patientendatenmanagementsystem datenanalyse - forschung · siloam springs - her story is one of...
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Patientendatenmanagementsystem
Datenanalyse - Forschung
ao. Univ. Prof. Dr. Harald Andel MSc
Abteilung für allg. Anästhesie und Intensivmedizin
Allgemeines Krankenhaus der Stadt Wien – Medizinischer Universitätscampus
Leiter: Univ. Prof. Dr. K. Markstaller
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Organigramm der Abteilung
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Datenauswertung
Metadaten (Resistenzsituation) therapeut. Hilfe
Leistungserfassung – Controlling
Qualitätsmanagement
Benchmarking (zB Datensatz Anästhesie / ICU)
Wissenschaftliche Studien
2011: Schwechat knapp 250.000 Flüge – AKH knapp 50.000 Operationen
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Eintreffen bis zum Einschleusen
Einschleusen bis Anaesthesielagerung
M e d i a n - W e r t e
160
140
120
100
80
60
40
20
0
Narkose-Einleitung
Anaesthesie-Lagerung bis Monitoring
OK Hautschnitt bis Hautschnitt
Operations-Dauer
Narkose-Ausleitung
Ausschleuszeit
Übergabe-Dauer
5
0
43
10
13
57
7
5
3
3
Transport zum AWR / IBST
Schematik der Zeitanalyse
Effektive Anaesthesiepräsentanz
Anaesthesie-Dauer
Ze
it
i
n
Mi
nu
te
n
Medianer Verlauf
Arbeitszeiten für eine
durchschnittliche
Operation
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Eins ch leus en bis Anaes thes ie lage rung
Ze
it
i
n
Mi
nu
te
n
0
50
10 0
15 0
20 0
25 0
MEDIAN 25, 75 PERZENTILEMW + STDWPATIENTEN
M i t t e l w e r t
M i t t e l w e r t + S t a n d a r t a b w e i c h u n g
2 5 . P e r z e n t i l e
M e d i a n
7 5 . P e r z e n t i l e
7 , 5
1 8 , 8
2
5
9
m i n
P a t i e n t ü b e r l a p p e n d e i n g e s c h l e u s t ,
i n t r a o p e r a t i v e K o m p l i k a t i o n
P a t i e n t ü b e r l a p p e n d e i n g e s c h l e u s t , i n t r a o p e r a t i v e K o m p l i k a t i o n
P a t i e n t ü b e r l a p p e n d e i n g e s c h l e u s t , i n t r a o p e r a t i v e K o m p l i k a t i o n
P a t i e n t ü b e r l a p p e n d e i n g e s c h l e u s t , i n t r a o p e r a t i v e K o m p l i k a t i o n
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Prozentueller Anteil der
Journaldienstzeit an der
Gesamtarbeitszeit
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Kummulative Aufteilung der
Gesamtarbeitszeit Stunden
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Zeitprofil der OP - Gruppe V
Uhrzeit
Pat./Monat
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QM im AKH-Wien
10
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Gedanken zur
Evidence based medicine
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Skydiver's parachute fails; survives fall from 10,000 feet
SILOAM SPRINGS - Her story is one of survival. Just two months ago,
Shayna Richardson, 21, of Joplin, Missouri faced certain death when
during a skydiving adventure her parachute and reserve chute failed above
Siloam Springs.
Shayna Richardson was not insured and faces hundreds of thousands of dollars in
medical bills.
Gedanken zur
Evidence based medicine
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As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
Smith GC, Pell JP. Parachute use to prevent death and major trauma
related to gravitational challenge: systematic review of randomised controlled trials.
BMJ. 2003 Dec 20;327(7429):1459-61. Review.
Gedanken zur
Evidence based medicine
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PDMS ermöglicht
Untersuchungen an dem
Gesamtkollektiv
Rahmenbedingungen
Geeignete Konfiguration
Datenqualität
Vorgehen nach SOP / Behandlungsprotokoll(en)
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PDMS Konfiguration
„das Pferd von hinten rum aufzäunen“
Vorab Definition der auswertbaren Parameter im
Sinne eines Pflichtenheftes.
Konfigurationsbeginn des PDMS erst nach
Erstellung des Pflichtenheftes
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PDMS Konfiguration
Dropdownlisten statt Freitext
Barcode-Listen zum einlesen
Verwendung von Interface-Parametern
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Überprüfung der Datenqualität
„Qualitätsschleifen einbauen“
Ausweisen (kritischer) fehlender Datenpunkte.
Plausibilitätskontrolle (Hautschnitt vor AN-Beginn)
Tägliche Auswertung – Nachtragen/Korrektur durch
Verursachenden
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Der Weg ist das Ziel