Abstract
BackgroundEmergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland.MethodsIn 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012.ResultsIn 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available.ConclusionsSwiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.
Highlights
Emergency departments (EDs) are an essential component of any developed health care system
Whereas Switzerland, populated with 8 million inhabitants and with four national languages, has a system of public health surpassed by only the USA in per capita costs [8], to this day it does not possess a description of its EDs, an essential component of any health care system
For the purpose of our survey, Switzerland was divided into five zones based on linguistics or geography; one or two of the co-authors per zone sent a questionnaire to the head physician of each emergency center, or in the absence of such, to the acting head or to the hospital administration
Summary
Emergency departments (EDs) are an essential component of any developed health care system. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. Whereas Switzerland, populated with 8 million inhabitants and with four national languages, has a system of public health surpassed by only the USA in per capita costs [8], to this day it does not possess a description of its EDs, an essential component of any health care system. Our objective was to establish the structural characteristics and location, the number of patient visits and flow, and the medical organization and personnel of Swiss EDs in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland
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