Zi insights: Experts discuss potential for reform in acute and emergency care
27.04.2023 16:01
Structured initial assessment is considered an important control tool in the care of emergency patients. Innovation fund project DEMAND Blueprint for better networking in acute and emergency care Structured initial assessment is assessed as an important control tool in the care of emergency patients. Innovation fund project DEMAND is considered a blueprint for better networking in acute and emergency care
The Central Institute for Statutory Health Insurance (Zi) presented current results from the DEMAND innovation fund project as part of its live streaming format “Zi insights” and discussed them with experts from statutory health insurance practices. The aim of DEMAND was to evaluate the management of patients into an adequate level of care based on a structured initial medical assessment. The focus was on control via the patient service number 116117 at selected hospital locations with a common counter for the emergency room and on-call practice.
For several years, we have been working hard to direct those seeking help to the right care at the right time through improved networking of the medical on-call service with the emergency departments of the clinics and the rescue service. This is intended to relieve the burden on emergency care in emergency rooms and in the rescue service from acute cases that can be better treated in practices. The model project DEMAND, funded by the Federal Joint Committee, is part of this series of work. As part of the project that began in 2018 under the leadership of the aQua Institute, the Zi evaluated the effects of a patient- and care-controlling initial assessment on outpatient emergency care. Eleven of the seventeen statutory health insurance associations (KVen) were involved in the project.
Every tenth insured person turns to a clinic's emergency department in an emergency
“People with acute health problems are often faced with the question of whether they should contact their family doctor or spontaneously present themselves to the hospital. Data evaluations show that every tenth insured person turns to a clinic's emergency department in an emergency. However, at least a third to around half of these patients could be treated on an outpatient basis by a contracted doctor. This could save resources that are actually used to deal with medical emergencies. Politicians are trying to change course, especially in view of the fact that there is an increasing lack of medical specialists, especially in the emergency services and in the emergency rooms of hospitals. Since January 1, 2020, those with statutory health insurance have had the opportunity to receive an initial assessment of acute symptoms by telephone using the patient service number 116117 of the statutory health insurance associations. The callers are questioned in a structured manner by qualified staff. On this basis, the KVs provide medical care appropriate to the urgency. They are supported in this by the software SmED (Structured Medical Initial Assessment in Germany),” said Zi CEO Dr. Dominik von Stillfried.
High approval ratings for DEMAND
According to Zi analysis, the DEMAND project provides strong evidence that this control is effective. It could be shown that hospital treatments decreased as a result of this service offer; However, no health risks could be identified. Surveys of participants as part of the DEMAND project revealed a high level of satisfaction. There were high levels of agreement with the statements that the participants could say anything they wanted to say (90.6 percent) and that the staff had enough time for them (85.5 percent). In addition, the willingness of the participants to follow one of the recommendations was very high (85.4 percent). Experts surveyed from self-administration and practice agreed that effective control requires a uniform tool for structured initial assessment, both in 116117 service centers and at the common counter in emergency rooms and on-call practices.
Structured initial assessment needs a permanent place in the healthcare system
Dr. Stephan Hofmeister, specialist in general medicine and deputy chairman of the National Association of Statutory Health Insurance Physicians (KBV), made it clear, with a view to upcoming draft laws for the further development of outpatient acute care and on-call services, that the structured initial assessment must have a permanent place in the healthcare system. Those seeking help in acute or emergency situations needed guidance in providing appropriate care. Given the complexity of the healthcare system, this is not a restriction, but a service. As DEMAND has also demonstrated, the KVs have an innovative instrument for this purpose with SmED.
“Everyone around the world is talking about digitalization in healthcare. We don't just talk. With SmED, we use a digital solution that is accessible to all citizens via telephone or internet. Anyone who feels they are in acute need of treatment can quickly and reliably determine whether a life-threatening situation may be present. If this is not the case, the service offered by 116117 helps you to get an appointment in a practice that is appropriate to the urgency in acute cases or, if necessary, to be referred to a suitable hospital. The software can also be used by hospitals, for example, to arrange an alternative treatment appointment in a practice for those seeking help who have to wait a long time in emergency rooms with acute but not life-threatening symptoms. But this is not competition to the inpatient care offer. Rather, it is a supplement that has been missing so far so that the scarce human resources in the healthcare system can be used appropriately. The importance of such a service offering for patients must be significantly increased in the future. This can be achieved if the considerable maintenance costs of the KVs and special expenses in the practices for acute treatments are adequately and sustainably financed. Politics must now create better conditions here. However, since resources are also finite in outpatient care, the use of such an offer for acute or emergency cases must not be unlimited. The impression of a new parallel treatment offer must not be created. Citizens must be aware of the value of such fast-track care. This control must then be used in a mandatory manner.”
More efficient patient control is required to relieve the burden on emergency care
Also Dr. Ulrike von Arnim, chief physician at the rescue center at the Vivantes Klinikum Berlin Neukölln, advocated for more efficient patient management to relieve the burden on emergency care. She also often experiences that patients who are not sufficiently informed ask for treatment in emergency rooms when in doubt. The challenge of an initial assessment tool to guide patients is to identify in a timely manner those who actually need to be treated in the emergency room.
“We have been observing for a long time that the health literacy of many people is continuing to decline. Given the increasing complexity, many people find it difficult to understand and evaluate health-related information and to draw the right conclusions from it for their own actions. This increases the uncertainty as to which level of care might be the right one for the respective complaints. Low social status, low level of education, financial deprivation and also low literate skills correlate very strongly with low health literacy. We see this particularly in the big cities, but not only there. This is a problem for society as a whole that we will only slowly be able to get under control through improved health education. But what we already have in hand and should use boldly is a structured initial assessment that takes the concerns and needs of the patients seeking help seriously. We can and must incorporate it better into our daily routine. Those seeking help who can be treated better and more continuously in a practice must immediately receive a suitable offer. That would help us a lot."
About Zi insights
With the virtual communication format “Zi insights”, the Zi briefly and concisely presents new study and project results approximately every eight weeks in order to discuss them with experts and digitally connected guests.