Der Anaesthesist
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Review
[Internal hospital emergency management : Concepts for optimization of patient safety in hospitals].
Critical incidents in hospitals can often be predicted hours before the event and can mostly be detected earlier and presumably avoided. Quality management programs from US hospitals to reduce deaths following a severe postoperative complication (failure to rescue, FTR), have in this form not yet become established in Germany. A sensitive score-based early warning system for looming complications is decisive for successful in-hospital emergency management. ⋯ Communication skills are particularly required not only to be able to handle the immediate emergency situation but also to organize the downstream diagnostics and escalation of treatment; however, the MET is only one of the links in the in-hospital rescue chain, which can only improve the patient outcome when alerted in a timely manner. Feedback systems, such as participation in the German Resuscitation Registry, allow reflection of one's own performance in a national comparison. The chances offered by a MET will only be fully realized when it is integrated into an in-hospital emergency concept and this determines the added value for patient safety.
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As one critical parameter for organ perfusion, microcirculation and its monitoring are gaining increasing attention for modern intensive care medicine. The growing understanding of its importance in organ failure and the improved modes of its visualization mark microcirculation as an interesting target. ⋯ A growing body of evidence is hinting towards online visualization of sublingual microcirculation using intravital video microscopy, which was shown to be of prognostic value. Furthermore, the measurement of objective and reproducible parameters hint towards use in individualized hemodynamic therapy.