[Challenges in the care for out-of-hospital intensive care patients - An observational study on the nurses' perspective].

Background: Out-of-hospital intensive care (AKI) is a growing sector and is gaining increasing attention in research. In addition, the GKV-Intensive Care and Rehabilitation Strengthening Act (GKV-IPReG) influences the organization of care for people with AKI as well as the implementation and obligations of service providers. The aim is to promote decannulation and weaning from mechanical ventilation through surveys of potential. However, there is still a lack of scientifically sound evidence on care structures and care processes in AKI and the effects of the GKV-IPReG. These care structures were analyzed in the innovation fund project ATME ("Needs, requirements and cross-sectoral care pathways of out-of-hospital ventilated intensive care patients").

Methods: As part of a mixed-methods approach, a quantitative online survey was conducted as part of the ATME project using a literature-based and interview-based questionnaire. Nurses in the AKI were surveyed from August to November 2023 on the care and care processes of patients in the AKI. Data was analyzed descriptively using SPSS. Critical care points and challenges of AKI were derived.

Results: There is a lack of both supply and personal capacities in the out-of-hospital intensive care setting. Hospital care is seen as critical and can lead to discontinuity of care. 308 nurses perceive themselves to be playing a central role in the coordination of care and everyday life, but at the same time they deplore the lack of recognition and want more room for autonomous care decisions. The primary therapeutic goal is not to wean patients from ventilation or decannulation, but to maintain their current health status. There is concern that the new legislation (GKV-IPReG) will lead to increased disruptions in care and additional bureaucracy.

Conclusion: The findings serve as a basis for further research and the optimization of interfaces and the solution to care issues. New care concepts need to be developed, in particular regarding the lack of personal and structural capacities. Greater cooperation across settings can prevent discontinuities in care and improve the perception of the care experienced. Also, there is a need for further monitoring of the effects of the GKV-IPReG and the implementation of the necessary conditions in patient care.