Structure of Neurological Departments in Germany: Results of the 12th Survey by the German Neurological Society

Abstract

AbstractThe German Neurological Society has conducted a survey of the structure of neurological in-patient care every other year. The present survey covers the year 2015. With a response rate of 62% in mind, the questionnaire allowed meaningful comparisons to former surveys covering the years 2013 and 2011.Only a minority of departments maintains intensive care units of their own. In contrast, 24/7 presence of neurological physicians has become standard in interdisciplinary emergency rooms. Stroke management has made neurology increasingly involved in emergency care. Since 2015, thrombectomy has been recognized as state-of-the-art therapy for a subgroup of stroke patients, raising special demands for the availability of CT and MRI on a 24/7 basis. However, infrastructure did not improve as compared to former surveys.Number of beds, total procedures and average procedures per case proceeds (case mix, case mix index) has remained roughly unchanged. However, case numbers increased, and average length of stay robustly decreased within 2 years by 17% to 5.4 days.Staff structures were heterogeneous and were involved in various duties apart from inpatient care covered by the German Diagnosis-Related Groups (DRG) system. Departments did not succeed in differentiating expenditures related to the DRG system from other procedures. Shortage of nursing staff forced 22% of departments to temporally reduce services, 6% of departments did so because of a shortage of physicians, and in 2% of departments, both occurred. Departments were confident of certifications as means of quality management, and a few suggestions were provided for more meaningful parameters for outcome-oriented quality management in the future.