What is Emergency Medicine Research

Evaluation of medical emergency rooms

Dtsch Arztebl Int 2010; 107 (15): 259-60; DOI: 10.3238 / arztebl.2010.0259
Editorial for the article: “Key figures and quality indicators of a medical emergency room” by Dormann et al. on the following pages
University Clinic and Polyclinic for Internal Medicine III University Clinic Halle (Saale) of the Martin Luther University Halle-Wittenberg: Prof. Dr. med. Will
The “emergency room” concept is changing. While the emergency department used to be a little beloved appendage to the great subjects of hospital medicine, which the clinic's doctors had to take care of "on the side", today independent emergency department clinics are increasingly being established and their advantages are being praised. There are all shades (1–3) within this range. A lot of effort and time is put into highlighting the advantages of one concept and the disadvantages of the other, and understandably, cost considerations often play an important role in the choice of a model (4, 5). However, what has so far been neglected is adequate examinations that compare the structural, process and outcome quality of the individual emergency room models with one another (6, 7). Both pre-hospital and in-hospital emergency medicine still have considerable deficits with regard to their research activities (8). As a result, any form of emergency medicine research is very welcome; this also applies to the article by Dormann and co-authors in this edition of Deutsches Ärzteblatt (9).

Key indicators
Dormann et al. (9) describe the range of patients who were treated in the medical emergency department of a German university clinic within twelve months. With the support of the available information systems of the clinic, a differentiated and informative breakdown of the patient data is carried out. The key indicators of the analysis are the diagnostic agreement (dÜ) of the admission diagnosis in the emergency room and discharge diagnosis from the hospital and the diagnostic efficiency (dEff) (dEff = dÜ × 100 / length of stay in minutes).

The standard results of this study are comparable with those from the literature and should only be briefly addressed here: In twelve months, 6,683 patients were treated, 64.6% of whom were further hospitalized, including the 14% in the intensive care unit. The spectrum of diseases, daily and weekly rhythms as well as the diagnosis-related length of stay were also comparable with literature data. The results for the quality indicators newly created by the authors are particularly exciting and innovative: the diagnostic agreement (dÜ) for the total collective was 0.71 and the diagnostic efficiency (dEff) - with an average length of stay of 116 minutes - was 0, 61 / min. The DE was highest at 0.92 for patients with atrial fibrillation / flutter and the DE at 0.85 / min for patients with acute myocardial infarction. Dormann and co-authors (9) conclude from their study that key figures and quality indicators of an emergency room can be presented transparently and the diagnostic agreement (dÜ) and the diagnostic efficiency (dEff) can be used as parameters for diagnosis-related and department-internal quality assessment. One can only fully agree with these statements of the authors: A further step with regard to the disclosure of the process quality of an emergency room is done.

New questions
Every good study usually brings up new questions, including the study by Dormann et al. (9) not excluded:

Of course, one can consider whether dÜ and dEff are the best quality indicators for the diagnostic tasks of an emergency room. There is no clear answer to this question. However, one thing seems plausible: the link between the diagnostic reliability and the time until the diagnosis is made produces added value in terms of quality assurance compared to the individual parameters.

The prospective validation of these retrospectively found indicators must be awaited, and of course one would prefer a “percentage of the optimal value” instead of a “min-1” value for diagnostic efficiency. Maybe the writers can think about it.

To measure the efficiency of an emergency department solely by the number of correctly made diagnoses and the diagnostic length of stay would appear to be too short-sighted, and the authors do not postulate that: On the one hand, it is often not the task of the emergency department to make the definitive diagnosis, but rather only a suspected diagnosis with further diagnostic and / or therapeutic consequences. On the other hand, it should not be forgotten that important emergency therapy measures should also take place in the emergency room, such as the guideline-based administration of an antibiotic within the first hour if sepsis is suspected (10). In this respect, dEff “only” reflects the diagnostic component of the emergency room activity, not the at least equally important therapeutic one. But what could prevent the emergency physicians from putting the disease-specific therapeutic efficiency tEff alongside the diagnostic efficiency dEff? The gate is open. The path to be striven for here would certainly be a coordinated and standardized procedure together with the responsible specialist societies. This seems particularly important.

One step forward
Dormann and co-authors have taken an important step forward in terms of process quality documentation in emergency medicine. You have retrospectively developed and proposed practicable quality indicators that can make work in an emergency room more transparent and thus more comparable, and that is important. In this respect, we can congratulate Dormann and co-authors on their work and wish the authors a lively reader discussion and a lively exchange of ideas with their colleagues and the specialist societies.

Conflict of interest
The author declares that there is no conflict of interest as defined by the International Committee of Medical Journal Editors.

Address for the authors
Prof. Dr. med. Karl Werdan
University Clinic and Polyclinic for Internal Medicine III
University Hospital Halle (Saale) der
Martin-Luther-University Halle-Wittenberg
Ernst-Grube-Strasse 40, 06120 Halle (Saale)
Email: [email protected]

The Evaluation of Emergency Admissions
How to cite: Dtsch Arztebl Int 2010; 107 (15): 259-60
DOI: 10.3238 / arztebl.2010.0259

@ The German version of this article is available online: