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  • 1
    Online Resource
    Online Resource
    Changes in emergency department utilisation in Germany before and during different phases of the COVID-19 pandemic, using data from a national surveillance system up to June 2021
    Springer Science and Business Media LLC ; 2023
    In:  BMC Public Health Vol. 23, No. 1 ( 2023-05-02)
    Details
    In: BMC Public Health, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-05-02)
    Abstract: During the COVID-19 pandemic and associated public health and social measures, decreasing patient numbers have been described in various healthcare settings in Germany, including emergency care. This could be explained by changes in disease burden, e.g. due to contact restrictions, but could also be a result of changes in utilisation behaviour of the population. To better understand those dynamics, we analysed routine data from emergency departments to quantify changes in consultation numbers, age distribution, disease acuity and day and hour of the day during different phases of the COVID-19 pandemic. Methods We used interrupted time series analyses to estimate relative changes for consultation numbers of 20 emergency departments spread throughout Germany. For the pandemic period (16-03-2020 – 13-06-2021) four different phases of the COVID-19 pandemic were defined as interruption points, the pre-pandemic period (06-03-2017 – 09-03-2020) was used as the reference. Results The most pronounced decreases were visible in the first and second wave of the pandemic, with changes of − 30.0% (95%CI: − 32.2%; − 27.7%) and − 25.7% (95%CI: − 27.4%; − 23.9%) for overall consultations, respectively. The decrease was even stronger for the age group of 0–19 years, with − 39.4% in the first and − 35.0% in the second wave. Regarding acuity levels, consultations assessed as urgent, standard, and non-urgent showed the largest decrease, while the most severe cases showed the smallest decrease. Conclusions The number of emergency department consultations decreased rapidly during the COVID-19 pandemic, without extensive variation in the distribution of patient characteristics. Smallest changes were observed for the most severe consultations and older age groups, which is especially reassuring regarding concerns of possible long-term complications due to patients avoiding urgent emergency care during the pandemic.
    Type of Medium: Online Resource
    ISSN: 1471-2458
    URL: Article
    DOI: 10.1186/s12889-023-15375-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2041338-5
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  • 2
    Online Resource
    Online Resource
    Medical and cardio-vascular emergency department visits during the COVID-19 pandemic in 2020: is there a collateral damage? A retrospective routine data analysis
    Springer Science and Business Media LLC ; 2022
    In:  Clinical Research in Cardiology Vol. 111, No. 10 ( 2022-10), p. 1174-1182
    Details
    In: Clinical Research in Cardiology, Springer Science and Business Media LLC, Vol. 111, No. 10 ( 2022-10), p. 1174-1182
    Abstract: In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure. Methods Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50). Results A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16%; CI (− 13)–(− 19)] , less urgent [− 18%; CI (− 12)–(− 22)] and non-admitted cases [− 17%; CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13%; CI (− 21)–2], myocardial infarction [− 2%; CI (− 9)–11] and heart failure [− 2%; CI (− 10)–6] were less affected and remained comparable to the previous year. Conclusions ED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies. Graphical abstract
    Type of Medium: Online Resource
    ISSN: 1861-0684 , 1861-0692
    URL: Article
    DOI: 10.1007/s00392-022-02074-3
    RVK:
    XA 37040
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2218331-0
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  • 3
    Online Resource
    Online Resource
    Sunday, 26 August 2012
    Oxford University Press (OUP) ; 2012
    In:  European Heart Journal Vol. 33, No. suppl 1 ( 2012-08-02), p. 19-338
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 33, No. suppl 1 ( 2012-08-02), p. 19-338
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehs281
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2012
    detail.hit.zdb_id: 2001908-7
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  • 4
    Online Resource
    Online Resource
    GRIPS - Gamma-Ray Imaging, Polarimetry and Spectroscopy
    Springer Science and Business Media LLC ; 2012
    In:  Experimental Astronomy Vol. 34, No. 2 ( 2012-10), p. 551-582
    Details
    In: Experimental Astronomy, Springer Science and Business Media LLC, Vol. 34, No. 2 ( 2012-10), p. 551-582
    Type of Medium: Online Resource
    ISSN: 0922-6435 , 1572-9508
    URL: Article
    DOI: 10.1007/s10686-011-9255-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 2012330-9
    SSG: 16,12
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  • 5
    Online Resource
    Online Resource
    Routinedaten aus Notaufnahmen: Unterschiedliche Dokumentationsanforderungen, Abrechnungsmodalitäten und Datenhalter bei identischem Ort der Leistungserbringung
    Georg Thieme Verlag KG ; 2020
    In:  Das Gesundheitswesen Vol. 82, No. S 01 ( 2020-03), p. S72-S82
    Details
    In: Das Gesundheitswesen, Georg Thieme Verlag KG, Vol. 82, No. S 01 ( 2020-03), p. S72-S82
    Abstract: Hintergrund Nicht nur im Kontext der Neuordnung der Notfallversorgung in Deutschland besteht derzeit ein hoher Bedarf an Daten aus Notaufnahmen. Für die Versorgungsforschung bieten sich Daten an, welche auf gesetzlicher Grundlage generiert werden. Unterschiedliche Kostenträger und Abrechnungsmodi stellen eigene Anforderungen an die Dokumentation dieser Routinedaten. Methodische Herausforderungen Aufgrund der sektoralen Trennung gibt es keinen Datensatz oder Datenhalter, der Auskunft über alle Notaufnahmebehandlungen geben kann. Aus administrativer Sicht gilt die gesamte Notaufnahmebehandlung als ambulant oder stationär, tatsächlich wird die Entscheidung darüber erst während der Versorgung getroffen. Für die stationäre Versorgung existiert ein administratives Notfallkennzeichen, allerdings kein direktes Merkmal für Notaufnahmebehandlungen. Bei Abrechnung ambulanter Fälle über die kassenärztlichen Vereinigungen ist mindestens eine Diagnose (ICD-10-Kode) zu erfassen, versehen mit einem Kennzeichen zur Diagnosesicherheit. Es können mehrere ICD-10-Kodes ohne Hierarchie angegeben werden. Bei stationär behandelten Patienten ist eine Aufnahmediagnose und nach Behandlungsende die Hauptdiagnose und ggf. Nebendiagose(n) an die zuständige Krankenkasse zu übermitteln. Die gesetzliche Unfallversicherung hat eigene Dokumentationsanforderungen. Lösungsansätze Je nach Forschungsfrage und Studiendesign sind unterschiedliche Vorgehensweisen erforderlich. Stammen die Daten unmittelbar aus Notaufnahmen bzw. Kliniken ist eine Information über den Kostenträger und den Abrechnungsmodus hilfreich. Bei Nutzung von Krankenkassendaten muss die Identifikation von stationär behandelten Patienten in einer Notaufnahme aktuell indirekt erfolgen. Dazu können unter anderem die Parameter Aufnahmegrund und definierte „eindeutige“ Notfall-Diagnosen herangezogen werden. Die fallpauschalenbezogene Krankenhausstatistik hat eigene Limitationen, enthält dafür aber die stationären Fälle aller Kostenträger. Diskussion Die divergierenden Anforderungen an die administrative Dokumentation verursachen einen hohen Aufwand in den Kliniken. Perspektivisch ist eine Vereinheitlichung der Leistungserfassung und Dokumentation von Notfallbehandlungen aller Kostenarten auch zur Generierung von validen, vergleichbaren und repräsentativen Daten für die Versorgungsforschung erstrebenswert. Die Einführung eines eigenen Fachabteilungsschlüssels würde zur Identifikation von Notaufnahmebehandlungen beitragen.
    Type of Medium: Online Resource
    ISSN: 0941-3790 , 1439-4421
    URL: Article
    DOI: 10.1055/a-0996-8371
    RVK:
    XF 1000
    RVK:
    QX 700
    RVK:
    XF 1100
    RVK:
    XA 10000
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 1101426-X
    SSG: 20,1
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  • 6
    Online Resource
    Online Resource
    Characteristics of older versus younger emergency patients : Analysis of over 356,000 visits from the AKTIN German emergency department data registry
    Springer Science and Business Media LLC ; 2022
    In:  Medizinische Klinik - Intensivmedizin und Notfallmedizin
    Details
    In: Medizinische Klinik - Intensivmedizin und Notfallmedizin, Springer Science and Business Media LLC
    Abstract: This nationwide study aims to analyze age-specific differences and characteristics of emergency patients with a special focus on older patients. Method In 2019, data were obtained from 11 emergency departments (EDs), all part of the German Emergency Department Data (AKTIN) registry. All patients 18 years and older visiting the EDs were included. In addition to demographic data, variables such as referral, type of transport, primary assessment, diagnoses, length of stay and type of transfer were recorded and compared by age group and specifically by younger (18–64 years) and older patients (65+ years). Results Data from 356,354 patients (39.1% were aged 65+ years) were included. Compared to younger patients, older ED patients were more likely to be accompanied by emergency medical services (15.4 vs. 34.3%) and almost twice as often by an emergency physician (6.4 vs. 12.2%). The need for treatment increased with age; 47.1% of younger and 66.1% of older people were classified as yellow, orange or red. The proportion of patients with internal diseases was higher for patients 65+ years (22.5 vs. 38.8%). Older patients were more often hospitalized (27.5 vs. 60.3%) and were more frequently transferred to an intensive care unit (4.5 vs. 11.9%). Conclusion About 40% of adult emergency patients are 65+ years. They require more urgent treatment and are more often hospitalized than younger patients. In older patients, internal diseases were more common.
    Type of Medium: Online Resource
    ISSN: 2193-6218 , 2193-6226
    URL: Article
    DOI: 10.1007/s00063-022-00968-8
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2636049-4
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  • 7
    Online Resource
    Online Resource
    German emergency department measures in 2018: a status quo based on the Utstein reporting standard
    Springer Science and Business Media LLC ; 2022
    In:  BMC Emergency Medicine Vol. 22, No. 1 ( 2022-12)
    Details
    In: BMC Emergency Medicine, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: Compelling data on clinical emergency medicine is required for healthcare system management. The aim of this survey was to describe the nationwide status quo of emergency care in Germany at the healthcare system level using the Utstein reporting template as the guideline to measure the data collected. Methods This cross-sectional survey collected standardized data from German EDs in 2018. All 759 of the EDs listed in a previously collected ED Directory were contacted in November 2019 using the online-survey tool SoSci Survey. Exclusively descriptive statistical analyses were performed. Absolute as well as relative frequencies, medians, means, ranges, standard deviations (SD) and interquartile ranges (IQR) were reported depending on distribution. Main Results A total of 150 questionnaires of contacted EDs were evaluated (response rate: 19.8%). Hospitals had a median of 403 inpatient beds ( n =147). The EDs recorded a median of 30,000 patient contacts ( n =136). Eighty-three EDs (55%) had observation units with a median of six beds. The special patient groups were pediatric patients ( 〈 5 years) and older patients ( 〉 75 years) with a median of 1.7% and 25%, respectively. Outpatients accounted for 55%, while 45% were admitted (intensive care unit 5.0%, standard care unit 32.3%, observation unit 6.3%) and 1.2% transferred to another hospital. Conclusions The use of the Utstein reporting template enabled the collection of ED descriptive parameters in Germany. The data can provide a baseline for upcoming reforms on German emergency medicine, and for international comparisons on admission rates, initial triage categories, and patient populations.
    Type of Medium: Online Resource
    ISSN: 1471-227X
    URL: Article
    DOI: 10.1186/s12873-021-00563-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2050431-7
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  • 8
    Online Resource
    Online Resource
    Evaluation of outcome relevance of quality indicators in the emergency department (ENQuIRE): study protocol for a prospective multicentre cohort study
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 9 ( 2020-09), p. e038776-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 9 ( 2020-09), p. e038776-
    Abstract: Quality of emergency department (ED) care affects patient outcomes substantially. Quality indicators (QIs) for ED care are a major challenge due to the heterogeneity of patient populations, health care structures and processes in Germany. Although a number of quality measures are already in use, there is a paucity of data on the importance of these QIs on medium-term and long-term outcomes. The evaluation of outcome relevance of quality indicators in the emergency department study (ENQuIRE) aims to identify and investigate the relevance of QIs in the ED on patient outcomes in a 12-month follow-up. Methods and analysis The study is a prospective non-interventional multicentre cohort study conducted in 15 EDs throughout Germany. Included are all patients in 2019, who were ≥18 years of age, insured at the Techniker Krankenkasse (statutory health insurance (SHI)) and gave their written informed consent to the study. The primary objective of the study is to assess the effect of selected quality measures on patient outcome. The data collected for this purpose comprise medical records from the ED treatment, discharge (claims) data from hospitalised patients, a patient questionnaire to be answered 6–8 weeks after emergency admission, and outcome measures in a 12-month follow-up obtained as claims data from the SHI. Descriptive and analytical statistics will be applied to provide summaries about the characteristics of QIs and associations between quality measures and patient outcomes. Ethics and dissemination Approval of the leading ethics committee at the Medical Faculty of the University of Magdeburg (reference number 163/18 from 19 November 2018) has been obtained and adapted by responsible local ethics committees. The findings of this work will be disseminated by publication of peer-reviewed manuscripts and presentations as conference contributions (abstracts, poster or oral presentations). Moreover, results will be discussed with clinical experts and medical associations before being proposed for implementation into the quality management of EDs. Trial registration number German Clinical Trials Registry (DRKS00015203); Pre-results.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-038776
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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  • 9
    Online Resource
    Online Resource
    Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)
    Springer Science and Business Media LLC ; 2022
    In:  Internal and Emergency Medicine Vol. 17, No. 4 ( 2022-06), p. 1199-1209
    Details
    In: Internal and Emergency Medicine, Springer Science and Business Media LLC, Vol. 17, No. 4 ( 2022-06), p. 1199-1209
    Abstract: Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.
    Type of Medium: Online Resource
    ISSN: 1828-0447 , 1970-9366
    URL: Article
    DOI: 10.1007/s11739-021-02919-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2378342-4
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  • 10
    Online Resource
    Online Resource
    Monthly in-house reports using the AKTIN Emergency Department Data Registry: advantages of standardised key figures : Development and implementation of a reporting system based on emergency department medical record data
    Springer Science and Business Media LLC ; 2023
    In:  Notfall + Rettungsmedizin Vol. 26, No. 6 ( 2023-09), p. 416-425
    Details
    In: Notfall + Rettungsmedizin, Springer Science and Business Media LLC, Vol. 26, No. 6 ( 2023-09), p. 416-425
    Abstract: With increasing utilisation and current changes in German emergency care, standardised recording of relevant key figures in emergency departments (EDs) is crucial. Objectives Consensus of key figures and technical implementation of an automated reporting for EDs that participate in the AKTIN Emergency Department Data Registry are described. The aim was a balanced monthly report for medical controlling and quality management of an ED. Materials and methods The basis is the Emergency Department Medical Record V2015.1 of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI). Consensus on key figures was reached based on external references and professional expertise. The technical development was based on a test dataset. The final report is created in PDF format automatically using R and Apache Formatting Objects Processor (FOP). Results The report contains, for example, information on case numbers, patient demographics, presenting complaints, acuity assessment, disposition and selected process indicators, presented as tables and graphs. It is generated automatically from the routine data on a monthly basis or on request. Missing values and outliers are shown separately in order to assess data quality. Conclusions The monthly AKTIN report is an instrument that summarises and visualises the work load and care provided in an ED. The key figures are a suitable and pragmatic approach and also reflect the requirements of the Federal Joint Committee for initial acuity assessment. The use of interoperability standards allows for the use of routine medical data, ensures independence from individual information technology (IT) systems and may serve as a basis for cross-institutional benchmarking.
    Type of Medium: Online Resource
    ISSN: 1434-6222 , 1436-0578
    URL: Article
    DOI: 10.1007/s10049-021-00910-z
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1478809-3
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