title: [Consideration of guidelines, recommendations and quality indicators for treatment of stroke in the dataset "Emergency Department" of DIVI].
abstract: BACKGROUND
  The dataset "Emergency Department" of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) has been developed during several expert meetings. Its goal is an all-encompassing documentation of the early clinical treatment of patients in emergency departments. Using the example of the index disease acute ischemic stroke (stroke), the aim was to analyze how far this approach has been fulfilled.
  
  
  METHODS
  In this study German, European and US American guidelines were used to analyze the extent of coverage of the datasets on current emergency department guidelines and recommendations from professional societies. In addition, it was examined whether the dataset includes recommended quality indicators (QI) for quality management (QM) and in a third step it was examined to what extent national provisions for billing are included. In each case a differentiation was made whether the respective rationale was primary, i.e. directly apparent or whether it was merely secondarily depicted by expertise. In the evaluation an additional differentiation was made between the level of recommendations and further quality relevant criteria.
  
  
  RESULTS
  The modular design of the emergency department dataset comprising 676 data fields is briefly described. A total of 401 individual fields, divided into basic documentation, monitoring and specific neurological documentation of the treatment of stroke patients were considered. For 247 data fields a rationale was found. Partially overlapping, 78.9 % of 214 medical recommendations in 3 guidelines and 85.8 % of the 106 identified quality indicators were primarily covered. Of the 67 requirements for billing of performance of services, 55.5 % are primarily part of the emergency department dataset. Through appropriate expertise and documentation by a board certified neurologist, the results can be improved to almost 100 %.
  
  
  CONCLUSIONS
  The index disease stroke illustrates that the emergency department dataset of the DIVI covers medical guidelines, especially 100 % of the German guidelines with a grade of recommendation. All necessary information to document the specialized stroke treatment procedure in the German diagnosis-related groups (DRG) system is also covered. The dataset is also suitable as a documentation tool of quality management, for example, to participate in the registry of the German Stroke Society (ADSR). Best results are obtained if the dataset is applied by a physician specialized in the treatment of patients with stroke (e.g. board certified neurologist). Finally the results show that changes in medical guidelines and recommendations for quality management as well as billing-relevant content should be implemented in the development of datasets for documentation to avoid duplicate documentation.
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Bundeswehrkrankhaus Ulm - Sektion Notfallmedizin, Akademisches Krankenhaus der Universität Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland. mail@kulla.de.
authors.forename: M
authors.initials: M
authors.lastname: Kulla
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Bundeswehrkrankhaus Ulm - Sektion Notfallmedizin, Akademisches Krankenhaus der Universität Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Friess
authors.affiliation: Neurologische Klinik und Neurogeriatrie, Johannes Wesling Klinikum Minden, Minden, Deutschland.
authors.forename: P D
authors.initials: PD
authors.lastname: Schellinger
authors.affiliation: Klinik für Neurologie, Bundeswehrkrankenhaus Ulm, Akademisches Krankenhaus der Universität Ulm, Ulm, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Harth
authors.affiliation: Deutsche Schlaganfallgesellschaft und Deutsche Gesellschaft für Neurointensiv - und Notfallmedizin, Berlin, Deutschland.
authors.forename: O
authors.initials: O
authors.lastname: Busse
authors.affiliation: Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Walcher
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Bundeswehrkrankhaus Ulm - Sektion Notfallmedizin, Akademisches Krankenhaus der Universität Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Helm
mesh_terms: D004282:Documentation / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D005060:Europe; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D009462:Neurology / Q000592:standards; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D014481:United States
keywords: Acute stroke; Dataset emergency department DIVI; Documentation; Guidelines; Stroke register