/dpa
Berlin – The reform of emergency care in Germany should primarily lead to better patient management. In addition to a uniform initial assessment procedure, a hotline-first strategy and a strengthening of telemedicine should be used. These are the key recommendations of a report that was prepared on behalf of the National Association of Statutory Health Insurance Physicians (KBV) by the Aqua Institute and the Institute and Polyclinic for General Medicine at the University Medical Center Hamburg-Eppendorf (UKE).
The recommendations are based on an analysis of emergency care in England, Denmark and the Netherlands. Today, the results of the report were discussed at a KBV symposium against the background of the emergency reform that the Federal Ministry of Health (BMG) recently launched.
The deputy chairman of the KBV, Stephan Hofmeister, summarised the most important statements of the report. “All three countries examined apply the same basic principle for care outside of practice opening hours,” he said. “First of all, this includes a hotline-first strategy, i.e. the initial assessment by telephone. This is the prerequisite for the patient to be able to prove that they have an acute right to care, a kind of accreditation.”
On this basis, the patient is assigned to an appropriate level of care. “This can be an emergency practice, an outreach emergency service or even telemedical care,” says Hofmeister. “In all three countries, the care units taking on the respective case, including the emergency services, can access the results of the initial assessment, so that duplicate surveys are avoided and a seamless and standardized flow of information is guaranteed.”
“Hard door” in other health systems
“So you could say that in other countries the same principle applies to care outside of office hours that Berlin clubbers are familiar with, namely the ‘hard door’ principle,” Hofmeister continued. “No one gets in without having been properly assessed. That may sound unkind at first, but in my view it is essential if we want to control the ever-widening gap between the demand for medical services at any time and anywhere on the one hand and the limited human and financial resources on the other.”
The draft bill for an emergency law aims to “relieve the burden on emergency rooms and the rescue service through more precise control and to direct patients who can be treated on an outpatient basis to a suitable care structure at any time”. In order to achieve this goal, the KVen should be obliged to provide telemedical and outreach care on a consistent basis.
The previous tasks of the appointment service centers in the area of acute case referral are to be carried out in the future by so-called acute control centers of the KVen. These are to be networked with the emergency control centers in a “health control system”, whereby a digital case transfer with seamless transmission of data already collected should be possible.
Emergency law not before cabinet until August
Federal Health Minister Karl Lauterbach (SPD) recently announced that a reform of the emergency services was also planned, but that this would not be done in a separate law. Instead, the content is expected to be included in the Emergency Services Act via amendments. The head of the Health Care and Health Insurance Department at the Federal Ministry of Health, Michael Weller, also hinted at such an approach at the KBV today. He expressed confidence that the government would be able to complete the emergency services reform and the reform of the emergency services during this legislative period. However, according to Weller, the Emergency Services Act will not be discussed in the cabinet in July, as originally planned, but in August.
The emergency reform should be tackled at the same time as the hospital reform, as both areas are interrelated. If the regulations for the reform of the emergency services are included in the cabinet draft of the emergency law, which will then be brought to the cabinet in August, “we are well on schedule,” said Weller. Then there will still be enough time for the parliamentary procedure after the summer break. The emergency law then has a realistic chance of being published in the Federal Law Gazette in 2025.
Do not leave the decision to the citizens
Hofmeister emphasized that there are already good structures in Germany with the KVs’ appointment service centers. “With the nationwide number 116117 of the KV system, we have a comprehensive offer in Germany that enables a hotline-first strategy,” he said. “However, these structures still need to be expanded and scaled.” Today, the KVs finance the appointment service centers mostly themselves. This is too small in terms of scale. “If we want to offer such an offer to the entire population around the clock, we need structural financing, which must be put in place by the legislature,” emphasized Hofmeister.
He explained how the KBV envisages patient management in emergency care in the future. “We are not demanding that patients should no longer have access to emergency care. They should all be heard. And we want to make them an offer in return. But the experts should then decide what care is appropriate. We cannot leave this decision to the citizens. Because they cannot make this decision.”
Drawing numbers in the emergency room shows poor control
Martin Scherer from the UKE, one of the authors of the report, criticized the fact that the low-threshold access to the emergency care system is now counteracting itself. He reported on a case in which a patient urgently needed emergency medical help, but in the emergency room of the hospital she went to, she had to draw a number like all other patients.
“This shows that our patient management in Germany is not good today,” he said. “An upstream mechanism with an initial assessment and a digital file would have been very helpful here.” He called for prioritization in emergency rooms to identify patients who are in particularly urgent need of medical help.
Fast lane regulation for urgent cases
Weller from the BMG pointed out that the draft bill for the emergency law includes a corresponding fast-lane regulation. This is because a regulation for preferential treatment for patients who are in urgent need of treatment should be found.
“That is exactly what the initial telephone assessment can result in,” said Hofmeister, “that a patient is classified as Priority 1 and sent directly to the hospital. What I understand by preferential treatment is that this patient is then treated immediately in the hospital and does not have to draw a number again.”
More telemedicine in emergency care
The authors of the report also emphasize that initial assessment procedures in emergency care should determine the urgency of further treatment. “The assessment of urgency and need for care creates the basis for a tiered acute and emergency care model and thus the efficient, needs-based use of the resources of hospital emergency rooms, statutory health insurance services outside of office hours and regular care,” they write. “A nationwide, uniform initial assessment procedure must be the basis for directing patients into the appropriate care structure.”
In order to relieve the burden on mobile emergency services and on-site contact points for outpatient emergency care, the authors of the report also suggest strengthening the role of telemedicine. The possibility of using telemedicine before a potential outreach appointment or face-to-face presentation should also be examined. In England, a telemedicine-first strategy has led to up to 40 percent of cases being transferred from outreach emergency services to telemedicine or equivalents at emergency practices.
The authors of the report also recommend that outpatient emergency care facilities should be allowed to book appointments for primary care in order to ensure seamless follow-up treatment. To relieve the burden on medical staff in the emergency services and to ensure comprehensive care, the use of non-medical staff, such as community emergency paramedics, should also be increased. © fos/aerzteblatt.de
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