Strukturelle Implementierung eines Fast-Track-Programms – wie geht das?

Wolfgang Schwenk; Ina Lang; Marion Huhn

doi:10.1055/a-1385-0357

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Table of Contents

Zentralbl Chir 2021; 146(03): 249-259
DOI: 10.1055/a-1385-0357

Übersicht

Strukturelle Implementierung eines Fast-Track-Programms – wie geht das?

Structured Implementation of a Fast-Track Program – How Does it Work?

Wolfgang Schwenk

Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland

,

Ina Lang

Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland

,

Marion Huhn

Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Fast-Track- oder ERAS-Konzepte gehen mit klinisch relevanten Vorteilen für operierte Patienten und ökonomischen Vorteilen für das Krankenhaus einher. Dennoch sind Fast-Track-Konzepte in Deutschland bislang nur in einzelnen chirurgischen Kliniken realisiert worden. Weder das Fehlen wissenschaftlicher Evidenz noch Einschränkungen durch das G-DRG-System sind Grund dieser ausbleibenden Fast-Track-Verbreitung in Deutschland. Vielmehr ist der Wandlungsprozess von der traditionellen perioperativen Behandlung zur evidenzbasierten Fast-Track-Therapie komplex und erfordert einen strukturierten und aufwendigen Implementierungsvorgang. International sind Programme zur Etablierung des Fast-Track etabliert und in zahlreichen Kliniken erfolgreich durchgeführt worden. Diese strukturierte Fast-Track-Implementierung wird in die Abschnitte organisatorische Vorbereitung, klinische Implementierung und Ergebnisüberprüfung gegliedert. Aufgrund der großen Komplexität der Wandlung ist eine externe Begleitung und Schulung des multiprofessionellen Teams durch externe Fast-Track-Spezialisten sinnvoll.

Abstract

Fast-track or ERAS programs can give clinically relevant benefits for patients undergoing surgery. They also have financial advantages for the hospital. Despite these facts, fast-track has been implemented in only very few hospitals in Germany. Neither scientific evidence nor reimbursement regulations explain this lack of fast-track acceptance. It seems however that a structured process of change from traditional perioperative medicine to evidence based fast-track therapy is missing in Germany. In other countries, structured programs for fast-track or ERAS implementation have been successful in many hospitals. This article describes structured fast-track implementation divided into three consecutive steps: organisational preparation, clinical implementation and continuous examination of fast-track adherence, functional recovery, morbidity and postoperative length of hospital stay. Due to its complex nature, fast-track implementation should be guided by external fast-track experts.

Schlüsselwörter

perioperative Medizin - Fast-Track-Rehabilitation - ERAS - Veränderungsmanagement

Key words

ERAS - fast-track rehabilitation - change management - perioperative medicine

Full Text

References

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