Networking with practices relieves the burden on emergency rooms: Minister Holetschek finds out about the pilot project

11.08.2023 13:16

Hospitals in Germany have been complaining about overloading emergency departments for years. The causes also include incorrect use of emergency care by acute patients who could be treated by a contracted doctor during general practice opening hours. A pilot project by the Bavarian Association of Statutory Health Insurance Physicians (KVB), the Central Institute for Statutory Health Care (Zi) and the RoMed Klinikum Rosenheim shows how emergency rooms can be effectively relieved through collaboration with local practices. The Bavarian Health Minister Klaus Holetschek was shown practical solutions for better patient management in Rosenheim at the beginning of August and sees this as a significant contribution to the reform of emergency care planned by Federal Health Minister Karl Lauterbach.

During the collaboration between RoMed-Klinikum and KVB, all incoming patients were prioritized according to urgency and divided into five groups: patients in the initial assessment groups “immediate (red)”, “very urgent (orange)” and “urgent” (yellow) as well as patients Those who require certain examinations or treatments, such as wound care, are treated directly in the hospital's emergency room. For patients with the triage levels “normal (green)” and “non-urgent (blue)”, a KVB specialist additionally checked whether treatment by a statutory health insurance provider was possible. The specialist was supported by the software SmED (Structured Medical Initial Assessment in Germany). If there was a recommendation for treatment by a statutory health insurance provider, the patients were offered treatment in a nearby general practice or specialist practice, so-called cooperative practices. The patients were immediately registered digitally in a suitable cooperative practice and treated there. Outside the practice's opening hours, a large number of patients were cared for by the KVB medical on-call practice located at the clinic, thus relieving the burden on the emergency room procedures. Another option, treatment by a contracted doctor via video consultation using the DocOnline system developed by the KVB, is already in preparation. In the context of the study, it was found that a significant proportion of patients who presented themselves to the emergency room were able to receive final treatment using video telephony.

Pilot project provides blueprint for planned emergency reforms at the federal level

Klaus Holetschek, Bavarian State Minister for Health and Care: “I welcome the constructive cooperation between clinics and practicing doctors. The pilot project in Rosenheim shows the way for a qualitative improvement in acute and emergency care in Bavaria and provides a blueprint for planned emergency reforms at the federal level. The results so far suggest that hospital emergency rooms can be relieved so that more time and resources are available for emergencies. And patients with acute symptoms can be cared for in a timely and appropriate manner by practices where possible follow-up treatment is also possible. Digitalization is an important component here. Both doctors and patients can benefit from video telephony and telemedicine. I encourage the clinics and the Bavarian Association of Statutory Health Insurance Physicians to continue on this path and would like the example from Bavaria to become a model nationwide.”

No patient is turned away

Dr. Michael Bayeff-Filloff, chief physician of the central emergency department at the RoMed Klinikum Rosenheim: “This staged procedure can be an important step in relieving the emergency rooms of less serious cases. No patient is turned away; everyone receives exactly the care that is necessary for their medical problem. A large proportion of the self-referring patients can be cared for by their resident colleagues. We have also clearly identified all people with particular risks. This means that the safety of patients and at the same time relieving the burden on our emergency department are possible through close cooperation with the contracted doctors. But it is also clear that large emergency rooms cannot manage the phased procedure without additional staff at the common counter.”

Treating easily treatable cases in clinic-based on-call practices during the day is counterproductive

Dr. Christian Pfeiffer, Dr. Peter Heinz and Dr. Claudia Ritter-Rupp, board member of the KVB: “The pilot project in Rosenheim shows that it is completely counterproductive to care for patients who go to the emergency room with easily treatable cases in on-call practices close to the clinic during the day, as the federal government is planning. Cooperating surrounding general practices or specialist practices can do this much more effectively during practice opening hours. The colleagues then do not have to close their practice in order to take over the shifts that need to be filled in the on-call practices at the clinic. The KV Bayerns offers its cooperation to the clinics in Bavaria. The insured should also know that if they are unsure whether going to the emergency room makes sense or is necessary, they can also call the service number 116117 to receive an initial assessment.”

Treat insured people in the right place at the right time

Dr. Dominik von Stillfried, Chairman of the Zi: “The challenge in acute and emergency care is that the insured are treated in the right place at the right time. The evaluation of the pilot project shows that this goal can be achieved through collaboration between emergency departments and practices. Supported by suitable software, it can be implemented quickly and safely under everyday conditions.”

Emergency care and acute care have different tasks

Dr. Gerald Quitterer, President of the Bavarian State Medical Association: “From a medical perspective, emergency care and acute care have different tasks. In an emergency, potentially life-threatening conditions must be diagnosed with great effort and treated quickly. In acute care, patients should receive timely relief from health problems. In some cases, in-depth medical advice is sufficient; in other cases, the illness is more complex, so the treatment should remain embedded in standard outpatient care. A structured initial medical assessment of treatment concerns and guidance to the right treatment location enables both areas, emergency and acute care, to work efficiently and for the benefit of the patients. The Bavarian State Medical Association therefore supports the pilot project in Rosenheim not only as a solution concept for Bavaria, but also as a possible nationwide approach.”

Patient control is key

Christina Leinhos, deputy. Managing Director of the Bavarian Hospital Society e. V. (BKG): “Patient control is the key to relieving the burden on emergency departments in hospitals, as the model project shows. Because patients don't think in sectors - through close cooperation between the RoMed Klinikum Rosenheim and established specialists and general practitioners, those seeking help can be quickly directed to the appropriate care structures. We are pleased that people here in Rosenheim have moved forward with good ideas.”