[Recommendations for the specialist further training of nursing personnel on intensive care units in the treatment of abdominal aortic aneurysms: results of a modified Delphi procedure with experts]. / Empfehlungen zur Fachweiterbildung von Pflegefachpersonen der Intensivstation bei der Behandlung des Bauchaortenaneurysmas: Ergebnisse eines modifizierten Delphi-Verfahrens mit Expert:innen.

INTRODUCTION: The medical development in the previous 15 years and the changes in treatment reality of the comprehensive elective treatment of abdominal aortic aneurysms necessitate a re-evaluation of the quality assurance guidelines of the Federal Joint Committee in Germany (QBAA-RL). In the current version this requires a specialist further training quota for nursing personnel in intensive care wards of 50%. The quota was determined in 2008 based on expert opinions, although a direct empirical evidence base for this does not exist. METHODS: Representatives from the fields of patient representation, physicians, nursing personnel and other relevant interface areas were invited to participate in a modified Delphi procedure. Following a comprehensive narrative literature search, a survey and focus group discussions with national and international experts, a total of three anonymized online-based voting rounds were carried out for which previously determined key statements were assessed with a 4­point Likert scale (totally disagree up to totally agree). In addition, the expert panel had also defined a recommendation for a minimum quota for the specialist training of nursing personnel on intensive care wards in the treatment of abdominal aortic aneurysms, whereby an a priori agreement of 80% of the participants was defined as the consensus limit. RESULTS: Overall, 37 experts participated in the discussions and three successive voting rounds (participation rate 89%). The panel confirmed the necessity of a re-evaluation of the guideline recommendations and recommended the introduction of a shift-related minimum quota of 30% of the full-time equivalent of nursing personnel on intensive care wards and the introduction of structured promotional programs for long-term elevation of the quota. CONCLUSION: In this national Delphi procedure with medical and nursing experts as well as representatives of patients, the fundamental benefits and needs of professional specialist qualifications in the field of intensive care medicine were confirmed. The corresponding minimum quota for specialist further training of intensive care nursing personnel should generally apply without limitations to specific groups. The expert panel stipulates a shift-related minimum quota for intensive care nursing personnel with specialist training of 30% of the nursing personnel on intensive care wards and the obligatory introduction of structured and transparent promotion programs for the long-term enhancement.

[Hip Fractures in Adults - Contemporary Clinical Management Based on International Standards]. / Zur hüftgelenknahen Femurfraktur des erwachsenen Menschen ­ Zeitgemäßes klinisches Management auf der Basis internationaler Standards.

BACKGROUND: Patients with hip fractures, often of advanced age and with multimorbidity-trauma, require early surgery and interdisciplinary treatment in order to avoid complications and reduce morbidity and mortality. "Time to surgery" is a sensitive quality indicator (QI) for the treatment process, reflecting multiple factors. Due to persistently noticeable problems in relation to this QI in external inpatient quality assurance in Germany, a special need for action was identified by the Federal Joint Committee (Gemeinsamer Bundesausschuss - G-BA). OBJECTIVES: Identification of methodologically particular reliable recommendations to establish structural and procedural standards to ensure adequate clinical care. METHODS: Systematic international web-based research and analysis of relevant guidelines for domain 3 of the AGREE II instrument; extraction of distinct, methodologically well-founded recommendations; supplementing the guideline analysis with an assessment of regulations with structure and process requirements or criteria for quality and care standards. RESULTS: Out of 66 identified, context-relevant guidelines, 15 were of "high methodological quality". Out of these 15, particular reliable recommendations could be extracted-among others - regarding surgical technique, combined orthogeriatric treatment, antibiotics, pressure ulcers and thromboembolic prophylaxis, time to surgery, anesthetics, physiotherapy, postoperative management and delirium. Further structural and procedural specifications could be extracted from nine other sets of rules. CONCLUSIONS: Surgery as early as possible and adequate care can be assured through a consistent, multifactorial, interdisciplinary and coordinated team approach in well structured and adequately staffed facilities of appropriate quality.