Full emergency rooms, long waiting times for emergency patients whose treatment is not classified as “urgent” and a lack of staff – the development of clinical emergency care has further intensified in the third Corona year 2022. This is the result of a survey of the heads of the Munich emergency departments. It was carried out by the health department – accompanying the second Munich emergency study, which the Institute for Emergency Medicine and Medical Management at the Clinic of the Ludwig Maximilian University (INM) developed on behalf of the city. The results will be presented to the City Council Health Committee this Thursday.
The emergency physicians surveyed report an “enormously high volume of treatment in the emergency rooms”, a “blatant shortage of staff” and an “increasing burden” on the staff. This information fits the forecast that the INM dares in the study for emergency care up to the year 2040: According to the evaluation, there will be 34,000 more cases by the year 2030. Even 60,000 cases by 2040. The study attributes the significant increase to the expected increase in population. “These numbers worry me,” says Stefan Jagel, chairman of the Die Linke/Die party parliamentary group in the city council. Emergency care had already been “at the limit” for the last two to three years.
The first Munich emergency study was conducted in 2015. It was based on data from one year in the period 2013/2014. The second study is now evaluating a period of five years, from January 1, 2015 to December 31, 2019. Data from twelve participating clinics was used, including the Klinikum Rechts der Isar of the Technical University of Munich (TUM), the LMU clinics or the Munich clinic with locations in Bogenhausen, Harlaching, Neuperlach and Schwabing.
1.6 million cases served as the basis for the study
The handles in the study cover 82 percent of the emergency volume in the city. However, the Helios Klinik Pasing, which is important for western Munich and also provides emergency care, did not take part in the study. A total of 1,655,674 treatment cases are the basis for evaluating the clinical data.
According to the study, resource bottlenecks in emergency care have continued to increase. Above all, the number of emergency doctor calls increased during the observation period. Rescue service operations have increased by five percent, operations with an emergency doctor by 17 percent. Jagel, who is otherwise not “further surprised” by the evaluations of the emergency study, is concerned about the pre-hospital time, i.e. the interval between the emergency call being received and the transfer to a suitable hospital. According to the evaluation, this has increased further: from 48 minutes in 2015 to 57 minutes in 2022. This is to be regarded as “critical”. “I think the transfer times from the emergency doctor to the emergency room just take too long,” says Jagel, who himself has worked in the emergency room for a long time. An ambulance that has to wait a long time is also not quickly ready for use again.
According to the study, outpatient treatments in the clinics are “slightly declining”. In 2019, 57 percent (2015: 60 percent) of adults received outpatient treatment in the clinical facilities and 80 percent (2015: 85 percent) in the emergency facilities for children. 70 percent of the patients who needed emergency care came from the Munich area. One reason for the slight decline could be the expansion of the on-call practices of the Bavarian Association of Statutory Health Insurance Physicians (KVB) since 2018. According to the study, which for the first time can also evaluate emergency medical data from the KVB, the number of cases treated there increased by 20 percent between 2015 and 2019.
The second mayor Verena Dietl (SPD) makes it clear how important this outpatient care option is to relieve the clinics. It continues to hold the Free State and the KVB accountable. Because too many cases that, in their opinion, could also be treated in a practice would still be treated in the emergency rooms. “The Free State and KVB are responsible for ensuring that there is sufficient capacity in clinics and medical or on-call practices in Munich.”
Frequent bottlenecks in pediatric emergency care
There are also problems with the emergency care of the children. “Frequent bottlenecks” in the intensive care units as well as in the area of pediatric emergency care for children have increased, according to the study. The INM recommends that a medical offer for outpatient care for children should be “optimized” between clinics, KVB and the health department. Stefan Jagel finds the number of treatments for children “striking”: According to the study, 46,353 children were treated on an outpatient basis in 2019 and 12,101 inpatients. “We simply don’t have enough paediatricians,” criticizes Jagel and hopes that the KVB will make it possible to have more medical and on-call practices, especially in districts that are underserved.
A map with hospital cases per postal code area shows high utilization in the north of the city for 2019, but also in the east. The forecast for 2040 is even clearer: Clinical cases will increase significantly in the north and east. Exactly where more and more people will live and the supply is already “not good”, as Jagel says.
The parliamentary group leader of the left/the party considers the regular survey of the Munich emergency study to be “sensible”. And Jagel hopes that the findings of the second edition will also flow into the new medical concept of the Munich Clinic, which will soon be presented to the supervisory board.