No Primary Care Physician Available
The study PiNo Nord („Patienten in der Notaufnahme von norddeutschen Kliniken“ [patients in the emergency departments of hospitals in Northern Germany]), for which 20% of the emergency patients during the survey period were interviewed, follows the hypothesis that crowding of German emergency departments is the result of a misdirection of patients (1).
The authors‘ „key message“ concludes that „More than half of patients … assessed their treatment urgency as low and therefore did not meet the definition of an emergency“, but this cannot be deduced from the data. Instead, it is correct that, of the 20% of patients who were interviewed, slightly more than half (only 9.6%) of the emergency department patients had an overall low subjective urgency for treatment.
It is shown that an objectively high medical need for treatment can exist in all categories of subjective urgency. As 49.9% of the patients did not receive an initial triage, this is thus a non-representative selection.
The high level of subjective urgency would also be difficult to influence by better familiarity with the „116 117“, especially as initial telephone contact is not suitable for general demand management (2). The reasons for low treatment urgency in PiNo Nord exist for clearly attributable reasons for presentation (trauma, skin conditions), whereby the third reason (no primary care physician available) also provides a main explanation for the other points. Patients with trauma and skin conditions are often sent to the emergency department, as care by a primary physician is frequently not possible, often simply for capacity reasons (3). This is confirmed by the testimony of 26% of respondents who were referred to the emergency department by a primary care physician or a specialist.
Thus, with the correct interpretation of these results, PiNo Nord confirms the necessity of adequately financing outpatient treatment in the emergency department, as most of these treatments could not be provided elsewhere.
Prof. Dr. med. Martin Möckel, FESC, FAHA
Dr. rer. medic Martina Schmiedhofer MPH
Division of Emergency and Acute Medicine, Chest Pain Units
Campus Virchow-Klinikum und Campus Charité Mitte
Charité – Universitätsmedizin Berlin, Germany
|1.||Scherer M, Lühmann D, Kazek A, Hansen H, Schäfer I: Patients attending emergency departments—a cross-sectional study of subjectively perceived treatment urgency and motivation for attending. Dtsch Arztebl Int 2017; 114: 645–52 VOLLTEXT|
|2.||Newbould J, Abel G, Ball S, et al.: Evaluation of telephone first approach to demand management in English general practice: observational study. BMJ 2017; 358: j4197 CrossRef MEDLINE PubMed Central|
|3.||Schmiedhofer M, Searle J, Slagman A, Frick J, Ruhla S, Mockel M: [Perception of the emergency department for outpatient care in a rural region in Saxony-Anhalt: a qualitative survey of patients and general practitioners]. Dtsch Med Wochenschr 2017; 142: 61–73 CrossRef MEDLINE|