Whether in the big cities or in the country: the emergency rooms in German hospitals are working to the limit in many places. The situation is often unbearable, especially at the weekend, when the regular medical practices are closed: Patients who do not know how to help themselves sometimes have to wait for hours. On the other hand, physicians spend a large part of their time sorting out acute, serious emergencies from harmless injuries and complaints.
A commission of experts set up by the Federal Ministry of Health has now submitted proposals to relieve the clinics and ensure functioning emergency and acute care around the clock. The focus is on setting up a new control system for emergency calls and setting up so-called integrated emergency centers at more than 400 hospitals.
Federal Minister of Health Karl Lauterbach (SPD) welcomed the proposals as a “good basis” for a reform. The “guiding principle” is “that care takes place where it makes medical sense,” he explained. “To do this, we have to break up existing structures and reorganize them.”
Experts recommend that anyone who dials the emergency number 112 or the numbers for the medical on-call service (116117) should first end up at a new integrated control center (ILS). This control center should then put the caller through to the “emergency structure that is most suitable for them”, as the ministry explained. The control centers should be staffed by medically qualified specialists.
These professionals should then make a standardized and scientifically based initial assessment of the emergency, the ministry said. In this way, “an over- or undersupply of emergencies should be prevented” – for example, cases in which people end up in the emergency room of hospitals, although this is not medically necessary. So “the scarce resources should be optimally used”.
The new control centers should be available around the clock and also offer telemedical medical help and appointments, the ministry explained. This should make them “so attractive for those affected that they become the primary point of contact in medical emergencies”.
The second key point of the recommendations concerns the establishment of so-called integrated emergency centers (INZ). Such a center should consist of the emergency room of a hospital, an emergency practice of the Association of Statutory Health Insurance Physicians and a “counter” as the central decision-making point. At the “counter” a decision should be made as to whether the patient really needs to go to the hospital’s emergency room or whether it is better to be treated in the emergency practice.
The INZ centers are to be set up at all hospitals offering extended and comprehensive emergency care, of which there are currently around 420 in Germany, according to the ministry. Separate emergency centers are to be set up for pediatric and adolescent medical cases.
“Helping patients in need quickly and effectively is the goal of good acute care,” explained Minister Lauterbach. “The hospital does not always have to be the first address in an emergency. But it must be able to offer rapid help in an emergency.”
“It is good that the reform of emergency care is now progressing, after the topic was not tackled in the last legislative period,” said Carola Reimann, Chairwoman of the AOK Federal Association. “Patients finally need a central point of contact and emergency care from a single source,” she emphasized. The planned integrated emergency centers are “the right way” for this.
The German Society for Pediatric and Adolescent Medicine (DGKJ) welcomed the fact that the reform recommendations recognized “that newborns, infants, children and adolescents need specific medical and nursing expertise in the event of an acute illness”. In order to ensure this outside of the metropolitan areas, the DGKJ spoke out in favor of greater use of telemedicine.
Green parliamentary group leader Maria Klein-Schmeink and health expert Armin Grau emphasized the importance of a successful reform. If this fails, “then a slow, uncontrolled death will follow, especially in the smaller hospital locations,” they warned in Berlin. “That would particularly endanger the local supply in the country.”
