Trentzsch Heiko, Dodt Christoph, Gehring Christian, Veser Alexander, Jauch Karl-Walter, Prückner Stephan
Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München (KUM), Ludwig-Maximilians-Universität (LMU), München.
München Klinik Bogenhausen, Notfallzentrum, München.
Gesundheitswesen. 2020 May;82(5):431-440. doi: 10.1055/a-0925-8989. Epub 2019 Aug 8.
Medical care provided at the hospital emergency rooms in Germany has hardly been explored. On the occasion of restructuring the Municipal Hospital, the Munich City Council initiated the "Round Table Emergency Care" in order to determine reference figures for capacity planning. The present study was designed to analyze treatment data from 14 emergency departments which mainly carry the city's hospital emergency service. For inpatient cases, data were used in accordance with §21 Hospital Charges Act, for outpatient cases - as far as available - similar data were used, anonymized and combined with data from prehospital emergency medical services (EMS). In order to describe the domains treatment urgency, diagnostic/therapeutic effort and bed requirements, data were categorized in a 4-stage system. Over 12 months, 524,716 treatment cases were recorded: 34% were admitted to hospital, 80% came without EMS. One in 7 patients who independently went to an emergency room needed a bed in the intensive care or intermediate care unit (ICU/IMC). There were 64 cases per day and per 100,000 inhabitants requiring 7 ICU/IMC and 15 regular ward beds. Most cases (66%) were treated as outpatients and presented to the hospital's emergency department at times when facilities of the ambulatory care system would have been available. Urgency of these cases was usually low (50.9%), but effort was often high, due to diagnostics and surgical procedures. This study offers fundamental knowledge for planning emergency care. A large proportion of the presentations, especially those with injuries and those with diagnosis that require a more differentiated work-up, seem to be medically justified, which is why appropriate capacities have to be planned in. The study also shows that capacity planning on the basis of EMS cases alone is an inappropriate, one-sided approach.
德国医院急诊室提供的医疗服务几乎未被深入研究。在慕尼黑市立医院重组之际，慕尼黑市议会发起了“急诊护理圆桌会议”，以确定容量规划的参考数据。本研究旨在分析来自14个主要承担该市医院急诊服务的急诊科的治疗数据。对于住院病例，数据依据《医院收费法》第21条使用；对于门诊病例（只要数据可用），使用类似数据，并进行匿名处理，然后与院前急救医疗服务（EMS）的数据相结合。为了描述治疗紧迫性、诊断/治疗工作量和床位需求等领域，数据被分类到一个四级系统中。在12个月的时间里，共记录了524,716例治疗病例：34%的患者住院治疗，80%的患者就诊时未通过EMS。每7名自行前往急诊室的患者中就有1人需要重症监护或中级护理病房（ICU/IMC）的床位。每天每10万居民中有64例需要7张ICU/IMC床位和15张普通病房床位。大多数病例（66%）作为门诊患者接受治疗，并且是在门诊护理系统有可用设施的时候前往医院急诊科就诊。这些病例的紧迫性通常较低（50.9%），但由于诊断和外科手术，工作量往往很大。本研究为急诊护理规划提供了基础知识。很大一部分就诊病例，尤其是那些受伤的病例以及那些需要更细致检查诊断的病例，似乎在医学上是合理的，这就是为什么必须规划适当的容量。该研究还表明，仅基于EMS病例进行容量规划是一种不恰当的、片面的方法。
