The barrel is full. Pretty full even. “In the past four weeks we have been confronted with about 45 percent more rescue service calls than at the same time last year,” says Viktoria Bogner-Flatz, chief physician of the central emergency room (ZNA) of the Ebersberg district clinic. But that alone is not the reason why the barrel is so full. Because at the same time there is a high level of sick leave among the staff due to the pandemic, and nurses and doctors are also leaving the areas of emergency and intensive care medicine – the workload and emotional stress have increased too much for some of those affected. “I currently have two resignations from the ZNA on my desk,” says the head of the clinic, Stefan Huber. The reason for one of them is very clear: “I can’t do it anymore.”
The situation that is currently in the Ebersberg emergency room is not special – at least not insofar as such statements can be heard from all Bavarian clinics. So just recently pointed out the Bavarian Hospital Society in a press release pointed out that the availability of emergency rooms in Bavarian hospitals for the emergency services was increasingly limited.
In other respects, of course, the situation is very special and cannot be accepted without concern. Because: “We can afford neither more patients nor fewer staff without the preclinical or clinical system partially or completely collapsing,” says Bogner-Flatz.
The incidence of the disease increases after major events
Under these circumstances, large events are a problem. “Most say that it is up to everyone to go there and thus take an increased risk of, for example, a corona infection,” says Stefan Huber. But such claims misunderstood one aspect: “Emergency care is at the absolute limit – if there is something on top of that, it could be the last straw.” After all the large gatherings of people in recent years, significantly higher incidences of disease have been found, as Bogner-Flatz explains – not only with Corona. And some of those affected end up in the emergency room. A logical conclusion from this would be: The risk when attending a major event is no longer an individual one, but a social one.
Viktoria Bogner-Flatz has been chief physician in the central emergency room of the district clinic in Ebersberg since January.
(Photo: district clinic/oh)
But what about outpatient emergency care, i.e. general practitioner practices or the on-call practice of the Association of Statutory Health Insurance Physicians in the rooms of the district clinic – can this not be seen as any relief for the ZNA? In the current time, the answer is: Probably not. And that’s for two reasons.
Patients with a slate in their finger expect short waiting times with “full service”
On the one hand, Viktoria Bogner-Flatz describes that patients go to the emergency room because of trifles, although treatment by the family doctor or the on-call service would be possible without any problems – and then sometimes a high or even very high expectation is present. “Short waiting times with ‘full service’ are expected here.” In concrete terms, this means that Bogner-Flatz and her team receive complaints about long waiting times for small cuts on the toes or pulled-in slates in the fingers. Managing Director Stefan Huber confirms that. The ambulances in front of the clinic, some of which bring serious or life-threatening cases, of which the patient with the minor injury does not necessarily notice – because the seriously injured person is not sitting next to him, but is being treated in the emergency room. “Then there is a rebellion after waiting two hours because the slate in the finger has not yet been treated – regardless of whether someone in the emergency room has to be resuscitated.”
Stefan Huber has been in charge of the Ebersberger Kreisklinik since 2009 – but only until the end of this year, when he will take over the management of three clinics of the Starnberger Kliniken GmbH.
(Photo: Peter Hinz-Rosin)
On the other hand, the structure of outpatient emergency care is also a problem. The times when there were emergency services in the doctor’s offices in the district outside of the usual office hours and when these on-call doctors also made house calls are over since 2016. Since then, there has been an on-call practice in the clinic rooms and an on-call transport service for the Ebersberg district – which, however, does not only cover the district. Exactly how large the area of responsibility is cannot be said exactly when asked by the Bavarian Association of Statutory Health Insurance Physicians (KVB) – the doctor on duty usually starts, who has to travel the shortest route to the patient. No information can be given about the average length of time a person affected has to wait in rural areas before the on-call doctor arrives. But according to the statements made by the head of the clinic, Huber, one conclusion seems clear: a lot of time has to be spent driving, but there is little time left for patient care.
Many in the field feel the need for emergency care reform
“Reform is urgently needed here,” says Bogner-Flatz. She speaks of a structure that can be used to determine whether the patient needs clinical emergency care or a clinical diagnostic resource – or whether the patient can also be well cared for in the outpatient area by resident doctors.
A reform of outpatient emergency care has been announced in the current coalition agreement. In June of this year, the German Hospital Society issued a position paper for a concept for such a reform. Accordingly, an integrated emergency center (INZ) should be established in every hospital. Such an INZ consists of the emergency room, which organizationally belongs to the clinic, and a so-called portal practice, which the associations of statutory health insurance physicians operate independently at the clinic – in the case of Ebersberg, this would be the on-call practice in the clinic rooms. An initial assessment of the patient is then made at a common counter, after which he is forwarded to the most suitable care structure for him: family doctor’s practice, on-call practice or emergency room. However, the decision on a reform has been postponed by the federal government for a year, as the Bavarian Hospital Society writes.
“Politicians absolutely have to step in and change something,” says Stefan Huber. It makes him sad that two employees from the 25-strong team at Ebersberger ZNA are now leaving – after all, that is eight percent of the workforce that will be lost. Because actually you want to motivate for the job. But if the load gets too big, it just doesn’t work anymore. “Unfortunately, as the head of the clinic, I can’t do much about that.” Due to the shortage of skilled workers, it will probably not be an easy task to fill the positions. “We may have to redeploy staff, which in turn would lead to further bottlenecks in other areas.”
In life-threatening situations such as chest pain, shortness of breath, serious accidents, the number 112 should still be dialled. In the case of less acute symptoms, patients should consult their general practitioner. If anything is unclear, call the medical on-call service on 116 117 for further care options.