Abstracts by keywords: obstetrics
Postpartum hemorrhage (PPH), defined as blood loss ≥500 ml within 24 hours of birth, is one of the most common causes of maternal mortality worldwide. In Germany, PPH occurred in 7.8% of the 693,000 births in 2023. In addition to medical therapy and uterine (balloon) tamponade, a vacuum-induced uterine compression (VUC) procedure has been available since 2024, enabling rapid hemostasis. Innovations such as VUC and the associated costs are initially not reflected in the DRG flat-rate fees in the inpatient sector, which is why additional fees are necessary for refinancing. At the same time, the product costs can be offset by resource-saving effects (including shorter lengths of stay, reduction in surgical procedures). To demonstrate these effects and evaluate them in monetary terms, a model was conducted: A resource saving in the DRG system leads to a downgrade of the DRG. Thus, a one-level reduction in the most common DRG results in a cost reduction of €983.24. The recent establishment of a specific procedure code for VUT will enable real-world analyses based on billing data in the future, as well as the long-term adjustment of case rates.
04.08.2025
Since 2003, hospital services have been reimbursed through the case-volume-dependent, flat-rate reimbursement system of the G-DRG (German Diagnosis Related Groups) (Section 17b (1) Sentence 1 KHG/Reimbursement Institute 2023). Diagnosis, severity of the illness, and the operations and procedures performed, along with other parameters if applicable, are entered into the patient classification system for grouping (Reimbursement Institute 2023). Although other countries, such as the United Kingdom, Finland, and the Netherlands, also use DRG systems, Germany has a strong performance and volume incentive compared to other countries1. Despite the additional refinancing of nursing care through the nursing budget introduced in 2020 (Reimbursement Institute 2023), there is no case-volume-independent refinancing of necessary provision (Federal Ministry of Health 2023).
04.12.2023
Patient safety is one of the highest goals of healthcare and, since 2022, the tenth national health goal in Germany. Care errors contribute significantly to temporary or permanent impairment, prolonged hospital stays, or even death of patients. Although the topic has received considerable attention in the USA since the publication of "To err is human" in 2000, there remains a significant need for action. Adverse events triggered in the treatment context cannot be completely prevented given the complexity of medical treatments and the range of patient pre-existing health conditions. Strategies to improve the quality of care therefore focus on preventing avoidable adverse events. These are defined as those that would not occur if current medical standards were adhered to. The Patient Safety Action Alliance (APS), an alliance of representatives of healthcare professions, institutions, associations, and patient organizations, has been committed to implementing strategies to prevent adverse events since its founding in 2005. Treatment errors usually occur within complex and collaborative contexts. Against this backdrop, the APS considers collaborative learning from mistakes to be the most important tool for improving patient safety [1]. To enable and successfully implement this, open communication is essential.
04.12.2023
Patient safety is a central goal in healthcare (Rodwin et al. 2020: 1; Zech et al. 2017: 333) and is defined as the “absence of adverse events” (Schrappe 2018: 3). In addition to medical skills and knowledge, successful communication has proven to be a central part of patient safety and its safeguarding, both within the staff team and between staff and patients (Barlett et al. 2008: 1555-1562; Leonard et al. 2004: 85-90; Hickson et al. 1992: 1359-1363). Disturbed communication, for example due to the use of medical terms that patients and relatives do not understand, or language barriers such as a lack of German or other languages can lead to a loss of information and reduced patient safety (Barlett et al. 2008: 1555-1562; Leonard et al. 2004: 85-90; Hickson et al. 1992: 1359-1363). There are other reasons for suboptimal communication and various barriers that prevent the implementation of successful communication. These include, for example, insufficient information transfer, work overload, lack of mutual respect, an insufficient feeling of belonging to a team or low self-confidence (Zegers et al. 2020). Too little further training was also identified as a risk factor (Olde Bekkink et al. 2018: 262-270). Lyndon and colleagues summarized in a review that successful communication in healthcare should be respectful, clear, direct and explicit (Lyndon et al. 2011: 94). Consistently implementing successful communication requires intensive listening, good administrative support, and community engagement to overcome hindering hierarchies and professional stereotypes to ensure patient safety.