It takes courage to change

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Written By Kampretz Bianca

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Berlin/Frankfurt am Main – When it comes to emergency reform, there is no shortage of expertise for a new order, no lack of courage and motivation to introduce new regulations for the correct management of patients in emergency rooms and emergency opening hours. This message was shared by many discussants in a forum organized by the Association of Surrogate Insurance Funds (vdek) Hesse organized in Frankfurt am Main on the need for reform in emergency care.

Janosch Dahmen, health policy spokesman for the Green Party parliamentary group in the Bundestag, particularly defended the reforms. “There are enough model projects, the federal and state governments now need to put good projects into practice,” he said in a video message. From his point of view, legislation must ensure that “solutions are designed with the patient in mind”.

“The system must find a response where the patient’s needs can be adequately met in their urgent emergency situation,” continued Dahmen. It is therefore important to organize a better network and control of emergency numbers 116117 and 112 at national level. The responses that would be given there to the respective emergency situations would have to be much more differentiated than today, continued Dahmen.

In a bill that is believed to be available before the summer parliamentary holidays, it calls for the inclusion of emergency services in Book V of the Social Security Code. “We have to take a step now,” Dahmen said. He commissioned a report from the Bundestag’s scientific service on the question of whether the rescue service could be included in the Social Security Code and would therefore fall under federal legislative sovereignty.

The peculiarities of the rescue service, which also includes risk prevention, must be taken into account in any reform, emphasized Sonja Optendrenk, State Secretary of the Hessian Ministry for Family, Elderly, Sport, Health and Care. There is no doubt that many people treated in rescue and emergency services do not belong there.

“We have to unite the two worlds and think together about their reasons. Because the limits of rescue service and emergency care are often greater than those of outpatient and inpatient care,” says Optendrenk, who worked for a long time at the Federal Ministry of Health before being appointed State Secretary (BMG) has worked.

Hessen sees her in the communication project IVENA well positioned, patient management should also receive greater attention in the future Hesse pact for the healthcare system. Optendrenk also called for more communication with the federal government about the emergency reform. This should be significantly improved compared to the Hospital Care Improvement Act.

Poorly positioned control centers

Christof Chwojka, managing director of the emergency service in Germany, assessed the organization of the emergency service in Germany Björn Steiger Foundation and former managing director of the Lower Austrian emergency call, not very positive. “Unfortunately, the German control centers are bad,” said Chwojka in Frankfurt am Main. The current situation, where patients don’t know where to call, urgently needs to change.

“The patient does not need to know where they are going, we guide the patient to the best point.” This will require “completely new staff” at future control centers, but they will have to be trained in very different ways. He described as “absurd” the ideas of some federal states that want to install three-year emergency training courses for telephone services. He criticizes the fact that the skills of emergency paramedics differ from district to district.

He also criticized the fact that in Germany only a third of resuscitation procedures are carried out by telephone. “Just read what needs to be done in the situation.” The Smed software, which was developed by the statutory health insurance associations, “is already good, but now it needs more advisory content,” says Chwojka.

He advocated the creation of health control centers in the future where all emergencies felt by patients would be managed. For example, one could imagine that, depending on the severity of the case, the control center would schedule appointments at the emergency room or with general practitioners, depending on the urgency, immediately, within four hours or the next day.

Studies carried out in Lower Austria show that around 77 percent of people who called health control centers also kept their scheduled appointments within the given time frame. “We didn’t expect this,” Chwojka emphasized.

Ulrich Wenner, former presiding judge of the Federal Social Court (BSG), confirmed that the federal government can give itself legislative authority for emergency services. He emphasized that, in his opinion, the federal government could use its legislative competence in matters of social security to “regulate insured people’s complaints about emergency services, the quality requirements of these services and the legal framework for price maintenance”.

However, in the design of the law, it is not entirely easy to separate the organization of emergency services as part of emergency response – and therefore as the responsibility of states – from the health care part. “There are constitutional risks here. But these are no bigger than current hospital renovation projects.”

Wenner highlighted that even if the federal government legislated, states would remain free to decide how they would organize the rescue service. There are very different models here about whether the rescue service is seen as a state task, a mandatory task for districts or as an autonomous task. For him, it takes a lot of courage if we want to set up committees in which health insurers and emergency service providers must establish common quality standards.

In discussion with representatives of the Hessian districts, politics as well as rescue control centers and the Association of Statutory Health Insurance Doctors (KV), however, it was also clear that many players already consider themselves well positioned. “As KV, we are committed to actively shaping emergency care in Hesse,” emphasized Armin Beck, Vice President of the Hessian Association of Statutory Health Insurance Doctors.

At the clinics in Frankfurt-Höchst and Darmstadt there is a counter shared between the hospital and the medical service on duty. In addition, intersectoral emergency outpatient care is being tested in a model project. “We have a network of emergency services and outpatient care. The rescue service takes patients who do not require emergency care to the doctor’s office or the on-call medical station,” continued Beck.

For the managing director of DRK Rescue Service Central Hesse, Markus Müller, “threat prevention and patient safety are not in contradiction”. He also argues that the spectrum of possible reactions to seeking help needs to be greater. “To do this, we have to open up and network,” says Müller.

But: “Despite all the changes, the perspective of those doing the work should never be lost sight of.” Ben Michael Risch from the Hessian Ministry of Health also emphasizes this perspective: “It is important that a reform of emergency care takes this into account.” account, especially in emergency services. It is ensured that resources are used sensibly and emergency response staff are visibly relieved.”

For Boris von Maydell, head of the outpatient care department at the Association of Surrogate Insurance Funds, it is imperative that the control centers and telephone numbers 116117 and 112 are now digitally connected. “It would be important to expand today’s control centers into health control centers where, in addition to the rescue service or emergency doctor, other care services such as emergency nursing care or the psychosocial emergency service also can be controlled,” von Maydell continued. According to him, spending on ambulances has increased by 161 percent in the last ten years and currently exceeds four billion euros. © bee/aerzteblatt.de

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