[National health target on patient safety]. / Nationales Gesundheitsziel Patientensicherheit.

Improving patient safety is key to better health and nursing care. The Association for the Continuous Development of the National Health Target Process, health-targets.de (gesundheitsziele.de), has defined two focus areas, each with six goals, to jointly initiate significant progress in patient safety in Germany and achieve the health target of the same name. It is based on the "Global Patient Safety Action Plan 2021-2030" of the World Health Organization (WHO) and contributes to its implementation on a national level.The national health target addresses all players in healthcare and highlights the role of patients. Strengthening patient safety culture and expanding patient safety competence are at the center of the target process.For patient safety culture, a systemic approach is crucial. Individual-related factors as well as structural and process-oriented variables are looked at. A cooperation that focusses on the wellbeing of patients is essential.Patient safety competence spotlights knowledge on security related aspects in healthcare. At the same time, it focuses on the ability of all those involved to influence care in a positive way-thereby being open to the capabilities of patients.

Educating physicians on strong opioids by descriptive versus simulated-experience formats: a randomized controlled trial.

BACKGROUND: Long-term prescriptions of strong opioids for chronic noncancer pain-which are not supported by scientific evidence-suggest miscalibrated risk perceptions among those who prescribe, dispense, and take opioids. Because risk perceptions and behaviors can differ depending on whether people learn about risks through description or experience, we investigated the effects of descriptive versus simulated-experience educative formats on physicians' risk perceptions of strong opioids and their prescription behavior for managing chronic noncancer pain. METHODS: Three hundred general practitioners and 300 pain specialists in Germany-enrolled separately in two independent exploratory randomized controlled online trials-were randomly assigned to either a descriptive format (fact box) or a simulated-experience format (interactive simulation). PRIMARY ENDPOINTS: Objective risk perception (numerical estimates of opioids' benefits and harms), actual prescriptions of seven therapy options for managing chronic pain. SECONDARY ENDPOINT: Implementation of intended prescriptions of seven therapy options for managing chronic pain. RESULTS: Both formats improved the proportion of correct numerical estimates of strong opioids' benefits and harms immediately after intervention, with no notable differences between formats. Compared to description, simulated experience led to significantly lower reported actual prescription rates for strong and/or weak opioids, and was more effective at increasing prescription rates for non-drug-based therapies (e.g., means of opioid reduction) from baseline to follow-up for both general practitioners and pain specialists. Simulated experience also resulted in a higher implementation of intended behavior for some drug-based and non-drug-based therapies. CONCLUSIONS: The two formats, which recruit different cognitive processes, may serve different risk-communication goals: If the goal is to improve exact risk perception, descriptive and simulated-experience formats are likely to be equally suitable. If, however, the goal is to boost less risky prescription habits, simulated experience may be the better choice. TRIAL REGISTRATION: DRKS00020358 (German Clinical Trials Register, first registration: 07/01/2020).

Hidden hazards of SARS-CoV-2 transmission in hospitals: A systematic review.

Despite their considerable prevalence, dynamics of hospital-associated COVID-19 are still not well understood. We assessed the nature and extent of air- and surface-borne SARS-CoV-2 contamination in hospitals to identify hazards of viral dispersal and enable more precise targeting of infection prevention and control. PubMed, ScienceDirect, Web of Science, Medrxiv, and Biorxiv were searched for relevant articles until June 1, 2021. In total, 51 observational cross-sectional studies comprising 6258 samples were included. SARS-CoV-2 RNA was detected in one in six air and surface samples throughout the hospital and up to 7.62 m away from the nearest patients. The highest detection rates and viral concentrations were reported from patient areas. The most frequently and heavily contaminated types of surfaces comprised air outlets and hospital floors. Viable virus was recovered from the air and fomites. Among size-fractionated air samples, only fine aerosols contained viable virus. Aerosol-generating procedures significantly increased (ORair  = 2.56 (1.46-4.51); ORsurface  = 1.95 (1.27-2.99)), whereas patient masking significantly decreased air- and surface-borne SARS-CoV-2 contamination (ORair  = 0.41 (0.25-0.70); ORsurface  = 0.45 (0.34-0.61)). The nature and extent of hospital contamination indicate that SARS-CoV-2 is likely dispersed conjointly through several transmission routes, including short- and long-range aerosol, droplet, and fomite transmission.

Voluntary peer review as innovative tool for quality improvement in the intensive care unit--a retrospective descriptive cohort study in German intensive care units.

INTRODUCTION: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. METHODS: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs - representing over 300 patient beds - had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. RESULTS: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.

[Medical leadership competency]. / Arztliche Führungskompetenz.

With all these changes in health care systems the physicians' professional duties are about to undergo changes as well. Especially economic, administrative and legal aspects are becoming more and more important in medical care. In order to take responsibility with respect to leadership aspects a profound professionalisation is required. The Curriculum Medical Leadership edited by the German Medical Association provides an extensive example of a framework for continuing professional development (CPD) courses in medical leadership.

[Impact of rationing on health care during the last years of life]. / Auswirkun gen einer Rationierung auf die medizinische Betreuung während der letzten Lebensphase.

Old-age-based rationing of health care takes places both implicitly and explicitly. Its effects show on an emotional level and it affects medical practice. A distinction is made between explicit and implicit health care rationing. For example, performing fewer human organ transplants can be regarded as explicit rationing. Implicit or soft rationing may arise through either an undersupply of medical and nursing staff or through an oversupply of medical care as a consequence of the DRG bonus system. In this way an underlying and misleading incentive for an oversupply of diagnoses and treatments is created while at the same time the pressure is increased to reduce the length of hospital stay. Consequently, patients especially miss out on what they need most at this late stage of life: care and time to care. There are no clear rules for old-age-based health care rationing, which undermines the credibility of the health care system.

[Quality assurance, quality management or quality control?]. / Qualitätssicherung, Qualitätsmanagement oder Qualitätskontrolle?

The current concept of quality in the German health care system dates back to the period of the 1950s and 1960s, also including current legislation. Nevertheless, quality initiatives are in full progress. The German health care system is supposed to learn from experiences described in the fields of industry, technology and commerce. The philosophy and technology of quality management can provide an ideal solution to the common problems of the health care system.