Roth Catharina, Breckner Amanda, Paulus Jan, Wensing Michel
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
JMIR Form Res. 2020 Sep 4;4(9):e18456. doi: 10.2196/18456.
Inadequate assessment of the severity and urgency of medical problems is one of the factors contributing to unnecessary emergency department (ED) visits. The implementation of a software-based instrument for standardized initial assessment-Standardisierte medizinische Ersteinschätzung in Deutschland (SmED) (Standardized medical Initial Assessment in Germany in English)-aims to support health care professionals and steer patients toward the right health care provider. This study aimed to explore the implementation process of SmED from a user perspective.
This study aims to evaluate the overall perception of SmED by health care professionals using the software, to examine to what extent SmED influences the workload and work routines of health care professionals, and to determine which factors are associated with the use of SmED.
An early qualitative process evaluation on the basis of interviews was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Participants were 30 health care professionals who work with SmED either at the joint central contact points of the outpatient emergency care service and the EDs of hospitals (ie, the Joint Counter; Gemeinsamer Tresen in German) or at the initial telephone contact points of the outpatient emergency care service (phone number 116117). Matrix-based framework analysis was applied to analyze the interview data.
Health care professionals perceived that workload increased initially, due to additional time needed per patient. When using SmED more frequently and over a longer time period, its use became more routine and the time needed per call, per patient, decreased. SmED was perceived to support decision making regarding urgency for medical treatment, but not all types of patients were eligible. Technical problems, lack of integration with other software, and lack of practicability during peak times affected the implementation of SmED.
Initial experiences with SmED were positive, in general, but also highlighted organizational issues that need to be addressed to enhance sustainability.
German Clinical Trials Register DRKS00017014; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017014.
对医疗问题的严重程度和紧迫性评估不足是导致不必要的急诊科就诊的因素之一。实施一种基于软件的标准化初始评估工具——德国标准化医学初始评估（SmED）（英文为Standardized medical Initial Assessment in Germany），旨在支持医护人员并引导患者找到合适的医疗服务提供者。本研究旨在从用户角度探索SmED的实施过程。
本研究旨在评估使用该软件的医护人员对SmED的总体看法，检查SmED在多大程度上影响医护人员的工作量和工作流程，并确定哪些因素与SmED的使用相关。
在德国11个联邦州的26个门诊急诊服务机构实施SmED的过程中，同时进行了基于访谈的早期定性过程评估。参与者为30名医护人员，他们在门诊急诊服务机构与医院急诊科的联合中央联络点（即联合柜台；德语为Gemeinsamer Tresen）或门诊急诊服务机构的初始电话联络点（电话号码116117）使用SmED。采用基于矩阵的框架分析来分析访谈数据。
医护人员认为，由于每位患者需要额外的时间，最初工作量有所增加。当更频繁、更长时间地使用SmED时，其使用变得更加常规，每次通话、每位患者所需的时间减少。SmED被认为有助于支持关于医疗紧迫性的决策，但并非所有类型的患者都适用。技术问题、与其他软件缺乏整合以及高峰时段缺乏实用性影响了SmED的实施。
总体而言，SmED的初步经验是积极的，但也突出了为提高可持续性需要解决的组织问题。
德国临床试验注册中心DRKS00017014；https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017014 。
