The Surging Influx in Emergency Departments and On-Call Services in Thuringia: A Persistent Conundrum
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Overflowing emergency rooms and non-stop on-duty services persistently being contacted - Persistent Flooding of ERs and Readiness on Standby
The rising influx of patients to hospital emergency departments and private on-call services in Thuringia continues to present a significant hurdle. Clinic representatives claim that the closure of specific hospital sites and the scarcity of general practitioners are increasingly having an impact. As per data from the Association of Statutory Health Insurance Physicians, emergency departments and the association's on-call service handle over half a million physician-patient contacts annually in the state.
Post the notable drop during the COVID-19 pandemic, the figure of 2019 has been reattained. Initially, the use of the on-call service, which can be reached via 116 117, was prominent, but now, the focus has shifted considerably towards clinic emergency departments. Patients often visit them during a medical practice's operating hours, essentially when the practices are responsible.
Those without a general practitioner mostly utilize the on-call service
The reasons behind this development are manifold. According to the chairwoman of the association, Annette Rommel, it is simply normal for people to visit hospitals when they have complaints. As per the Thuringian Hospital Act, clinics are prohibited from refusing patients. Gundula Werner, managing director of the Altenburger Land Clinic and chairwoman of the State Hospital Association, points out, "In rural regions, many people cannot find a general practitioner and then perhaps go directly to the emergency department."
Sometimes, practice physicians suggest their patients head to the emergency department. The question of whether it's a genuine medical emergency in each case is consistently questioned. Werner: "From the patient's perspective, certainly, but perhaps not always from the doctor's viewpoint."
"Now, it's the case that patients cannot find a doctor, assess themselves as an urgent case, and then proceed to the emergency department," shared Stephan Breidt, spokesperson for Thuringia Clinics Saalfeld. Often, it is complaints that should be attended to by general practitioners. "In most cases, these are not indications for inpatient admission," Breidt added.
The burden on the emergency department in Saalfeld has intensified considerably since the hospitals in Schleiz and Neuhaus am Rennweg were shut down last year. Since then, the number of cases in the emergency department has doubled. "Previously, there were up to 80 cases a day, now there are 150," said Breidt. "That's no longer manageable."
The association also struggles with issues in organizing the statutory health insurance on-call service. Currently, around 115 general practitioner positions are vacant in Thuringia, which impacts the supply of on-call service staff, secured via approximately two dozen on-call service centers, typically located at hospitals, driving services, or even through video consultations. The association is currently discussing how it should be developed further.
From the perspective of the association and the State Hospital Association, a reform of emergency care is urgently required. The previous traffic light government had already submitted a bill for this. According to this bill, access points should be set up in clinics where patients are directed to the emergency department or an on-call practice based on the urgency.
Insights
While specific, recent reports on the exact challenges in Thuringia's emergency department usage and on-call services are not readily available, broader German healthcare trends suggest the following general issues:
- Resource Constraints and Staff Shortages: Overcrowding, long wait times, and inadequate medical staff are escalating, burdensome for care delivery and staff well-being.
- Increasing Patient Volumes: Rising patient numbers, particularly for elderly populations and those with complex conditions, exacerbate the situation in EDs.
- Mental Health and Psychiatric Care: Improved focused attention on mental health issues in emergency situations to address acute psychiatric cases within the ED.
- Coordination with On-Call and Out-of-Hours Services: Successful collaboration and timely communication are vital, especially in rural areas like parts of Thuringia, where access to specialist care may be limited.
- Technological and Infrastructure Needs: Continuous advancement with emergency response technology, patient monitoring equipment, and infrastructure to meet emerging demands is essential.
Initiatives like relying on digital health tools, emergency services collaboration, staff training improvements, ensuring regional access, and standardizing quality control are being proposed to buffet the aforementioned challenges.
- Vocational training programs in health-and-wellness and science fields could be beneficial to alleviate the staff shortages and provide more healthcare professionals in Thuringia. This could lead to improving the quality of care and reducing wait times in emergency departments and on-call services.
- As part of the reform of emergency care, vocational training programs focused on community policy could aid in directing patients to the appropriate resources, whether it's an emergency department or an on-call practice, based on the urgency of their condition. This could help manage the influx of patients in hospitals and offload the burden on the emergency departments.
