[Redirection of patients from the emergency department to ambulatory care: a feasibility study].

Autor:	Koech L; Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Berlin, Germany., Ströhl S; Forschung, GWS - Gesundheit, Wissenschaft, Strategie GmbH, Bayreuth, Germany.; Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth, Germany., Lauerer M; Forschung, GWS - Gesundheit, Wissenschaft, Strategie GmbH, Bayreuth, Germany.; Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth, Germany., Oslislo S; Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Berlin, Germany., Bayeff-Filloff M; Notaufnahme, RoMed Klinikum Rosenheim, Rosenheim, Germany.; Ärztlicher Landesbeauftragter Rettungsdienst, Bayerisches Staatsministerium des Innern für Bau und Verkehr, München, Germany., Thoß R; Notdienste, Vermittlungs- und Beratungszentrale, Kassenärztliche Vereinigung Bayerns, München, Germany., Nagel E; Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth, Germany., Carnarius S; Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Berlin, Germany., Stillfried D; Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Berlin, Germany.
Jazyk:	němčina
Zdroj:	Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) [Gesundheitswesen] 2024 May; Vol. 86 (5), pp. 339-345. Date of Electronic Publication: 2024 Feb 14.
DOI:	10.1055/a-2206-1738
Abstrakt:	Background: § 120 para. 3b SGB V mandates the Federal Joint Committee to define guidelines for the initial assessment of self-referred walk-in patients as well as for the redirection of patients who can be treated by office-based physicians. A corresponding streaming and redirection process was tested in a feasibility study at the RoMed Clinic Rosenheim. Materials and Methods: For the duration of the study, triage nurses of the emergency department (ED) first assessed self-referred walk-in patients with the Manchester Triage System (MTS). Patients in categories green and blue who did not obviously need the ED's resources were additionally assessed by health professionals of the Association of Statutory Health Insurance Physicians of Bavaria using the software Structured Initial Medical Assessment in Germany (SmED). Patients with a recommendation for non-hospital medical treatment were streamed to the out-of-hours practice on campus or were redirected to a physician office after video consultation with an office-based physician. Patient pathways were documented and a qualitative survey using semistructured guided interviews of all stakeholder groups was carried out. Results: 1,091 self-referred walk-in patients were included. Direct streaming to the ED occurred in 525 cases,13 refused to participate. Based on SmED, 24 additional patients were referred to the ED, 514 patients were streamed to the out-of-hours practice, 23 received a video consultation and five left the ED. After video consultation, eight patients were redirected to a physician's office, 10 were discharged, and five referred to the ED of which one did not want an office-based physician. No returnees from practices to the ED were identified. Generally, the redirection process was evaluated positively in the interviews (n=18). In particular, potential for technical improvement was identified. Conclusion: Overall, the results indicate the feasibility of the redirection process and high acceptance levels. Using SmED in addition to MTS appeared useful before redirection but not necessary for streaming on campus. Redirection to physician offices can help reduce strain on the ED when the out-of-hours practice is not operating. In addition to arranging acute care appointments, video consultations offer an additional potential to treat patients. In a follow-up study, a broader range of patients should be included and appropriateness of redirection decisions should be evaluated. Competing Interests: Dominik von Stillfried, Sebastian Carnarius, Sarah Oslislo und Lea Koech sind für das Zi tätig. Das Zi stellt die Ersteinschätzungssoftware SmED für Deutschland bereit. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze:	MEDLINE
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