Emergency care reform must improve patient management

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Written By Kampretz Bianca

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Berlin – The reform of emergency care in Germany should mainly lead to better patient management. In addition to a uniform initial assessment procedure, a hotline strategy should also be used and telemedicine should be strengthened. These are the central recommendations of a report commissioned by the National Association of Statutory Health Insurance Practitioners (KBV) in Aqua Institute and the Institute and Polyclinic of General Medicine at the University Hospital Hamburg-Eppendorf (UK) was made.

The recommendations are based on a review of emergency care in England, Denmark and the Netherlands. Today the results of the report were discussed at a KBV symposium in the context of the emergency reform that the Federal Ministry of Health (BMG) recently released.

Deputy Chairman of the KBV Board of Management Stephan Hofmeister summarized the report’s most important statements. “All three countries examined apply the same basic principle for care outside of training hours,” he said. “Firstly, this includes a hotline strategy, i.e. the initial assessment by telephone. It is the prerequisite for the patient to demonstrate the need for intensive care, a type of accreditation.”

Based on this, allocation to an appropriate level of care occurs. “This could be an emergency practice, an emergency outreach service, or even telemedical care,” says Hofmeister. “In the three countries, the care units responsible for the respective case, including emergency services, can access the results of the initial assessment, avoiding duplication of inquiries and ensuring a continuous and standardized flow of information.”

“Hard door” in other health systems

“We could say that in other countries the same principle applies to care during non-appointment hours that Berlin clubbers are also familiar with, namely the ‘hard door’ principle,” continued Hofmeister. “No one enters who has not been properly evaluated beforehand. This may seem impolite at first glance, but in my opinion it is essential if we are to reduce the ever-widening gap between the demand for medical services at any time and everywhere, on the one hand, and limited human and financial resources, on the other. another, in control.”

The emergency bill aims to “ease the burden on emergency rooms and emergency services through more precise control and to refer patients who can be treated on an outpatient basis to an appropriate care structure at all times.” To achieve this goal, KVs must be required to consistently provide telemedical and outpatient care.

The previous tasks of the consultation centers in the area of ​​acute referral will in future be carried out by the so-called KVen acute control centers. These must be networked with the rescue control centers in a “health control system”, through which the digital transfer of cases with transmission without means of communication of already collected data must be possible.

Emergency law only enters the cabinet in August

Federal Health Minister Karl Lauterbach (SPD) recently announced that a reform of emergency services was also planned, but that this should not be included in any separate law. Instead, the content is expected to be incorporated into the emergency law through amendments. The head of the health and health insurance department at BMG, Michael Weller, also indicated this approach at KBV today. He expressed confidence that the government will be able to complete the emergency reform and emergency services reform in this legislature. However, according to Weller, the emergency law will not be discussed in the cabinet in July, as was initially planned, but rather in August.

Emergency reform must be addressed at the same time as hospital reform, as both areas are interconnected. If regulations for emergency services reform were included in the cabinet’s emergency bill, which is then presented to the cabinet in August, “we are on schedule,” Weller said. So there is still enough time for parliamentary procedure after the summer holidays. The emergency law then has a realistic chance of being published in the Official Gazette of the Union in 2025.

Don’t leave the decision to citizens

Hofmeister emphasized that there are already good structures in Germany with KVen service points. “With the national system number KV 116117, we have a comprehensive offer in Germany that enables a hotline strategy,” he said. “But these structures still need to be expanded and scaled.” Today, KVs mainly finance their own service points. This is too small in terms of scale. “If we want to make such an offer to the entire population 24 hours a day, we need structural financing that must be initiated by the legislator,” Hofmeister emphasized.

He explained how KBV envisions managing patients in emergency care in the future. “We are not demanding that patients no longer have access to emergency care. Everyone should be heard. And we want to make you an offer in return. But experts must then decide what care is appropriate. We cannot leave this decision to the citizens. Because they can’t make that decision.”

Drawing numbers in the emergency room shows poor control

UKE’s Martin Scherer, one of the report’s authors, criticized the fact that low-threshold access to the emergency care system is now being undermined. He reported a case in which a patient urgently needed emergency medical care, but she had to draw a number like all the other patients in the emergency room of the hospital she was going to.

“This shows that our patient management in Germany is not good today,” he said. “An upstream mechanism with an initial assessment and a digital archive would have been very helpful here.” He called for prioritization in emergency rooms, where patients who need medical help with particular urgency are identified.

Fast track regulation for urgent cases

BMG’s Weller highlighted that a corresponding fast track regulation was foreseen in the emergency bill. A regulation should be found for preferential treatment of patients who are in urgent need of treatment.

“This is exactly what the result of the initial telephone assessment might be,” Hofmeister said, “that a patient is classified as priority 1 and sent directly to the hospital. By preferential treatment I mean that this patient is treated immediately in the hospital and no longer needs to carry a number.”

More telemedicine in emergency care

The report’s authors further emphasize that initial assessment procedures in emergency care are intended to determine the urgency of further treatment. “The assessment of urgency and need for care creates the basis for a tiered model of acute and emergency care and therefore for the efficient and needs-based use of hospital emergency room resources, legal health insurance offers outside of appointment times and standard care,” they write. “A comprehensive and uniform initial assessment procedure should be the basis for guiding patients to the appropriate care structure.”

In order to ease the burden on the mobile emergency service and on-site contact points for emergency outpatient care, the report authors also suggest strengthening the role of telemedicine. The possibility of utilizing telemedicine prior to a potential walk-in consultation or in-person presentation should also be considered. In England, a strategy that prioritizes telemedicine has resulted in up to 40 percent of cases being transferred from outpatient emergency services to telemedicine or equivalent emergency practices.

The report authors also recommend that appointment scheduling be made possible by primary care outpatient emergency care units to ensure uninterrupted additional treatment. In order to ease the burden on medical personnel in emergency services and ensure comprehensive care, the use of non-medical personnel such as community emergency paramedics should also be increased. © fos/aerzteblatt.de

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