System Understanding PZC

General
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There are already here some explanations on the topic of IVENA and patient assignments to hospitals.

According to the answer in the aforementioned post, if an adequate specialist department is lacking, “Emergency Department” can be selected, since the departments are of an optional nature. If one now wanted to enable every hospital to at least provide initial care, this would mean that one would have to be able to assign every PZC via “Emergency Department” to every hospital, which apparently reduces the system to absurdity.

This gives rise to the following additional questions for system understanding:

  1. PZC vs. actual suitability of the hospital

Does assignment to a specific hospital mean that the patient stays there permanently regardless of their needs—in other words, does the assignability of a PZC to a specific hospital presume its actual suitability for the patient, or can transfers occur?

  1. Multiple requirements and patient age

Example: A pediatric hospital may not have a “proper” trauma center, while a clinic with a proper trauma center may not have pediatrics, etc. What is the relationship between the stored departments, what requirements do sim patients place on the clinic (can multiple departments be needed simultaneously?), and how do emergency services communicate this? What determines which PZC the emergency service selects?

3 Likes

7 Answers

7
2

I see it the same way as you! If everything can be handled through the emergency department, what’s the point of all this? I can only speak from the reality in my counties: In Harburg district, there’s Buchholz Hospital and Winsen (Luhe) Hospital, neither of which are specialized hospitals in the classical sense, but they do have some specialist departments. In Rotenburg-Wümme district, there’s Diakonieklinikum, which can already be considered a specialized hospital, but this hospital doesn’t have everything either. In both districts, emergency patients are primarily taken to these hospitals for initial care. If needed, transfer takes place to a clinic that is specifically equipped for emergencies, e.g., one that has an eye department or neurosurgery. Some emergencies are announced directly via emergency physicians to target hospitals in Hamburg, or in the case of Rotenburg, to Bremen.

If I’ve understood correctly so far, in the future in the sim, the rescue service will report the diagnosis, based on which we dispatchers will then assign an appropriate hospital. Since we’re only simulating and probably won’t receive a central bed registry, I already have some questions about the procedure the developers have in mind. If it’s as I’ve described…IVENA would be purely cosmetic without any basis in reality, because if every emergency department can admit every patient…I don’t need specialist departments.

My suggestion would still be to remove the property “specialized hospital” and simply control transports via functional departments. The “emergency department” should be reconsidered here. By the way, more and more central emergency departments are being established in hospitals, where patients are triaged and then assigned to the appropriate wards.

I hope that with the IVENA component, intensive care transfers will finally happen, as well as requests for a helicopter rescue service for primary and secondary deployments, even from an existing scene of operations, for example in cases of polytrauma, burn injuries, etc.

This is not criticism, but rather my thoughts on this topic, which are based on my current knowledge

5

The idea itself is not bad.

However, in my opinion, the announced version is still missing the ability to differentiate the PTC (Primary Trauma Center) into pediatric care and adult care. Some hospitals are quite capable of accepting SK1 (Severity Category 1) adult patients, but don’t have pediatric trauma rooms.

Similarly, for some PTCs it makes a huge difference whether it’s SK1 or SK3. One might be a trauma room indication and can only accept 5 cases, while other patients might be able to be accepted 50 times. Some hospitals might be able to accept SK3 but not SK1.

I believe a differentiation of these factors would contribute to a more realistic simulation experience.

3

It is optional in nature as long as, for example, no bed capacities are assigned. If a small hospital, for instance, specifies only one trauma room slot, it will then be necessary for rescue units to continue on if that one space is occupied. Corresponding emergency scenarios such as traffic accidents with multiple “red” patients already exist in SIM Dispatcher.

Making every patient care center assignable to every hospital would be the same as assigning every rescue unit all equipment items — why should the system intentionally circumvent this? SIM Dispatcher is primarily a modular system in the administrative area of dispatch centers. It is up to the administrators to handle it accordingly. In this respect, I would disagree that it reduces the system to absurdity; rather, it is questionable why an administrator would invest their free time in disabling certain functions in SIM Dispatcher.

The specialized departments already selectable under “Patient Care Center” are the patient handover points. With the assignment, a capacity is then blocked in the supply report (from green to yellow to red). In the first expansion stage (4.9), there will be no transfer dynamics yet. This is partly because a major revision through standardized emergency call intake will come first, and partly because the simulation focus is (still) not on the internal hospital course.

The simulation selects a potentially applicable patient care center from the emergency scenario for transmission. Rescue units send an assignment request or the patient care center via the interface. Through the supply report, the assignment can then be made by the dispatch center and is fed back to the rescue unit. If, as in your example, an assignment cannot be made but the rescue unit still wants to go there, it can still go there. An assignment is then simply not possible. This is also how it works in reality.

Above all, it’s about: Which clinic is, based on current knowledge, best suited (proximity, capacity, capabilities) to admit and treat the patient further?

As already noted in the explanations, SIM Dispatcher receives a supply report. That is the essential content.

4

That answers a lot, thank you!

I think that came across differently than it was meant. The question was whether one could/should make every PZC assignable via emergency admission in case of doubt, in order to implement an initial care option in small hospitals.

If I understand that correctly now, then can an emergency vehicle be sent to a hospital even if the code there is not assignable?

Kein Problem. Ja absolut - aktuell sind die mehr oder weniger zufälligen Fahrten ohne Ressourcenknappheit belegt. So kann der Versorgungskapazität, in der Simulation, an bestimmten Stellen ein Flaschenhals verpasst werden, ohne die Möglichkeit zu nehmen, dass Patienten in besonderer Absprache trotzdem behandelt werden können.

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Ich denke ich muß das erst einmal sehen, momentan fehlt mir wirklich die Fantasie dafür es zu verstehen und den Nutzen zu erkennen.

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6

Would it make sense to assign everything to SK1 rather than SK2/3? Because some facilities in my system are only displayed for SK1, but not for SK2/3 and of course vice versa as well.

Example:

261 50 2 (open pool, 50 years, stationary care) — it’s possible to go to the Frankfurt hospital “Heilig Geist”, but with SK 1, i.e. 261 50 1, it’s not.

Ja, werden wir ergänzen.

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Ist schon ungefährt geplant ab wann und wie es dann sein soll? muss ich dann ALLE PZC erneut bearbeiten? oder wie soll es sein?

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7

Is the PZC already active?

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Not as far as I know, but since it’s quite involved, they’ve already enabled it now so it can be worked on.

and yes: it’s very exhausting… I finally got everything finished