Every 5th patient wrong in the emergency department

Too many patients are treated in the emergency department

09/11/2013

A recent study shows that hospital casualty appears to be used by too many patients. About every fifth patient is mistaken in the emergency room.

About 20 percent in the emergency department wrong
According to a study, about 20 percent of patients who have been treated in an emergency room at a hospital could have been treated elsewhere. The examination with nearly 5,000 patients was presented yesterday at the meeting of the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) in Hamburg. In addition, there is a trend that generally more patients come to the emergency rooms. About a quarter of the German population search for projections of the DGINA at least once a year on an emergency room.

Often family doctors would be sufficient
For the current survey of Hamburg hospitals, the physicians evaluated data from 4,927 patients who were treated for a period of 16 days. The patients came both by ambulance and by instruction of general practitioners or on their own. As Michael Wünning, spokesman of the Association of Chief Physicians of interdisciplinary emergency departments in Hamburg, said, for seven percent of these patients actually other physicians such as family doctors or emergency services were directly available.

Patients misjudge complaints
These doctors could also have been reached in ten percent of cases within a reasonable time. „If I wake up with a cough at four o'clock in the morning, in most cases it is probably reasonable to wait for a doctor to open up“, so DGINA conference president Wünning. The severity of the complaints had been misjudged in three percent of the cases of patients or had merely been in need of nursing measures, such as a wound dressing.

No blame
The investigations are not about blaming, but they should be an inventory, so as not to have to act after a gut feeling. So far, there are no comparative figures from previous years. „There are reasons why patients act that way, they obviously have worries and understandable suffering. Of course they will be treated with us. But we have to adapt to them with our structures“, so Wünning from the Catholic Marienkrankenhaus.

Specialist in emergency medicine demanded
From the point of view of emergency physicians, the problem of emergency rooms is a consequence of decades of neglecting their field of specialization. Both in 16 EU Member States, as well as in the US, there is a specialist in emergency medicine. In Germany, however, several disciplines traditionally feel called upon to provide quick help. The aim of the DGINA is to change this gradually. DGINA President Christoph Dodt of the Munich Municipal Clinical Office, as an intermediate step towards becoming a specialist in emergency medicine, is hoping to be able to create an additional qualification for specialists with two years of additional training by 2015. The training as a specialist should be five years. Barbara Hogan, president of the European Society for Emergency Medicine (Eusem), is convinced that her own specialist would also benefit the patient, because the emergency physicians are experts in all acute diseases and could either act on their own or quickly become the right specialist Bring patients.

Emergency doctor questioned
Above all, the emergency physicians must convince the doctors in the medical parliaments of the federal states, the medical doctors and the medical associations if they want to achieve their goal of having their own specialist. Therefore, one possible incentive would be that the Panel Medical Associations, which are responsible for on-call and emergency medical services, are finding it increasingly difficult to fill these posts. A way out could be a centralized concentration of emergency care at clinics that DGINA President spoke at the meeting. However, the discussion about a specialist in emergency medicine also calls into question another German peculiarity: the emergency doctor who comes to the patient. In many countries worldwide, the patient is being transported to the doctor by well-trained rescue personnel, and in view of the medical resource problems, the question is how long it will be in this country that doctors also come to the patients.

Financial shortage
At the meeting, the DGINA also complained one „gross underfunding.“ According to projections, at least 21 million such treatments were performed annually, but this included the number of patients hospitalized after treatment. Pawls could redeem an average of 30 euros for outpatient treatment at legally insured fees. However, the real average cost is expected to be between € 120 and € 150 per treatment. Therefore, the company demands a lump sum that covers the actual costs incurred. Timo Schöpke of the Vivantes Klinikum am Urban estimated that at least one billion euros in the annual emergency coverage in German emergency rooms. (Ad)