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      German emergency department measures in 2018: a status quo based on the Utstein reporting standard

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          Abstract

          Background

          Compelling data on clinical emergency medicine is required for healthcare system management.

          The aim of this survey was to describe the nationwide status quo of emergency care in Germany at the healthcare system level using the Utstein reporting template as the guideline to measure the data collected.

          Methods

          This cross-sectional survey collected standardized data from German EDs in 2018. All 759 of the EDs listed in a previously collected ED Directory were contacted in November 2019 using the online-survey tool SoSci Survey.

          Exclusively descriptive statistical analyses were performed. Absolute as well as relative frequencies, medians, means, ranges, standard deviations (SD) and interquartile ranges (IQR) were reported depending on distribution.

          Main Results

          A total of 150 questionnaires of contacted EDs were evaluated (response rate: 19.8%). Hospitals had a median of 403 inpatient beds ( n=147). The EDs recorded a median of 30,000 patient contacts ( n=136). Eighty-three EDs (55%) had observation units with a median of six beds. The special patient groups were pediatric patients (< 5 years) and older patients (> 75 years) with a median of 1.7% and 25%, respectively. Outpatients accounted for 55%, while 45% were admitted (intensive care unit 5.0%, standard care unit 32.3%, observation unit 6.3%) and 1.2% transferred to another hospital.

          Conclusions

          The use of the Utstein reporting template enabled the collection of ED descriptive parameters in Germany. The data can provide a baseline for upcoming reforms on German emergency medicine, and for international comparisons on admission rates, initial triage categories, and patient populations.

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          Most cited references11

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          Comparison of an informally structured triage system, the emergency severity index, and the manchester triage system to distinguish patient priority in the emergency department.

          The objective was to compare the validity of an existing informally structured triage system with the Emergency Severity Index (ESI) and the Manchester Triage System (MTS). A total of 900 patients were prospectively triaged by six trained triage nurses using the three systems. Triage ratings of 421 (48%) patients treated only by emergency department (ED) physicians were compared with a reference standard determined by an expert panel. The percentage of undertriage, the sensitivity, and the specificity for each urgency level were calculated. The relationship between urgency level, resource use, hospitalization, and length of stay (LOS) in the 900 triaged patients was determined. The percentage of undertriage using the ESI (86 of 421; 20%) was significantly higher than in the MTS (48 of 421; 11%). When combining urgency levels 4 and 5, the percentage of undertriage was 8% for the informally structured system (ISS), 14% for the ESI, and 11% for the MTS. In all three systems, sensitivity for all urgency levels was low, but specificity for levels 1 and 2 was high (>92%). Sensitivity and specificity were significantly different between ESI and MTS only in urgency level 4. In all 900 patients triaged, urgency levels across all systems were associated with significantly increased resource use, hospitalization rate, and LOS. All three triage systems appear to be equally valid. Although the ESI showed the highest percentage of undertriage and the ISS the lowest, it seems preferable to use a verifiable, formally structured triage system. © 2011 by the Society for Academic Emergency Medicine.
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            Kennzahlen von Notaufnahmen in Deutschland

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              The French Emergency National Survey: A description of emergency departments and patients in France

              Introduction Some major changes have occurred in emergency department (ED) organization since the early 2000s, such as the establishment of triage nurses and short-track systems. The objectives of this study were to describe the characteristics of French EDs organization and users, based on a nationwide cross-sectional survey. Methods The French Emergency Survey was a nationwide cross-sectional survey. All patients presenting to all EDs during a 24-hr period of June 2013 were included. Data collection concerned ED characteristics as well as patient characteristics. Results Among the 736 EDs in France, 734 were surveyed. Triage nurses and short-track systems were respectively implemented in 73% and 41% of general EDs. The median proportion of patients aged > 75 years was 14% and median hospitalisation rate was 20%. During the study period, 48,711 patients presented to one of the 734 EDs surveyed. Among them, 7% reported having no supplementary health or universal coverage (for people with lower incomes). Overall, 50% of adult patients had been seen by the triage nurse in less than 5 minutes, 74% had a time to first medical contact shorter than one hour and 55% had an ED length of stay shorter than 3 hours. Conclusion The French Emergency Survey is the first study to provide data on almost all EDs in France. It underlines how ED organization has been redesigned to face the increase in the annual census. French EDs appear to have a particular role for vulnerable people: age-related vulnerability and socio-economic vulnerability with an over-representation of patients without complementary health coverage.
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                Author and article information

                Contributors
                florian.wallstab@st.ovgu.de
                Journal
                BMC Emerg Med
                BMC Emerg Med
                BMC Emergency Medicine
                BioMed Central (London )
                1471-227X
                11 January 2022
                11 January 2022
                2022
                : 22
                : 5
                Affiliations
                [1 ]GRID grid.5807.a, ISNI 0000 0001 1018 4307, Department of Trauma Surgery, , Otto von Guericke University Magdeburg, ; Magdeburg, Germany
                [2 ]GRID grid.5807.a, ISNI 0000 0001 1018 4307, Department of Anesthesiology and Intensive Therapy, , Otto von Guericke University Magdeburg, ; Magdeburg, Germany
                [3 ]Department of Emergency Medicine, Hospital Berlin-Buch, Berlin, Germany
                [4 ]GRID grid.477704.7, ISNI 0000 0001 0275 7806, Department of Interdisciplinary Emergency Medicine, , Pius-Hospital, ; Oldenburg, Germany
                [5 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Department of Emergency Medicine, , Medical University of Vienna, ; Vienna, Austria
                Article
                563
                10.1186/s12873-021-00563-8
                8753932
                35016633
                eadccf43-ef39-450c-bfc5-4a075869c5e8
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 15 October 2021
                : 13 December 2021
                Funding
                Funded by: Otto-von-Guericke-Universität Magdeburg (3121)
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Emergency medicine & Trauma
                emergency medicine,emergency department structures,utstein reporting standard,germany

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