Quality contract weaning: first insured people weaned

21.01.2022 10:59

In December 2018, the SBK Siemens company health insurance company and the Karl-Hansen-Klinik Bad Lippspringe concluded the GKV's first quality contract. The aim of the contract is to wean more people off ventilators and give them a better life. 22 clinics and 34 health insurance companies are now taking part in the contract. However, due to various hurdles, weaning has so far been made possible for fewer insured people than hoped. For example, many general practitioners do not know about this option or are not specialized enough in this area. Intensive care services also often prevent these lucrative patients from being weaned.

So far, SBK has been able to include a small number of insured persons in the contract. A few months ago, the first SBK insured person was successfully weaned off ventilation as part of the quality contract. The 70-year-old Thuringian woman was treated in intensive care and ventilated in February 2021 due to COPD. Weaning from ventilation was not successful in the first attempt in the treating clinic: the patient was discharged on a ventilator to an intensive care shared apartment. However, the discharge letter from the hospital made Heide Wittig, intensive care consultant at the SBK and trained nurse with experience in intensive care, take notice: The patient was cardiopulmonary stable and physiotherapeutic mobilization to the point of standing on the edge of the bed was possible. In addition, according to the discharge letter, she was “sufficiently communicative” and could eat food while sitting on the bed during the day.

Weaning potential confirmed by clinic

After evaluating the anamnesis, Heide Wittig contacted the Bad Berka Central Clinic in Thuringia. This specializes in weaning and takes part in the quality contract. “The senior doctor confirmed to me that our insured person had a good chance of living without a tracheostomy tube. In his opinion, there was no contraindication to the decannulation check,” said Heide Wittig, who then informed the patient’s husband. “Her family was completely surprised. Until now it was said that the sick person would have to be ventilated until the end of her life. She and her husband were correspondingly very happy.” Henning Müller, attending senior physician in Bad Berka, adds: “Thanks to the good preparation on the part of the SBK, a quick compilation of the findings was possible. We also saw the potential for decannulation and admitted the patient to our weaning unit at short notice.”

Successful weaning from ventilation after two weeks

The SBK consultant therefore prepared everything for the hospital admission in Bad Berka. She also established contact between the clinic, nursing service and the insured person's family doctor. The insured person was admitted to Bad Berka at the beginning of April. Just four days later, ventilation could be dispensed with three times a day for two hours. After twelve days the patient was breathing spontaneously. Her blood gas values were good. Before the tracheostomy tube was removed, granulation tissue was detected endoscopically. The granulation tissue was easily removed using rigid bronchoscopy. Decannulation was carried out periinterventionally with the creation of a placeholder, which could be removed two days later. So after a total of 14 days, the patient was without artificial airway access, which had previously been very restrictive. She was released from the clinic at the end of April and is currently being cared for at home by a nursing service.

Successful management of the disease at home

Today, the Thuringian can live well with her advanced chronic lung disease thanks to targeted training from the clinic. Non-invasive ventilation adapted during weaning for the night hours, a PEP system to support secretion management and inhalation therapy help her with this. “After instruction from us respiratory therapists, the patient was able to use the devices completely independently and without any problems and to implement the therapies. She also received targeted training in dealing with her illness in order to avoid exacerbations and thus unplanned hospital stays,” says Dorit Schimandl, head respiratory therapist at the Bad Berka Central Clinic. “The patient will certainly be able to cope with her everyday life with the disease in the best possible way in the future.”