Hospital.Help

Berlin With the innovation fund project Enhanced Recovery after Intensive Care (ERIC), the quality indicators of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) were incorporated into patient care.

The doctors and nursing staff providing follow-up care were also included in the treatment via an e-health platform. In a conversation with the German Medical Journal (D), the head of the project, Claudia Spies from the Charité, explains what has become of the project results and how the Innovation Fund is helping to connect science and care.

5 questions for Claudia Spies, Director of the Department of Anesthesiology and Intensive Care Medicine at the Charité

Professor Spies, what was the ERIC project about?
Making evidence-based medicine available in the form of guidelines, for example, is one thing. But implementing these findings in practice is a different and far more challenging undertaking. In the ERIC project, we created an e-health platform that brought together hospitals of different sizes.

Every day, the intensive care patients included in the project received a telemedical visit from experienced doctors and nurses, in which compliance with the eight DIVI quality indicators was recorded.

Three and six months after their discharge, the patients received follow-up care in cooperation with their family physicians for organ damage and possible long-term impairments with regard to their mental health, cognition, mobility and strength, as well as their health-related quality of life.

What results did you achieve in the project?
The results showed that the televisit significantly increased adherence to seven of the eight quality indicators, including management of sedation, analgesia and delirium and early weaning from invasive ventilation.

With ERIC, we have created a catalyst for evidence-based medicine with a telemedicine network. We have succeeded in implementing the DIVI’s multi-professional intensive care quality indicators in routine care and at the same time building a strong network structure in a care region that is sustainable and can provide stability even in crisis situations.

We were able to demonstrate this during the COVID-19 pandemic: ERIC developed rapidly through the SAVE-Berlin@Covid-19 project. We delivered a tool that is useful, saved lives in the case of COVID-19, enabled relevant resource allocations and offers real added value in the healthcare landscape.

In what way have the findings from the project become part of patient care in Germany?
The Federal Joint Committee has used the findings from ERIC to expand its center regulations. Hospitals that perform special tasks as intensive care competence and coordination centers in addition to patient care can now receive financial subsidies for this.

These tasks primarily include case conferences with other hospitals via video transmission and fulfilling a mentoring function for these hospitals, including case-independent quality circles and continuing education and training opportunities. This is a very positive development for which our entire team is very grateful.

This has made intensive care safer for patients. Being treated in a network offers the advantage that you can draw on the resources and knowledge of more experts. On the other hand, all participating departments are also developing further in terms of the implementation of evidence-based standards – and I include our own teams here.

In this way, promising innovations to improve patient care can be implemented more quickly into routine, both translationally and transformationally. In addition to the individual medical benefit, this also has a group benefit for all patients who are treated there. The presence also offers advantages for colleagues: for example, a low-threshold second opinion procedure, case conferences and structured visits.

The fact that ERIC has found its way into routine financing is due not only to the positive results we have found, but also to the political and creative will of the decision-makers at the G-BA and the support we have received from all sides. In any case, the findings have reached patient care in Germany via the intensive care center regulation, i.e. a path has been created with which the results can be carried out more widely. The next few years will show whether this happens.

In your opinion, how should the implementation of ERIC in healthcare proceed?
During the pandemic, we have seen that the acceptance of forms of care is particularly high when there is a legal framework and cooperation is provided with incentives.

Networking, as proposed and implemented in ERIC and other projects, undoubtedly has a positive effect on care, which can be demonstrated in an intersectoral, multi-professional and interdisciplinary approach.

In my opinion, it would now be important for this to be reflected in the remuneration for services by providing financial incentives for interdisciplinary cooperation with positive outcomes for patients.

In your opinion, how great is the influence of the Innovation Fund on improving the supplyquality in Germany?
The Innovation Fund offers healthcare researchers a platform. The fund is the first instrument that directly links healthcare design and science. This takes into account the speed of the growth of knowledge, which is currently doubling every three months, as well as the implementation of this knowledge into routine. It is therefore very welcome that the Innovation Fund has been made permanent.

Ultimately, it is clear that, in addition to scientific findings, political will is always needed to implement new forms of care. Ideally, as with ERIC, successful projects from the innovation funds and political activities can go hand in hand. This will probably make it possible to achieve the best effect for patients in many areas in terms of the highest quality of care. © fos/aerzteblatt.de