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Möckel M, Janssens K, Pudasaini S, Garcia-Castrillo Riesgo L, Moya Torrecilla F, Golea A, Reed MJ, Karamercan M, Fernández Cejas JA, Laribi S. The syncope core management process in the emergency department: a consensus statement of the EUSEM syncope group. Eur J Emerg Med 2024:00063110-990000000-00131. [PMID: 38874507 DOI: 10.1097/mej.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The European Society of Cardiology issued updated syncope guidelines in 2018 which included recommendations for managing syncope in the emergency department (ED) setting. However, these guidelines lack detailed process-oriented instructions regarding the fact that ED syncope patients initially present with a transient loss of consciousness (TLOC), which can have a broad spectrum of causes. This study aims to establish a European consensus on the general process of the workup and care for patients with suspected syncope and provides rules for sufficient and systematic management of the broad group of syncope (initially presenting as TLOC) patients in the ED. A variety of European diagnostic and therapeutic standards for syncope patients were reviewed and summarized in three rounds of a modified Delphi process by the European Society for Emergency Medicine syncope group. Based on a consensus statement, a detailed process pathway is created. The primary outcome of this work is the presentation of a universal process pathway for the structured management of syncope patients in European EDs. The here presented extended event process chain (eEPC) summarizes and homogenizes the process management of European ED syncope patients. Additionally, an exemplary translation of the eEPC into a practice-based flowchart algorithm, which can be used as an example for practical use in the ED, is provided in this work. Syncope patients, initially presenting with TLOC, are common and pose challenges in the ED. Despite variations in process management across Europe, the development of a universally applicable syncope eEPC in the ED was successfully achieved. Key features of the consensus and eEPC include ruling out life-threatening causes, distinguishing syncope from nonsyncopal TLOCs, employing syncope risk stratification categories and based on this, making informed decisions regarding admission or discharge.
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Affiliation(s)
- Martin Möckel
- Department of Emergency and Acute Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kelly Janssens
- Department of Emergency Medicine, St. Vincents University Healthcare Group, Dublin, Ireland
| | - Samipa Pudasaini
- Department of Emergency and Acute Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Francisco Moya Torrecilla
- Vithas Xanit International Hospital and Clinical Lead, International Medical Services Vithas Xanit International Hospital Benalmadena, Malaga, Spain
| | - Adela Golea
- University of Medicine and Pharmacy Cluj, Emergency Unit - University Emergency County Hospital, Cluj Napoca, Romania
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Acute Care Edinburgh, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Mehmet Karamercan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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Bienzeisler J, Becker G, Erdmann B, Kombeiz A, Majeed RW, Röhrig R, Greiner F, Otto R, Otto-Sobotka F. The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study. J Med Internet Res 2024; 26:e45593. [PMID: 38743464 PMCID: PMC11134237 DOI: 10.2196/45593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/02/2024] [Accepted: 03/31/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. OBJECTIVE This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. METHODS We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. RESULTS The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. CONCLUSIONS Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.
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Affiliation(s)
- Jonas Bienzeisler
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | | | - Alexander Kombeiz
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Raphael W Majeed
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Felix Greiner
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Ronny Otto
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Fabian Otto-Sobotka
- Division of Epidemiology and Biometry, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Koech L, Ströhl S, Lauerer M, Oslislo S, Bayeff-Filloff M, Thoß R, Nagel E, Carnarius S, Stillfried D. [Redirection of patients from the emergency department to ambulatory care: a feasibility study]. DAS GESUNDHEITSWESEN 2024; 86:339-345. [PMID: 38354744 PMCID: PMC11077551 DOI: 10.1055/a-2206-1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND § 120 para. 3b SGB V mandates the Federal Joint Committee to define guidelines for the initial assessment of self-referred walk-in patients as well as for the redirection of patients who can be treated by office-based physicians. A corresponding streaming and redirection process was tested in a feasibility study at the RoMed Clinic Rosenheim. MATERIALS AND METHODS For the duration of the study, triage nurses of the emergency department (ED) first assessed self-referred walk-in patients with the Manchester Triage System (MTS). Patients in categories green and blue who did not obviously need the ED's resources were additionally assessed by health professionals of the Association of Statutory Health Insurance Physicians of Bavaria using the software Structured Initial Medical Assessment in Germany (SmED). Patients with a recommendation for non-hospital medical treatment were streamed to the out-of-hours practice on campus or were redirected to a physician office after video consultation with an office-based physician. Patient pathways were documented and a qualitative survey using semistructured guided interviews of all stakeholder groups was carried out. RESULTS 1,091 self-referred walk-in patients were included. Direct streaming to the ED occurred in 525 cases,13 refused to participate. Based on SmED, 24 additional patients were referred to the ED, 514 patients were streamed to the out-of-hours practice, 23 received a video consultation and five left the ED. After video consultation, eight patients were redirected to a physician's office, 10 were discharged, and five referred to the ED of which one did not want an office-based physician. No returnees from practices to the ED were identified. Generally, the redirection process was evaluated positively in the interviews (n=18). In particular, potential for technical improvement was identified. CONCLUSION Overall, the results indicate the feasibility of the redirection process and high acceptance levels. Using SmED in addition to MTS appeared useful before redirection but not necessary for streaming on campus. Redirection to physician offices can help reduce strain on the ED when the out-of-hours practice is not operating. In addition to arranging acute care appointments, video consultations offer an additional potential to treat patients. In a follow-up study, a broader range of patients should be included and appropriateness of redirection decisions should be evaluated.
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Affiliation(s)
- Lea Koech
- Zentralinstitut für die kassenärztliche Versorgung in
der Bundesrepublik Deutschland, Berlin, Germany
| | - Sarah Ströhl
- Forschung, GWS – Gesundheit, Wissenschaft, Strategie GmbH,
Bayreuth, Germany
- Institut für Medizinmanagement und Gesundheitswissenschaften,
Universität Bayreuth, Bayreuth, Germany
| | - Michael Lauerer
- Forschung, GWS – Gesundheit, Wissenschaft, Strategie GmbH,
Bayreuth, Germany
- Institut für Medizinmanagement und Gesundheitswissenschaften,
Universität Bayreuth, Bayreuth, Germany
| | - Sarah Oslislo
- Zentralinstitut für die kassenärztliche Versorgung in
der Bundesrepublik Deutschland, Berlin, Germany
| | - Michael Bayeff-Filloff
- Notaufnahme, RoMed Klinikum Rosenheim, Rosenheim, Germany
- Ärztlicher Landesbeauftragter Rettungsdienst, Bayerisches
Staatsministerium des Innern für Bau und Verkehr, München,
Germany
| | - Reno Thoß
- Notdienste, Vermittlungs- und Beratungszentrale,
Kassenärztliche Vereinigung Bayerns, München,
Germany
| | - Eckhardt Nagel
- Institut für Medizinmanagement und Gesundheitswissenschaften,
Universität Bayreuth, Bayreuth, Germany
| | - Sebastian Carnarius
- Zentralinstitut für die kassenärztliche Versorgung in
der Bundesrepublik Deutschland, Berlin, Germany
| | - Dominik Stillfried
- Zentralinstitut für die kassenärztliche Versorgung in
der Bundesrepublik Deutschland, Berlin, Germany
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Petravić L, Bajec B, Burger E, Tiefengraber E, Slavec A, Strnad M. Emergency physician personnel crisis: a survey on attitudes of new generations in Slovenia. BMC Emerg Med 2024; 24:25. [PMID: 38355454 PMCID: PMC10865631 DOI: 10.1186/s12873-024-00940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Emergency departments globally are overburdened, and emergency medicine residency is losing popularity among students and physicians. This raises concerns about the collapse of a life-saving system. Our goal was to identify the key workforce reasoning and question medical staff employment behavior. METHODS This was a prospective cross-sectional study. In December 2022, medical students and pre-residency doctors in Slovenia were invited to complete a web-based questionnaire. The data were analyzed using T-test, chi-square test, Mann‒Whitney-Wilcoxon tests, and principal component analysis. Open-ended questions were hand-categorized. RESULTS There were 686 participatns who clicked on the first page and 436 of those finished the survey. 4% of participants gave a clear positive response, while 11% responded positively regarding their decision to pursue emergency medicine residency. The popularity of emergency medicine decreases significantly among recent medical school graduates upon their initial employment. People who choose emergency medicine are less concerned about its complexity and pressure compared to others. Most respondents preferred 12-hour shift lengths. The preferred base salary range for residents was I$ 3623-4529, and for specialists, it was I$ 5435-6341. The sample's primary personal priorities are achieving a satisfactory work-life balance, earning respect from colleagues, and engaging in academic activities. Factors that attract individuals to choose emergency medicine include high hourly wages, establishment of standards and norms, and reduced working hours. CONCLUSIONS Our findings indicate that enhancing compensation, establishing achievable standards and norms, facilitating a beneficial work-life equilibrium, providing assistance with initial property acquisition, stimulating participation in deficit residency programs, fostering collegiality among peers, restricting the duration of shifts, and enabling pension accrual may be imperative in attracting more individuals to pursue emergency medicine residency.
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Affiliation(s)
- Luka Petravić
- Center for Emergency Medicine, University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
| | - Boštjan Bajec
- Department of Psychology, Faculty of Arts, University of Ljubljana, Aškerčeva 2, 1000, Ljubljana, Slovenia
| | - Evgenija Burger
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska ulica 19, 1000, Ljubljana, Slovenia
| | - Eva Tiefengraber
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
| | - Ana Slavec
- InnoRenew CoE, Livade 6a, 6310, Izola, Slovenia
- Department of Applied Natural Sciences, University of Primorska, Glagoljaška 8, 6000, Koper, Slovenia
| | - Matej Strnad
- Center for Emergency Medicine, University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
- Community healthcare center dr. Adolf Drolca, Prehospital unit, Ulica talcev 9, 2000, Maribor, Slovenia
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Tschoellitsch T, Seidl P, Böck C, Maletzky A, Moser P, Thumfart S, Giretzlehner M, Hochreiter S, Meier J. Using emergency department triage for machine learning-based admission and mortality prediction. Eur J Emerg Med 2023; 30:408-416. [PMID: 37578440 DOI: 10.1097/mej.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
AIMS Patient admission is a decision relying on sparsely available data. This study aims to provide prediction models for discharge versus admission for ward observation or intensive care, and 30 day-mortality for patients triaged with the Manchester Triage System. METHODS This is a single-centre, observational, retrospective cohort study from data within ten minutes of patient presentation at the interdisciplinary emergency department of the Kepler University Hospital, Linz, Austria. We trained machine learning models including Random Forests and Neural Networks individually to predict discharge versus ward observation or intensive care admission, and 30 day-mortality. For analysis of the features' relevance, we used permutation feature importance. RESULTS A total of 58323 adult patients between 1 December 2015 and 31 August 2020 were included. Neural Networks and Random Forests predicted admission to ward observation with an AUC-ROC of 0.842 ± 0.00 with the most important features being age and chief complaint. For admission to intensive care, the models had an AUC-ROC of 0.819 ± 0.002 with the most important features being the Manchester Triage category and heart rate, and for the outcome 30 day-mortality an AUC-ROC of 0.925 ± 0.001. The most important features for the prediction of 30 day-mortality were age and general ward admission. CONCLUSION Machine learning can provide prediction on discharge versus admission to general wards and intensive care and inform about risk on 30 day-mortality for patients in the emergency department.
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Affiliation(s)
- Thomas Tschoellitsch
- Johannes Kepler University Linz, Kepler University Hospital, Department of Anesthesiology and Critical Care Medicine
| | - Philipp Seidl
- European Laboratory for Learning and Intelligent Systems Unit Linz, Linz Institute of Technology Artificial Intelligence Lab, Institute for Machine Learning, Johannes Kepler University
| | - Carl Böck
- JKU LIT SAL eSPML Lab, Institute of Signal Processing, Johannes Kepler University Linz, Altenberger Straße 69, Linz
| | - Alexander Maletzky
- Research Unit Medical Informatics, RISC Software GmbH, Hagenberg i. M., Austria
| | - Philipp Moser
- Research Unit Medical Informatics, RISC Software GmbH, Hagenberg i. M., Austria
| | - Stefan Thumfart
- Research Unit Medical Informatics, RISC Software GmbH, Hagenberg i. M., Austria
| | | | - Sepp Hochreiter
- European Laboratory for Learning and Intelligent Systems Unit Linz, Linz Institute of Technology Artificial Intelligence Lab, Institute for Machine Learning, Johannes Kepler University
| | - Jens Meier
- Johannes Kepler University Linz, Kepler University Hospital, Department of Anesthesiology and Critical Care Medicine
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Slagman A, Fischer-Rosinský A, Legg D, Schmieder K, Möckel M. Identification of low-acuity attendances in routine clinical information documented in German Emergency Departments. BMC Emerg Med 2023; 23:64. [PMID: 37280527 DOI: 10.1186/s12873-023-00838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION It has not yet been possible to ascertain the exact proportion, characterization or impact of low-acuity emergency department (ED) attendances on the German Health Care System since valid and robust definitions to be applied in German ED routine data are missing. METHODS Internationally used methods and parameters to identify low-acuity ED attendances were identified, analyzed and then applied to routine ED data from two EDs of the tertiary care hospitals Charité-Universitätsmedizin Berlin, Campus Mitte (CCM) and Campus Virchow (CVK). RESULTS Based on the three routinely available parameters `disposition´, `transport to the ED´ and `triage´ 33.2% (n = 30 676) out of 92 477 presentations to the two EDs of Charité-Universitätsmedizin Berlin (CVK, CCM) in 2016 could be classified as low-acuity presentations. CONCLUSION This study provides a reliable and replicable means of retrospective identification and quantification of low-acuity attendances in German ED routine data. This enables both intra-national and international comparisons of figures across future studies and health care monitoring.
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Affiliation(s)
- Anna Slagman
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Antje Fischer-Rosinský
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - David Legg
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kristin Schmieder
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin Möckel
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Schleef T, Engeleit K, Krause O, Schneider N. Allgemeinmedizinische Behandlungsfälle in einer universitären Notaufnahme vor und nach Einführung eines strukturierten Ersteinschätzungssystems. Med Klin Intensivmed Notfmed 2022:10.1007/s00063-022-00950-4. [DOI: 10.1007/s00063-022-00950-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/05/2022] [Accepted: 07/31/2022] [Indexed: 12/01/2022]
Abstract
Zusammenfassung
Hintergrund
In einer universitären Notaufnahme werden Patienten mit niedriger Behandlungsdringlichkeit und allgemeinmedizinisch-internistischen Beschwerden werktags durch Allgemeinärzte versorgt. Zur Festlegung der Behandlungsdringlichkeit wurde der Emergency Severity Index (ESI) eingeführt.
Ziel der Arbeit
Ziel war es, die Auswirkung der ESI-Einführung auf die Zusammensetzung des allgemeinmedizinischen Patientenkollektivs zu untersuchen sowie die Verteilung der ESI-Kategorien bei diesen Patienten darzustellen.
Methodik
Vergleich der allgemeinmedizinisch versorgten Patienten je 6 Monate vor (t0) und nach (t1) ESI-Einführung basierend auf Routinedaten und einem vom Allgemeinarzt auszufüllenden Erhebungsbogen. Die Analyse erfolgte deskriptiv und mittels χ2-Test bzw. t‑Test.
Ergebnisse
Es wurden 615 Behandlungsfälle in t0 und 751 Fälle in t1 ausgewertet. Dabei zeigten sich keine signifikanten Unterschiede hinsichtlich des Alters, des Geschlechts, des Anteils der mit ärztlicher Einweisung vorstelligen Patienten oder der stationären Aufnahmen. Die ESI-Einstufung erfolgte überwiegend in die niedrigen Dringlichkeitskategorien ESI 5 (37 %) und ESI 4 (46 %), bei 8 % der Patienten in ESI 3 bzw. 2. Der prognostizierte Ressourcenbedarf stimmte für 76 % der Patienten in ESI 5, für 36 % in ESI 4 und für 44 % der Patienten in ESI 3 überein. Für 3 % der ESI-5-Patienten und 7 % der ESI-4-Patienten war eine stationäre Aufnahme erforderlich.
Diskussion
Auch bei niedriger Behandlungsdringlichkeit kann eine stationäre Aufnahme indiziert sein, zudem weisen Abweichungen vom prognostizierten Ressourcenbedarf auf Triagierungsprobleme im untersuchten Patientenkollektiv hin. Zur Steuerung von Patienten in Versorgungsstrukturen außerhalb der Notaufnahme scheint die ESI-Ersteinschätzung nicht geeignet.
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Notfallversorgung – Reformbedarf aus ambulanter Sicht. DIE INNERE MEDIZIN 2022; 63:905-913. [PMID: 35925125 PMCID: PMC9399008 DOI: 10.1007/s00108-022-01382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/05/2022]
Abstract
Seit Jahren stehen Reformen der Akut- und Notfallversorgung auf der gesundheitspolitischen Agenda. So auch im aktuellen Koalitionsvertrag. Zur Einordnung der Ausgangslage werden ein inhaltlicher Rückblick sowie eine Analyse der Abrechnungsdaten aus der ambulanten und stationären Notfallversorgung vorgenommen. Folgt man der Hypothese, dass bisherige Reformansätze insbesondere auf einen Anstieg ambulant vertragsärztlich behandelbarer Fälle in der Notfallversorgung reagierten, muss die Fallzahlentwicklung in der Dekade bis zum Pandemiebeginn (2010–2019) zur Kenntnis genommen werden. Sie zeigt eine Stagnation der Fallzahl in Notaufnahmen und einen seit 2016 rückläufigen Trend insbesondere bei ambulanten Notfallbehandlungen durch Krankenhäuser. Dieser Effekt kann nicht zweifelsfrei auf bereits eingeführte Maßnahmen zur Patientensteuerung (Bereitschaftspraxen, Telefontriage) zurückgeführt werden. Die Analyse der Abrechnungsdiagnosen spricht dafür, dass eine klare Arbeitsteilung zwischen Bereitschaftspraxen und Notaufnahmen besteht. Die konsistente Verlagerung der Fälle hochbetagter Patienten in die ambulante Versorgung durch Notaufnahmen legt aber eine notwendige Weiterentwicklung dieser Arbeitsteilung nahe. Weitere Maßnahmen der Steuerung durch Weiterleitung von Patienten aus Notaufnahmen in die vertragsärztliche Versorgung müssen noch im Detail beschlossen und umgesetzt werden (§ 120 Abs. 3b Sozialgesetzbuch [SGB] V). In der Diskussion wird die Auffassung vertreten, dass Implementierung und Evaluation dieser Maßnahmen abgewartet werden sollten, bevor weitergehende Reformschritte ergriffen werden.
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9
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Lindner T, Campione A, Möckel M, Henschke C, Dahmen J, Slagman A. [Direct admission of patients to doctors' offices by prehospital emergency services-an effective method to relieve emergency departments? : Analysis of routine pre- and in-hospital emergency data]. Med Klin Intensivmed Notfmed 2022; 117:447-456. [PMID: 34468771 PMCID: PMC8408819 DOI: 10.1007/s00063-021-00860-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/17/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the 2018 advisory opinion concerning the realignment of healthcare, it is advocated that in order to relieve pressure on emergency departments (ED) prehospital medical emergency services should be given the option to directly transport suitable patients to doctors' offices. OBJECTIVES To determine the prevalence of patients treated by prehospital emergency services that have the potential to be directly allocated to a primary care provider. MATERIALS AND METHODS Preclinical and clinical data of adult patients who in a 2-month period were transported to the ED of a university hospital by an ambulance were evaluated. To determine a safe and meaningful transport directly to a doctor's office, a stepwise assessment was carried out: patients were categorized on the basis of the prehospital assessment of urgency as "urgent" (contact to doctor necessary within a maximum time of 30 min) and "less urgent" (contact to doctor not necessary within 30 min, maximum 120 min). "Less urgent" patients were further divided and those treated as outpatients were identified. This group was further restricted to cases whose administrative reception in the ED was documented Monday-Friday between 8 am and 7 pm. In addition, these cases were further differentiated with regard to medical content and compared with the triage results in the ED (Manchester Triage, MTS). RESULTS In all, 1260 patients were brought to the ED by ambulance within the study period (total number of patients treated in this time period n = 11,506); 894 cases had a documented prehospital level of urgency and could therefore be included. Of these n = 477 (53.4%) were categorized as "less urgent"; 317 (66.5%) of these "less urgent" cases were treated as outpatients in the ED, and n = 114 (23.9%) in a time frame potentially suitable for direct transport to doctors' offices, which is 1% of all patients treated in the ED in the time period examined. However, 70 of the cases suitable for doctors' office (63.6% of n = 110 with documented MTS) were rated more urgent in the ED. With regards to prehospital complaints and documented diagnosis we assume employment of a relevant amount of resources in the treatment of these cases. CONCLUSIONS EDs could be relieved from every tenth patient brought in by prehospital emergency services (1% of all patients treated) during normal offices hours by direct allocation to doctors' offices. Regarding patient's safety this process however has to be seen critically as > 60% of these cases were potentially undertriaged. Necessary resources for diagnostics and treatment have to be available in the doctors' offices and known to prehospital emergency services. Primary assignment of patients to doctors' offices by prehospital emergency can only relieve urban EDs to a negligible extent, is potentially dangerous and linked to a tremendous logistic effort.
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Affiliation(s)
- Tobias Lindner
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Alessandro Campione
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Cornelia Henschke
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Janosch Dahmen
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
| | - Anna Slagman
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland
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10
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Cost effects of nurse led triage at an emergency department with the advice to consult the adjacent general practice cooperative for low-risk patients, a cluster randomised trial. Health Policy 2022; 126:980-987. [DOI: 10.1016/j.healthpol.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022]
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11
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Oslislo S, Kümpel L, Resendiz Cantu R, Heintze C, Möckel M, Holzinger F. Redirecting emergency medical services patients with unmet primary care needs: the perspective of paramedics on feasibility and acceptance of an alternative care path in a qualitative investigation from Berlin, Germany. BMC Emerg Med 2022; 22:103. [PMID: 35690710 PMCID: PMC9187922 DOI: 10.1186/s12873-022-00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Against the backdrop of emergency department (ED) overcrowding, patients’ potential redirection to outpatient care structures is a subject of current political debate in Germany. It was suggested in this context that suitable lower-urgency cases could be transported directly to primary care practices by emergency medical services (EMS), thus bypassing the ED. However, practicality is discussed controversially. This qualitative study aimed to capture the perspective of EMS personnel on potential patient redirection concepts. Methods We conducted qualitative, semi-structured phone interviews with 24 paramedics. Interviews were concluded after attainment of thematic saturation. Interviews were transcribed verbatim, and qualitative content analysis was performed. Results Technical and organizational feasibility of patients’ redirection was predominantly seen as limited (theme: “feasible, but only under certain conditions”) or even impossible (theme: “actually not feasible”), based on a wide spectrum of potential barriers. Prominently voiced reasons were restrictions in personnel resources in both EMS and ambulatory care, as well as concerns for patient safety ascribed to a restricted diagnostic scope. Concerning logistics, alternative transport options were assessed as preferable. Regarding acceptance by stakeholders, the potential for releasing ED caseload was described as a factor potentially promoting adoption, while doubt was raised regarding acceptance by EMS personnel, as their workload was expected to conversely increase. Paramedics predominantly did not consider transporting lower-urgency cases as their responsibility, or even as necessary. Participants were markedly concerned of EMS being misused for taxi services in this context and worried about negative impact for critically ill patients, as to vehicles and personnel being potentially tied up in unnecessary transports. As to acceptance on the patients’ side, interview participants surmised a potential openness to redirection if this would be associated with benefits like shorter wait times and accompanied by proper explanation. Conclusions Interviews with EMS staff highlighted considerable doubts about the general possibility of a direct redirection to primary care as to considerable logistic challenges in a situation of strained EMS resources, as well as patient safety concerns. Plans for redirection schemes should consider paramedics’ perspective and ensure a provision of EMS with the resources required to function in a changing care environment. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00660-2.
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Affiliation(s)
- Sarah Oslislo
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Rebecca Resendiz Cantu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
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12
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de Barros LB, Caldas LP, Bohomol E, Sarantopoulos A, Minatogawa V, Gasparino RC. Evaluation of Waste Related to the Admission Process of Low-Complexity Patients in Emergency Services, in Light of the Lean Healthcare Philosophy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127044. [PMID: 35742293 PMCID: PMC9223152 DOI: 10.3390/ijerph19127044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022]
Abstract
The adequacy of work processes in healthcare services contributes to the quality of care provided to the patient. However, in emergency units, overcrowding is a constant reality, resulting in the lack of materials and long waiting lines. Taking this into consideration, this study aimed to map and analyze the value stream of patients classified as blue, green, or yellow in a Referral Emergency Unit. The evaluation research with analysis of processes was carried out in a teaching hospital on 30 patients seen at the emergency service. Value Stream Maps were drawn and the times involved in the process were calculated. Wastes and their possible causes were identified. A total of 13 maps were created and the mean process time between the activities involved in the process ranged between 7.3′ and 114.0′; the interruption time, between 0′ and 27.6′; the waiting time, between 43.2′ and 507.5′; and the lead time between 56.6′ and 638.0′ min. Some causes of waste were: high demand from patients; a shortage of personnel and offices. Following the Ishikawa Diagram, most of the waste is found regarding methods, human resources, and physical structure.
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Affiliation(s)
| | - Laura Passos Caldas
- School of Nursing, Pontíficia Universidade Católica de Campinas, Campinas 13087-571, Brazil;
| | - Elena Bohomol
- School of Nursing, Federal University of São Paulo, São Paulo 04024-002, Brazil;
| | | | - Vinicius Minatogawa
- Escuela de Ingeniería de Construcción y Transporte, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340000, Chile;
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13
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Cotte F, Mueller T, Gilbert S, Blümke B, Multmeier J, Hirsch MC, Wicks P, Wolanski J, Tutschkow D, Schade Brittinger C, Timmermann L, Jerrentrup A. Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study. JMIR Mhealth Uhealth 2022; 10:e32340. [PMID: 35343909 PMCID: PMC9002590 DOI: 10.2196/32340] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/17/2021] [Accepted: 02/18/2022] [Indexed: 01/29/2023] Open
Abstract
Background Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments. Objective The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED. Methods The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app’s urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs). Results Of 378 participants, 344 (91%) were triaged the same or more conservatively and 34 (8.9%) were undertriaged by the app. Of the 378 patients, 14 (3.7%) had received safe advice determined by the expert panel and 20 (5.3%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all. Conclusions The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Trial Registration German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00024909
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Affiliation(s)
- Fabienne Cotte
- Charité Universitäsmedizin Berlin, Berlin, Germany.,Department of Emergency Medicine, University Clinic Marburg, Philipps-University, Marburg, Germany.,Ada Health GmbH, Berlin, Germany
| | - Tobias Mueller
- Center for Unknown and Rare Diseases, UKGM GmbH, University Clinic Marburg, Philipps-University, Marburg, Germany
| | - Stephen Gilbert
- Ada Health GmbH, Berlin, Germany.,Else Kröner Fresenius Center for Digital Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | | | - Martin Christian Hirsch
- Ada Health GmbH, Berlin, Germany.,Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
| | | | | | - Darja Tutschkow
- Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Germany, Marburg, Germany
| | - Carmen Schade Brittinger
- Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Germany, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Andreas Jerrentrup
- Department of Emergency Medicine, University Clinic Marburg, Philipps-University, Marburg, Germany
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14
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Dickson SJ, Dewar C, Richardson A, Hunter A, Searle S, Hodgson LE. Agreement and validity of electronic patient self-triage (eTriage) with nurse triage in two UK emergency departments: a retrospective study. Eur J Emerg Med 2022; 29:49-55. [PMID: 34545027 DOI: 10.1097/mej.0000000000000863] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Triage and redirection of patients to alternative care providers is one tool used to overcome the growing issue of crowding in emergency departments (EDs). Electronic patient self-triage (eTriage) may reduce waiting times and required face-to-face contact. There are limited studies into its efficacy, accuracy and validity in an ED setting. OBJECTIVES The aim of this study was to assess the agreement and validity of eTriage with a reference standard of nurse face-to-face triage. A secondary aim was to assess the ability of both systems to predict high and low acuity outcomes. DESIGN This was a retrospective study conducted over 8 months in two UK hospitals. Inclusion criteria were all ambulatory patients aged ≥18. All patients completed an eTriage and nurse-led triage using the Manchester Triage System (MTS). MAIN RESULTS During the study period, 43 788 adult patients attended one of the two ED sites and 26 757 used eTriage. A total of 1424 patient episodes had no recorded MTS and were excluded from the study leaving 25 333 paired triages for the final cohort. Agreement between eTriage and nurse triage was low with a weighted Kappa coefficient of 0.14 (95% CI, 0.14-0.15) with an associated weak positive correlation (rs 0.321). Level of undertriage by eTriage compared with nurse triage was 10.1%, and overtriage was 59.2%. The sensitivity for prediction of high acuity outcomes was 88.5% (95% CI, 77.9-95.3%) for eTriage and 53.8% (95% CI 41.1-66.0%) for nurse MTS. The specificity for predicting low risk patients was 88.5% (95% CI, 87.4-89.5%) for eTriage and 80.6% (95% CI, 79.3-81.8%) for nurse MTS. CONCLUSION Agreement and correlation of eTriage with the reference standard of nurse MTS was low; patients using eTriage tended to over triage when compared to the triage nurse. eTriage had a higher sensitivity for high acuity presentations and demonstrated similar specificity for low acuity presentations when compared to triage nurse MTS. Further work is necessary to validate eTriage as a potential tool for safe redirection of ED attenders to alternative care providers.
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Affiliation(s)
- Sarah J Dickson
- Emergency Department, University Sussex Hospitals NHS Foundation Trust, Worthing
| | - Colin Dewar
- Emergency Department, University Sussex Hospitals NHS Foundation Trust, Worthing
| | | | - Alex Hunter
- Intensive Care Department, University Sussex Hospitals NHS Foundation Trust, Worthing
| | - Steve Searle
- Emergency Department, University Sussex Hospitals NHS Foundation Trust, St Richards Hospital, Chichester
| | - Luke E Hodgson
- Intensive Care Department, University Sussex Hospitals NHS Foundation Trust, Worthing
- University of Surrey Faculty of Health and Medical Sciences, Department of Clinical and Experimental Medicine, Guildford, UK
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15
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Gräff I, Pin M. [Primary assessment in the emergency department]. Dtsch Med Wochenschr 2021; 146:1543-1546. [PMID: 34826841 DOI: 10.1055/a-1059-1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
First goal in an emergency department must be the immediate recognition of patients at risk. The primary success of therapy depends mainly on whether a critical risk is identified immediately upon arrival at the central emergency department and appropriate therapy is initiated. In order to identify critical patients among the many patients with a wide range of diseases and, nurse-assisted initial assessment systems can help. The assessment thus represents a complex decision-making process to identify critically ill patients in times of high patient volume and limited resources.
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Affiliation(s)
- Ingo Gräff
- Abteilung Klinische Akut- und Notfallmedizin, Universitätsklinikum Bonn
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus Düsseldorf
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16
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Prävalenz und Ursachen von Fehltriagierung am Beispiel einer universitären Notaufnahme. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Pabst D, Schibensky J, Fistera D, Riße J, Kill C, Holzner C. [Risk management in the triage of emergency room patients to outpatient care : Manchester Triage System and CEReCo-blue as a tool for low-risk patient management in integrated emergency centers]. Med Klin Intensivmed Notfmed 2021; 117:410-418. [PMID: 34448886 PMCID: PMC9452430 DOI: 10.1007/s00063-021-00853-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/21/2021] [Accepted: 07/03/2021] [Indexed: 11/25/2022]
Abstract
Hintergrund Zur frühzeitigen Entscheidung in zukünftigen „Integrierten Notfallzentren“, ob eine ambulante oder innerklinische Versorgung indiziert ist, wäre es hilfreich, ein System zu haben, mit dem die Identifizierung von Patienten mit ambulanter Behandlungsindikation möglich ist. In dieser Studie untersuchten wir, ob das Manchester Triage System (MTS) dafür geeignet ist, Patienten zu erkennen, die sicher der ambulanten medizinischen Versorgung zugeteilt werden können. Methode Notaufnahmepatienten der „blauen“ MTS-Dringlichkeitsstufe wurden auf den Endpunkt „stationäre Aufnahme“ untersucht und mit der nächsthöheren MTS-Kategorie „grün“ verglichen. In einem zweiten Schritt wurde die „blaue“ Dringlichkeitsstufe auf die häufigsten gemeinsamen Kriterien untersucht, die zur stationären Aufnahme führten. Ergebnisse Nach Ausschluss von Patienten, die durch den Rettungsdienst oder nach vorherigem Arztbesuch vorstellig wurden, war die Rate der stationären Aufnahmen in der blauen Dringlichkeitsstufe signifikant niedriger als in der grünen Kategorie (10,8 % vs. 29,0 %). Die Rate konnte durch die Etablierung einer Untergruppe mit den zusätzlichen Ausschlusskriterien chronische Erkrankung und Wiedervorstellung nach vorheriger stationärer Behandlung auf 0,9 % gesenkt werden. (CEReCo-blue-Gruppe: Chronic Disorder (C), Emergency Medical Service (E), Readmission (R), Prior Medical Consultation (Co)). Schlussfolgerung Die blaue MTS-Dringlichkeitsstufe scheint zur Selektion von Patienten mit ambulanter Behandlungsindikation nicht geeignet zu sein. Wir schlagen die Einführung einer Untergruppe, der sog. CEReCo-blue-Gruppe vor, die für die Selektion dieser Patientengruppe hilfreich sein könnte.
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Affiliation(s)
- Dirk Pabst
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Jonas Schibensky
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - David Fistera
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Joachim Riße
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Clemens Kill
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Carola Holzner
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Schleef T, Schneider N, Krause O. Allgemeinmedizin in der Notaufnahme – Welche Patienten? Welche Beschwerden? Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00923-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Zusammenfassung
Hintergrund
Vor dem Hintergrund des zunehmenden Anteils ambulant verbleibender Patienten wurde die Fachdisziplin Allgemeinmedizin in die zentrale Notaufnahme (ZNA) einer Universitätsklinik integriert. In der ZNA werden der Allgemeinmedizin diejenigen Patienten zugewiesen, die sich mit Beratungsanlässen aus dem allgemeinmedizinischen Spektrum vorstellen sowie bei Ersteinschätzung eine niedrige Behandlungsdringlichkeit aufweisen. Ziel war es, diese Patienten hinsichtlich ihrer Beratungsanlässe zu charakterisieren.
Methodik
Deskriptive Auswertung auf Basis der klinischen Routinedaten sowie eines selbst entwickelten Erhebungsbogens.
Ergebnisse
Etwa 80 % der Patienten suchten die Notaufnahme ohne ärztliche Einweisung auf. Die fünf häufigsten Beratungsanlässe waren Bauchschmerzen, Rückenschmerzen, Brustschmerzen, Schmerzen der unteren Extremitäten sowie Übelkeit und/oder Erbrechen. Bei knapp 25 % der Patienten setzten die Beschwerden erst am Tag der Vorstellung ein, bei etwa 33 % bestanden diese seit mehr als einer Woche. Die Hälfte der Patienten war wegen der Beschwerden bereits in ambulanter ärztlicher Behandlung, bei Patienten mit einer Beschwerdedauer von länger als einer Woche lag dieser Anteil bei mehr als 80 %. Patienten mit den Beratungsanlässen Fieber oder Verschlechterung des Allgemeinzustands wurden anteilig am häufigsten stationär aufgenommen. Von den Selbstzuweisern konnten knapp 94 % in die ambulante Versorgung entlassen werden.
Diskussion
Patienten suchen auch mit nichtakuten Beschwerden und trotz vorangegangener ambulanter ärztlicher Behandlung die Notaufnahme auf. Die häufigsten Beratungsanlässe allgemeinmedizinisch versorgter Patienten in der ZNA decken sich nur zum Teil mit denen der hausärztlichen Versorgung.
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Mayerhofer C, Rettl H, Graziadei I, Stummer H. [Assessment of validity of the German version of the Manchester Triage System]. Med Klin Intensivmed Notfmed 2021; 117:283-288. [PMID: 33877424 DOI: 10.1007/s00063-021-00813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/07/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Manchester Triage System (MTS) was first introduced in 1996. Since then, the original English MTS version has undergone multiple evaluations of its validity and reliability. Due to translation and differing algorithms, only contradictory data regarding accuracy are available for the German MTS version. The aim of this study was to assess the validity of the current German version of the MTS in a retrospective observational setting. MATERIALS AND METHODS All surgical and medical patients presenting at the emergency department of an Austrian regional hospital between 1 and 30 July 2020 were included in this study. Data of vital parameters at the time of triage, overall hospitalisation rate, length of hospitalisation, mortality rate as well as referral and discharge modalities were collected. RESULTS A total of 773 patients were included in the study after primary triage. There was a significant correlation between risk level and both hospitalisation rate (p < 0.001) and the length of hospitalisation (p = 0.001). Interestingly, this correlation was lower in patients over 70 years (r2 = 0.101 vs. 0.045). Vital signs and mortality rate did not correlate significantly with the initial risk level. The average time for one triage process was 2.1 ± 3.9 min. CONCLUSION The German version of the MTS shows good correlation with central risk surrogates, but this correlation is weaker in the subgroup of elderly patients. As the original English version, it does not predict long-term mortality. In clinical practice, the German version of the MTS is as good as the original version in enabling the urgency of treatment to be rapidly assessed so that resource allocation can be optimised.
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Affiliation(s)
- C Mayerhofer
- Institut für Management und Ökonomie im Gesundheitswesen, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Österreich.
| | - H Rettl
- Abteilung für Qualitäts- und Risikomanagement, Landeskrankenhaus Hall in Tirol, Hall in Tirol, Österreich
| | - I Graziadei
- Abteilung für Innere Medizin, Landeskrankenhaus Hall in Tirol, Hall in Tirol, Österreich
| | - H Stummer
- Institut für Management und Ökonomie im Gesundheitswesen, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Österreich
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20
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Reinhold AK, Greiner F, Schirrmeister W, Walcher F, Erdmann B. [Even low-acuity patients prefer hospital-based emergency care : A survey of non-urgent patients in an emergency department with unique regional position]. Med Klin Intensivmed Notfmed 2020; 116:511-521. [PMID: 32291507 DOI: 10.1007/s00063-020-00681-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/10/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Besides increasing numbers of cases in German emergency departments (ED), the spectrum of attending patients is also changing. Patients with acute illnesses tend to prefer EDs to ambulatory care as primary contact point. This study examines the motives for use and use behavior of low-urgent ED-patients. METHODS Anonymous patient survey in the ED of Wolfsburg Hospital between 12/2015 and 03/2016 with descriptive analysis. All patients with low urgency (Manchester-Triage-System (MTS), levels blue and green) were eligible. RESULTS 81.5% of respondents (729 evaluable out of 7000 questionnaires distributed) attended the ED between 8:00 a. m. and 5:00 p. m., 70.1 % of them were walk-in patients. The motive most frequently cited was that they would receive better care in the ED (48.3 %). Contrary to acuity assessment, 67.8 % of respondents considered themselves a medium to life-threatening emergency. As alternative option, 49.2 % would choose a nearby clinic in the region for their complaints. CONCLUSION Self-assessed urgency differs with acuity assessment according to MTS. Patients who fear an acute threat to their health do not use services provided in the ambulatory sector such as the emergency practice of the Association of Statutory Health Insurance Physicians in the immediate proximity sufficiently. Previous approaches for patient navigation do not seem to be successful in this setting. Strengthening of EDs as a single 24/7 access point for emergency care with simultaneous abolition of parallel care structures should be discussed.
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Affiliation(s)
- A K Reinhold
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - F Greiner
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - W Schirrmeister
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - F Walcher
- Medizinische Fakultät, Universitätsklinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - B Erdmann
- Zentrale Notfallaufnahme, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440, Wolfsburg, Deutschland.
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21
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Graf von Stillfried D, Czihal T, Meer A. Sachstandsbericht: Strukturierte medizinische Ersteinschätzung in Deutschland (SmED). Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0627-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Zusammenfassung
Ab 01.01.2020 müssen die Kassenärztlichen Vereinigungen eine telefonische Ersteinschätzung im 24/7-Betrieb anbieten. Ziel ist die Ersteinschätzung der Dringlichkeit akuter Beschwerden und eine Vermittlung an die angemessene Versorgungsstufe. Sehr schwer kranke Patienten müssen unmittelbar der Notfallversorgung, weniger oder nicht dringliche Anliegen alternativen Versorgungsangeboten zugeführt werden. Diese anspruchsvolle Aufgabe werden Fachpersonen übernehmen, die durch geeignete Software unterstützt werden. Im Ausland existieren hierfür Vorbilder. Das Zentralinstitut für die kassenärztliche Versorgung (Zi) überträgt gemeinsam mit der Health Care Quality System GmbH (HCQS) das in Teilen der Schweiz bereits angewendete Swiss Medical Assessment System (SMASS) für eine Anwendung in Deutschland. Das System soll unter dem Namen Strukturierte medizinische Ersteinschätzung in Deutschland (SmED) im Jahr 2019 in den Arztrufzentralen unter der Nummer 116117 eingeführt werden. Auch eine Anwendung für den sogenannten „gemeinsamen Tresen“ von Bereitschaftsdienstpraxen und Krankenhausnotaufnahmen wird entwickelt. Beide Anwendungen werden in dem vom Innovationsfonds geförderten DEMAND-Projekt evaluiert. Die Entwicklung von SmED erfolgt unter Einbeziehung von Vertretern des Marburger Bundes sowie der Deutschen Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA) und Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI). Eine technische Integration mit der 112 ist in Arbeit.
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