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    Clinics: Badly equipped for emergencies – politics

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    Night duty in a Bavarian emergency room that a young assistant doctor experienced: Two patients bleeding in the gastrointestinal area should have been laid when a woman was taken with multiple brain bleeding. Shortly after the arrival, the patient was dying. Then she had to treat another acute emergency: a man who vomited himself bleeding. She couldn't save him either.

    This night was “difficult to process”, says the assistant doctor. And in general: the working conditions in the emergency rooms are “underground”. Sometimes you just don't know “where there is up and down”. It does not want to be cited by name, otherwise she could have problems. Other assistant doctors also confirm what she tells.

    In an elevation in 2023, almost all emergency clinics indicated personnel bottlenecks

    The emergency rooms in Germany's hospitals work on the limit. According to a survey by the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) in 2023, in which over a third of all emergency clinics in Germany took part, personnel bottlenecks existed in 93 percent of clinics. 59 percent of the emergency recordings surveyed stated a sometimes massive overload situation for the day of the survey. More than half signed up with the responsible control center because they could no longer provide patients.

    Health Minister Karl Lauterbach (SPD) wanted to reorganize the emergency care with a reform. The law should relieve the staff and improve the care of the patients. The design from Lauterbach's ministry provided for the fact that in “integrated emergency centers” it should be decided faster and more efficiently which cases are urgent – and which are not. At best in advance with an assessment on the phone. Less acute cases should be treated in an emergency service practice in a family practice or outside of opening hours.

    The political help for emergency care in Germany is initially absent after the end of the traffic light coalition. Lauterbach's goal remains to implement the emergency reform promptly, his ministry announced. But neither the FDP nor the Union wanted to support the reform in parliament. The Union also sees a need for action, but, according to health politician Tino Sorge, demands further measures. The CDU MP announces “to quickly get the emergency reform on the way in the event of a change of government”. Sorge does not say how quickly this can work and what exactly the Union wants to do differently. In the Union's election program, it only says in general that the emergency care is to be developed and strengthening the emergency services. It is unclear whether and when a new reform comes.

    “The failure of the emergency reform already hits us badly,” says the Vice President of the DGINA

    “It is a big problem,” says Janosch Dahmen, health politician of the Greens. Dahmen worked as an emergency doctor himself. The situation is precarious, he says, because until a new government can get the reform on the way again, it will certainly take a year or two.

    And the location should continue to worsen. Christoph Dodt, chief physician of the interdisciplinary emergency center in Munich-Bogenhausen, indicates that emergency rooms are increasingly being claimed by an aging population. Situations in which the staff are heavily burdened would occur regularly and endangered patient safety. A central problem is also that there are often too few capacities in order to quickly move emergency patients to other stations and to provide them there. Ulrike von Arnim, chief doctor of the central emergency room at the Vivantes Clinic in Berlin-Neukölln and Vice President of the DGINA, agrees: “The failure of the emergency reform affects us,” she says. The German Hospital Society (DKG) also considers a reform urgently necessary.

    The chief doctor Ulrike von Arnim considers an emergency reform urgently necessary. (Photo: Winfried Mausolf)

    But would the planned emergency reform really improve the situation? Many experts doubt this. They want a closer interlinking of emergency and hospital reform. The introduction of a specialist in emergency medicine, as the DGINA has been demanding for a long time, was not part of the draft law. There is no one in most EU countries, but in Germany. Assistant doctors also report that they have to work and make decisions in weekends and night services without specialist and senior physicians. Chief physician Dodt says that in his clinic there is always a specialist or senior doctor in the house. But he also says that many hospitals could not afford it. Lauterbach's emergency reform has not solved this problem either.

    In addition, the experts agree that they need more experienced staff. The specialist company DGINA complains that in emergency rooms, “inexperienced” staff from various disciplines are often used in a quick change. The result is “over- or underdiagnostics, excessive demands for young personnel and delayed treatment”.

    Some doctors can no longer guarantee adequate patient care

    The assistant doctor from the Bavarian Clinic says that she was partly responsible for the entire emergency room and another station. Also on weekends or evening, assistant doctors are often alone with nurses in the emergency room. “The system is sewn to edge in such a way that good training and further education is not guaranteed.” Specialists or senior doctors can be reached by phone to help if the staff on site do not know. However, it is not always easy to get help: “You often don't dare because you are afraid to be put on stupid.”

    The DKG sees no problem in this. In principle, specialist and senior physicians in the hospital can be reached at any time if they were needed due to the severity of the disease, DKG boss Gerald Gaß said. Assistant doctors are trained doctors and worked under the guidance of specialist and senior doctors. “A lack of quality cannot be derived from their use,” says Gaß.

    How borderline the service in the emergency room can still be shows a risk and overload indicator that the SZ has. In it, assistant doctors of a hospital in southern Germany warn their home management that they could not guarantee adequate patient care due to the burden. In addition, the health of the staff is at risk.

    Blind daring inflammation has been confused with gastrointestinal flu several times

    Other assistant doctors also report that they have provided such risk and overload ads, some of them several per year. The ads are forwarded to the works council, clinic management, chief physicians. The latter must then justify how the overload could occur and suggest solutions. For the emergency doctor Christoph Dodt, however, the overload displays are only subjective snapshots. What is more important is a systematic recording of the situation in the emergency rooms.

    As early as 2022, the Bertelsmann Foundation stated that there is a lack of data, transparency and thus also on secure knowledge of which measures are sensible and effective in emergency rooms. Therefore, it is difficult to judge: was it correctly decided? What could have run differently or better? And above all: what can be learned from the previous situation? Arnim's DGINA vice also complains of a lack of quality control: “We are a high risk area. We need a lot more and much better data. ”The German hospital company, on the other hand, considers the existing controls sufficient. In international comparison, the German clinics worked at a high level.

    Marcus Rall, Managing Director of the Institute for Patient Safety and Team Training, knows the misery. He worked in emergency medicine for a long time. He also sees reform needs as a patient representative. He knows cases in which people with abdominal pain were sent home with the diagnosis of gastrointestinal flu and the appendicitis remained undetected. Rall does not blame individual doctors: “These are highly motivated teams who want to help the patients. They also suffer from it if that doesn't work. “

    This also applies to the assistant doctor from the Bavarian Hospital. Despite everything, she likes to work in the emergency room. At the same time, she often has the feeling that “the job will finish me mentally and physically”. And she is concerned about the well -being of her patients. “If people knew what is going on in the emergency room and how many inexperienced people work there, then many would be even more afraid.”

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