Abstract
BackgroundInadequate assessment of the severity and urgency of medical problems is one of the factors contributing to unnecessary emergency department (ED) visits. The implementation of a software-based instrument for standardized initial assessment—Standardisierte medizinische Ersteinschätzung in Deutschland (SmED) (Standardized medical Initial Assessment in Germany in English)—aims to support health care professionals and steer patients toward the right health care provider. This study aimed to explore the implementation process of SmED from a user perspective.ObjectiveThis study aims to evaluate the overall perception of SmED by health care professionals using the software, to examine to what extent SmED influences the workload and work routines of health care professionals, and to determine which factors are associated with the use of SmED.MethodsAn early qualitative process evaluation on the basis of interviews was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Participants were 30 health care professionals who work with SmED either at the joint central contact points of the outpatient emergency care service and the EDs of hospitals (ie, the Joint Counter; Gemeinsamer Tresen in German) or at the initial telephone contact points of the outpatient emergency care service (phone number 116117). Matrix-based framework analysis was applied to analyze the interview data.ResultsHealth care professionals perceived that workload increased initially, due to additional time needed per patient. When using SmED more frequently and over a longer time period, its use became more routine and the time needed per call, per patient, decreased. SmED was perceived to support decision making regarding urgency for medical treatment, but not all types of patients were eligible. Technical problems, lack of integration with other software, and lack of practicability during peak times affected the implementation of SmED.ConclusionsInitial experiences with SmED were positive, in general, but also highlighted organizational issues that need to be addressed to enhance sustainability.Trial RegistrationGerman Clinical Trials Register DRKS00017014; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017014
Highlights
In recent years, steadily increasing utilization of emergency departments (EDs) has aroused public and political attention, in Germany but in many nations [1,2,3,4,5,6,7]
Health care professionals perceived that workload increased initially, due to additional time needed per patient
Lack of integration with other software, and lack of practicability during peak times affected the implementation of Standardisierte medizinische Ersteinschätzung in Deutschland (SmED)
Summary
Steadily increasing utilization of emergency departments (EDs) has aroused public and political attention, in Germany but in many nations [1,2,3,4,5,6,7]. Factors that may explain high use of emergency resources include an aging population, increased number of chronically ill people, lack of cost awareness, lack of accessibility, unclear organization of outpatient emergency care service, and patients’ personal assessments regarding severity and urgency of medical conditions [9,10,11]. Unnecessary ED visits are defined as using the ED for health issues that do not require immediate medical treatment. Those visits could be classified as inappropriate, because ED resources are used for health issues that can be treated elsewhere (eg, in primary medical care or outpatient emergency care) [13]. Inadequate assessment of the severity and urgency of medical problems is one of the factors contributing to unnecessary emergency department (ED) visits. This study aimed to explore the implementation process of SmED from a user perspective
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