorter implementation time in community hospitals compared to tertiary care hospitals, including university hospitals, both at the start of anesthesia (mean 287.8 min versus 417.1 min; p = 0.045) and at the start of surgery (mean 316.3 min versus 459.0 min; p = 0.032). The implementation of trauma surgery emergencies classified as N1 took place, based on the start of surgery in community hospitals with an average duration of 91.2 min, statistically significantly faster than in hospitals with a maximum care of 133.0 min (p = 0.036). In urology, there were notable variations between smaller and larger hospitals in emergency interventions with the classification N4/Urgent for both periods of time, both up to the start of anesthesia (p = 0.012) and up to the start of surgery (p = 0.007). At an average of 291.8 min (start of anesthesia) or 294.4 min (start of surgery), the implementation time in hospitals with maximum care, including university hospitals, was shorter than in urological clinics of community providers (626.5 min and 645.6 min, respectively). In gynecology/obstetrics, there was no statistically significant difference between the two groups. CONCLUSION: Cases with high urgency were surgically treated within a short time period. Overall, differences in time management of emergencies were only small between hospital types. The gradations in the temporal implementation of the individual emergency categories were due particularly to distinctions in the resources available, such as the number of operating theaters, including the run times.

[Implementation of emergency classifications-Where do we stand? : Results of a nationwide survey]. / Der Umgang mit Notfallklassifikationen ­ Wo stehen wir? : Ergebnisse einer deutschlandweiten Umfrage.

BACKGROUND: This study aimed to determine the current state of implementation of the recommendations for the classification of emergency surgery published in 2016 by the German societies of anesthesiology (BDA/DGAI), surgery (BDC/DGCH) and operating room management (VOPM). METHODS: Based on these societies' recommendations, various organizational issues were explored using an online questionnaire that was limited to German operating room (OR) managers and coordinators for hospitals that had surgical programs and at least 200 hospital beds. RESULTS: A total of 550 hospitals were contacted and 274 participated in the survey (49.8%). Of these 70.7% reported that they had implemented the recommendations, and 15.2% were aware of the recommendations but did not consistently apply them. Of the participating OR managers and coordinators that had either implemented or were aware of the recommendations, 78.2% agreed that the standardized definition of medical emergencies led to improvements in emergency treatment but 33.6% stated that the defined response intervals for emergency categories induced a certain degree of subjectivity in categorizing emergencies. Additional in-house guidelines specifically for the most frequent surgeries were or would be welcomed by 80.1% of the respondents and 39.1% of the surveyed hospitals had already implemented such guidelines. Of the OR managers and coordinators, 62.9% were informed about their emergency volumes and 47.3% stated that they regularly assessed them. There was no dedicated capacity for emergency care in 65.2% of hospitals. Of the respondents 3.9% stated that a separate emergency OR was reserved with a freely available team, which, during core operating hours, could be used for interdisciplinary emergency care and 26.2% of hospitals considered the capacity required for emergency procedures when planning the OR program or determining OR capacities. CONCLUSION: The recommendations for classifying emergency operations are an essential and generally accepted control mechanism in OR coordination. They simplify interdisciplinary coordination and communication when dynamically incorporating emergency procedures into an OR program. Most OR managers and coordinators view the recommendations as improving the speed of action in emergency care. To support the adoption of emergency classifications within an organization it may be advisable to incorporate them into the OR statutes and integrate them within the hospital information systems. The majority of participants supported additional specifications based on medical indicators for classifying the most frequent emergency operations. Being cognizant of key metrics concerning in-house emergency volume represents a crucial basis for interdisciplinary OR management and emergency care integration. Contrary to common perception, blocking fixed OR capacities remains the exception. When establishing a concept to provide emergency capacity, it is advisable to align developments with demand calculations based on in-house figures and to emphasize interdisciplinary participation and consensus.

Use of XTT-assay to assess the cytotoxicity of different surfactants and metal salts in human keratinocytes (HaCaT). A feasible method for in vitro testing of skin irritants.

Because of the increasing need of reliable skin irritation tests and in order to reduce the number of animal experiments, in vitro alternatives have to be developed. We studied four surfactants and five metal salts for their cytotoxic potency in HaCaT cells, a spontaneously immortalized human keratinocyte line. The endpoint used to assess cellular viability was metabolization of the tetrazolium salt XTT (2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide). The tested substances revealed a significant rank order of their cytotoxicity at an exposure time of 24 h. It was 1) benzalkonium chloride, 2) sodium lauryl sulphate, and 3) Tween 20 (polyoxyethylene sorbitanmonolaurate) and Tween 80 (polyoxyethylene sorbitanmonooleate), for the surfactants; and 1) potassium bichromate, 2) copper sulphate, 3) cobalt chloride and palladium chloride, and 4) nickel sulphate, for the metal salts. There is an excellent correlation to the rank order of their known irritative potency in vivo. Being practicable and effective, the presented XTT-assay on HaCaT cells would be well suitable for an initial orientating screening of substances, subsequently followed by irritation tests directly in humans.