Hospitals | More information should save emergency reform

Volunteer nursing staff and medical teams simulating a mass accident at the Rostock University Medical Center. Photo: afp/Stefan Sauer The emergency reform was passed by the Bundestag in mid-October and is due to come into force in January. The latter, however, only in parts: The new integrated emergency centers (INZ) and the digital merging of the numbers 112 and 116 117 require a lot of preparation, and that will take time. Especially since the approval of the state chamber is also mandatory, which is scheduled for November 20th.

Although on the one hand everything is already quite advanced, the criticism of the reform does not stop. The Barmer health insurance company has now joined the ranks of the skeptics, introducing arguments from its latest “hospital report”. According to this, the number of outpatient emergency treatments in Germany has increased by 8.7 percent within ten years. In every tenth hospital, the number of these treatments has more than doubled.

"It's no use referring patients to a doctor's office that doesn't have appointments."

Now Barmer boss Christoph Straub is also betting that the initial telephone assessment, supported digitally, would be very useful to relieve the burden on emergency rooms (from incorrectly managed patients), including inclusive appointment allocation. However, this was not made binding as part of the reform. Patients can make a phone call before driving themselves to the emergency room, but they don't have to. Without a clear guideline, the success of the reform is questionable, says the treasurer. There are several such deficiencies in the law. Straub obviously has little hope that improvements will be made quickly - but he makes the demand anyway.

Meanwhile, report author Daniel Grandt sees things more optimistically, even if patients are not yet required to undergo the initial telephone assessment. “Those who call beforehand have an advantage; they save waiting time and may not have to go to the doctor at all.” These patients could be reassured and “treated” to their satisfaction without an emergency room or even without another doctor’s appointment. This just needs to be communicated better. A necessary part of the reform is an educational campaign for patients, says Grandt.

Experiences in Denmark, which were also summarized in the Barmer report, have shown that it is possible to relieve the burden on emergency rooms. Here the patients have to go through the initial telephone assessment - and in 42 percent of the cases the telephone calls were case-closing.

According to Straub, individual patients in Germany visit the emergency room up to 32 times a year without being admitted to hospital once. Surveys have also shown that 60 percent of emergency room patients were treated without the use of diagnostic equipment - something that family doctors can also do. But then there would have to be enough free family doctor appointments at all times, and this is another bottleneck in the system. Fewer and fewer family doctors have to treat more and more older, chronically ill people. In addition, patients perceive the emergency room as a common alternative to a family doctor's appointment.

Barmer boss Straub sees this as a fundamental problem in the German healthcare system with its frequent contact with doctors. “Here we are still using the quarterly logic.” This means that chronically ill people are regularly called in every three months and may block access for acutely ill people. For Barmer, this is about the integration of non-medical professional groups - a point that has not yet been finally clarified legally. Among other things, this would be useful for more home visits and for care in nursing homes, where qualified nursing staff work.

The German Hospital Association also spoke up again on the issue. She also wants more health literacy among the population. "Patients need to understand again that colds, abrasions, sprained fingers and the like are not cases for emergency rooms, often heal on their own or do not require any medical care at all," it said in a statement. However, more outpatient care options and adequate funding for emergency rooms are also necessary.

The criticism of the reform from Stella Merendino, spokeswoman for hospital and emergency care for the Left parliamentary group in the Bundestag, is more fundamental. The failure of the care structures should not be interpreted as patient misconduct: “There is no point in referring patients to a doctor’s office that does not have appointments. And an emergency room cannot be relieved if patients are not transferred to the ward due to a lack of free beds. Emergency departments must finally be financed in line with needs and sufficient positions must be created.

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