BACKGROUND:The directives of the Federal Joint Committee (G-BA) define tiered emergency care structures, but their influence on patient decision-making has not been sufficiently studied. OBJECTIVE (RESEARCH QUESTION):This study examined patient-related determinants of utilising emergency departments (ED) of different emergency levels in Bavaria. MATERIALS AND METHODS:From September to November 2024, we carried out a standardised, cross-sectional survey in 18 ED at basic, extended and comprehensive care levels (n = 7527 participants). Data were analysed descriptively and with multinomial logistic regression. Subjective urgency, reason for visit, travel time and mode of arrival were included as influencing factors. RESULTS:15.4% of respondents who visited the ED independently (n = 5300) chose to do so because of the expected specialization. Patients in comprehensive EDs used emergency medical services significantly more often, rated their urgency higher and more frequently reported neurological, urological or ophthalmological complaints. They accepted longer travel times and were less likely to have sought outpatient care beforehand. DISCUSSION:The choice of emergency level is chiefly influenced by subjective urgency, specialty-related complaint types, mode of arrival and institutional structure. Even the existing heterogeneity among institutions exerts a steering effect. Future management concepts-such as integrated emergency centres-should incorporate these patient preferences and regional care realities to enable need-oriented direction without undersupply.

Aim The quantitative effect of several inhibitory drugs on the development of adverse drug reactions (ADRs) is currently difficult to estimate. Our aim was to identify metabolic pathways, which, when inhibited, increase the risk for certain ADRs, and to use this system to consider comedication at individual level.Methods Data of a prospective multicentre cohort of ADRs on emergency department admissions were used (ADRED-study, trial registration: DRKS00008979). A score system to rate the burden of inhibition on pathways was implemented to calculate individual burdens per patient. These cumulative burden scores were used as predictors in binary logistic regressions to identify pathways, which were significantly positively correlated with the ADRs falls and haemorrhages, respectively.Results Regarding falls, CYP2D6, OCT2 and carboxylesterase 1 were identified as relevant metabolic pathways with cumulative inhibitory burden. Concerning haemorrhages, CYP2C19, CYP3A4, MRP4, OAT2, OATP1B1 and carboxylesterase 1 were determined. Within relevant pathways for the occurrence of falls, common fall-risk-increasing drugs (FRIDs) and associated drugs were found, as well as bleeding inducing drugs within relevant pathways for the occurrence of haemorrhages.Conclusion Our approach identifies plausible inhibited pathways, raising awareness that a high burden of pathway inhibition can contribute to the occurrence of ADRs. Further validation in a second dataset is necessary.

Metabolic dysfunction–associated steatotic liver disease (MASLD) as the main cause of chronic liver disease worldwide is associated with increased mortality. Especially in patients with fibrosis, an increased risk of adverse drug reactions (ADRs) might be present. Therefore, the impact of high-risk for liver fibrosis on the outcome of ADRs was analyzed. Patients of a multicenter cohort study in maximum care emergency departments (ED) with admissions due to ADRs with available FIB-4 score parameters were analyzed. The cohort was divided into patients with low (FIB-4 < 2.67) and high (FIB-4 ≥ 2.67) liver fibrosis risk. Triage at ED admission, ADR seriousness criteria, discharge status, and length of hospital stay were used as outcomes. Logistic and linear regression analyses were applied. Among the 1087 patients, 407 had a high risk of fibrosis (37.4

Abstract Background Many drugs influence blood potassium levels and are often prescribed to older adults. Aim of this study was to estimate the extend of potassium level changes of drugs in the case of older, multi-medicated patients respecting renal function. Methods Data of patients from an outpatient clinic (polypharmacy consultations hours) at the University Hospital RWTH Aachen and from a prospective, multicenter study on adverse drug reactions in emergency departments (ADRED) was used. Data of patients aged ≥ 70 years taking ≥ 3 drugs with available blood potassium levels were included. Quantile regression models were used to analyze drug effects in the context of multi-medication. Results In total, N = 1097 patient cases were included with hypokalemia in 28.4% ( n = 311) and hyperkalemia in 20.3% ( n = 223). Male sex, use of low-ceiling diuretics, loop diuretics, mineralocorticoid receptor antagonists (MRAs), angiotensin-converting-enzyme inhibitors/ angiotensin II receptor blockers, number of other drugs, and CKD stage were associated with serum potassium levels and included in quantile regression models. In CKD stages 1 and 2, the use of MRAs (+ 0.49, p = 0.002), together with low-ceiling diuretics (-0.54, p < 0.001) had highest impact on serum potassium levels. In CKD stage 3, use of low-ceiling diuretics (-0.52, p < 0.001) and in CKD stages 4 and 5, the use of MRAs (+ 0.86, p < 0.001) had highest impact on serum potassium levels. Conclusions Hypo- as well as hyperkalemia occur frequently in geriatric, multi-medicated patients. While renal function is an important predictor of blood potassium levels, drug effects can differ per drug class in the context of multi-medication. Trial registration The ADRED-study is registered at the German Clinical Trials Register under: DRKS00008979. The cohort study of the polypharmacy consultation hours at the University Hospital RWTH Aachen is registered at the ClinicalTrials.gov under: NCT05247814.

Die Richtlinien des Gemeinsamen Bundesausschusses (G-BA) definieren gestufte Notfallversorgungsstrukturen. Bislang ist jedoch unzureichend untersucht, inwieweit sich Patienten bei Selbstvorstellungen in Notaufnahmen an der Versorgungsstruktur orientieren. Untersucht wurden patientenbezogene Determinanten der Inanspruchnahme von Notaufnahmen unterschiedlicher Notfallstufen in Bayern. Von September bis November 2024 wurde in 18 Notaufnahmen mit Basis-, erweiterter und umfassender Versorgungsstufe eine standardisierte, querschnittliche Befragung durchgeführt (n = 7527 Teilnehmende). Die Auswertung erfolgte deskriptiv und mittels multinominaler logistischer Regression. Subjektive Dringlichkeit, Beschwerdeanlass, Fahrzeit wurden als Einflussfaktoren berücksichtigt. 15,4

INTRODUCTION:Emergency care in Germany is under strain due to increasing patient numbers, limited resources, and a high proportion of non-urgent consultations. Against the backdrop of the hospital reform, which stipulates that patients should be able to reach a basic care hospital within 30 minutes (min), this sub-analysis examines patients who deliberately accept longer travel times (>30 min). The aim was to identify predictors and motives of this group. METHODS:In the Bavarian Emergency Department (ED) Utilisation Survey (n = 7,527), 1,128 patients with travel times exceeding 30 min were analysed. Travel times were calculated using postal code coordinates. Descriptive analyses and multivariate logistic regression were performed. RESULTS:Fifteen percent of respondents reported travel times of more than 30 min (mean: 44 min); 79.5% accepted travel times of at least 10 minutes more than to the nearest emergency department. High perceived urgency (31% very urgent; 18% emergency), severe pain (51% of respondents with pain), and prior attempts to contact outpatient physicians (49%) were frequently reported. Contact attempts were successful in 87% of cases for general practitioners and in 82% for specialists. Gynaecological, ophthalmological, and otorhinolaryngological complaints showed the strongest associations with longer travel distances. DISCUSSION AND CONCLUSION:Longer travel times may not only reflect a perceived need for greater expertise and safety but also indicate actual gaps in service provision, particularly in specialties that are only available at larger emergency departments. Policy and management measures should therefore consider geographic accessibility along with the regional availability of specialized services, awareness of consultation services, and transparent communication about hospital service profiles.

Background: Medication errors (MEs) are a frequent cause of preventable harm but remain insufficiently quantified in emergency care. This study assessed the frequency, characteristics, and clinical impact of MEs among adverse drug reaction (ADR)–related emergency department (ED) admissions in Germany. Methods: We conducted a prospective multicenter study across six EDs over six years (n=7,967). ADRs and MEs were classified using standard causality (World Health Organization-Uppsala Monitoring Centre (WHO-UMC)) and preventability criteria (Schumock). Patient, drug, symptom, and outcome characteristics were compared between ADRs with and without MEs. Regression models assessed predictors of MEs and length of stay in hospital. Results: 20.1% of ADR-related cases, involved a preventable ME. Clinical presentation between groups; symptom burden, triage severity, and discharge outcomes, were similar. MEs clustered around chronic medications (pantoprazole, torasemide, metoprolol, ramipril, phenprocoumon, ibuprofen). Schumock analysis showed preventability as primarily linked to dosing errors (30%), non-adherence (28%), contraindications (26%), and monitoring (20%). Drug-specific symptom clusters mirrored expected pharmacology but were not error-specific. Multimorbidity was modestly protective (OR 0.84, 95%CI 0.71–1.00), while age, sex, polypharmacy, and number of diagnoses were not. Length of hospital stay was slightly longer in ME cases (+0.37 days; p = 0.037). Conclusion: MEs were identified in a substantial proportion of ADR-related ED admissions. Most MEs arose from routine prescribing and monitoring processes involving commonly used drugs suggesting that preventive efforts should focus on upstream safeguards, including medication reviews, electronic prescribing support, pharmacist involvement, and adherence monitoring, rather than detection at emergency presentation.

Die außerklinische fallabschließende Akutversorgung rückt angesichts einer wachsenden Zahl der Gesamteinsätze und einer Zunahme niedrigprioritärer Hilfeersuchen und damit struktureller Überlastung von Rettungsdienst und ambulanter Versorgung in den Fokus. Sie beschreibt einen neuen, intersektoralen Versorgungsmodus zwischen außerklinischer Regelversorgung und Rettungsdienst, der akute, aber nicht lebensbedrohliche Fälle wohnortnah versorgt. Der Beitrag diskutiert und analysiert entlang von 13 Empfehlungen notwendige strukturelle Anpassungen und entwirft ein gestuftes Qualifikationssystem für neue professionelle Rollen im Rettungsdienst und in der außerklinischen Notfall- und Akutversorgung.

Für die Abschätzung der sozioökonomischen Folgen der SARS-CoV-2-Pandemie mangelt es an belastbaren Daten, die den zeitlichen Verlauf der COVID-19-Infektionen in Deutschland unter Berücksichtigung des Dunkelzifferfaktors abbilden. Auf Basis von drei unterschiedlich aufgebauten Modellrechnungen schätzen wir die monatlichen SARS-CoV-2-Infektionszahlen in Deutschland für die ersten 5 Jahre der Pandemie (2020–2024) ab. Es ergeben sich insgesamt zwischen 160 und 197 Mio. Infektionen, d. h. wesentlich mehr als die vom RKI gemeldeten 39 Mio. Infektionen. Im Jahr 2024 liegt der Dunkelzifferfaktor bzgl. der offiziellen RKI-Daten bei über 80.

Background: The utilisation of emergency departments (ED) by patients with non-life-threatening conditions poses an increasing challenge. The aim of this study was to examine the reasons for ED visits, subjective urgency, prior use of primary care services, awareness of the 116117 (urgent care telephone number in Germany), and willingness to use digital self-assessment among patients in Bavarian EDs. Methods: In a multicentre cross-sectional survey, patients in 18 Bavarian EDs were surveyed using a standardized questionnaire between September and November 2024. Results: Of 7527 patients surveyed, 49.7% were female and 32.6% had a higher education. The main reasons for ED visits were symptom severity (49.6%) and health-related anxiety (23.9%). In all, 88.0% assessed their concern as at least "urgent" or "emergency", and 39.7% of respondents had previously attempted to reach a physician's practice. The telephone number 116117 was known to 61.8% of respondents, with significant differences regarding age, education, migration background, and online research; 23.7% were generally open to digital self-assessment. Discussion: The results show that subjectively perceived symptom severity and health-related anxieties are central motives for ED consultations. The moderate awareness level of 116117 with pronounced sociodemographic disparities indicates untapped potential for patient flow-management. Conclusion: The study emphasises the potential and the need to improve awareness of 116117 and the implementation of digital decision support tools for more efficient allocation of patients within emergency care services.

Die Inanspruchnahme von Notaufnahmen durch Patienten mit nichtlebensbedrohlichen Beschwerden stellt eine zunehmende Herausforderung dar. Ziel der Studie war es, die Beweggründe zur Notaufnahmevorstellung, die subjektive Dringlichkeit, die vorherige Nutzung vertragsärztlicher Angebote, die Bekanntheit der 116117 sowie eine Bereitschaft zur digitalen Selbsteinschätzung unter Patienten in bayerischen Notaufnahmen zu untersuchen. In einer multizentrischen Querschnittserhebung wurden zwischen September und November 2024 Patienten in 18 bayerischen Notaufnahmen standardisiert mittels Fragebogen befragt. Von 7.527 befragten Patienten waren 49,7

Background/Objectives: Pharmacovigilance aims to identify, assess, and minimize drug risks, with spontaneous reporting playing a central role. However, the high level of underreporting and the varying data quality are limitations that should be minimized through prospective cohort studies. Methods: Spontaneous reports reported to the Drug Commission of the German Medical Association (AkdÄ) over one year were compared with the adverse drug reaction (ADR) cases systematically recorded in hospital emergency departments. The frequencies of the demographic patient characteristics and the odds ratios, as the relationship between suspected and concomitant medication, were calculated. Results: In the spontaneous reports, cases were reported by patients a median of 12 years younger, and the group of older patients was less represented (10.8% versus 27.3% in the prospective cohort study). Within the study, cases with polypharmacy were documented significantly more often (a median of seven drugs [IQR 3;10] versus a median of two drugs [IQR 1;5] in the spontaneous reports). New drugs and drugs discussed in the media were frequently reported as causing ADRs, whereas drugs with an effect on the central nervous system were more often suspected in the emergency department setting. Conclusions: Both sources for ADRs provide complementary information that improves the detection of risk signals. The aim for the future is to further increase the awareness of spontaneous reports and to answer specific questions with the help of structured investigations. It is important to compare and validate the findings of spontaneous reports and investigations in regular intervals to improve drug safety.

Background:Even though abdominal pain is one of the most frequent chief complaints in emergency medicine, standardized care pathways are still lacking. In this study, a standardized, digitally-supported care pathway for non-traumatic abdominal pain in the emergency department was investigated with regard to emergency department length of treatment, pain score at discharge, and patient satisfaction. Methods:In a prospective mixed-methods, multicentre, cluster-randomised, controlled stepped wedge trial, adult patients with non-traumatic abdominal pain were enrolled in ten emergency departments across Germany. The new care pathway was implemented at randomly assigned time points (every four months) within a 24-month recruitment period and consisted of a structured care pathway for the management of abdominal pain patients in the emergency department. During the control period, the standard treatment for abdominal pain in the emergency department was administered. The planned sample size was 2000. Primary outcomes were: emergency department length of treatment, pain score (numeric rating scale 0-10), and patient satisfaction score at the end of emergency department treatment. Exploratory safety outcomes were serious adverse events within 30 days. Trial registration: DRKS00021052. Findings:Of 2119 patients, 1017 were enrolled in the control group, and 1102 in the intervention group. Crude mean emergency department length of treatment was 5.2 h (±3.0) in the control group, and 4.3 h (±2.2) in the intervention group while the adjusted mean difference was -0.31 h (95% confidence interval (CI) -0.70 to 0.07). Mean pain score was 4.3 (±2.5) in the control group, and 3.6 (±2.4) in the intervention group, resulting in an adjusted mean difference of -0.69 (95% CI -1.04 to -0.34). The adjusted mean difference of patient's satisfaction score was 1.54 (95% CI 0.96 to 2.12); mean control group: 26.7 (±4.0); mean intervention group: 27.9 (±3.8)). Serious adverse events were comparable between both groups while 30-day mortality was 2.3% (n = 23) in the control group, and 0.8% (n = 9) in the intervention group (mean difference: -1.4% (95% CI -2.5 to -0.4)). Interpretation:The APU process is safe and did not increase emergency department length of treatment, while patient-reported outcomes and safety were improved accompanied by an increased use of diagnostic procedures. Funding:The study was funded by the German Innovations Funds.

Certifications and the associated standards are of great importance in the quality assurance of health care in Germany. Over the last few years, the number of certificates issued by the different professional associations has increased significantly, making it increasingly difficult to keep track of them. Especially in the preclinical setting, rescue services and emergency medical service (EMS) physicians encounter unfiltered patient clientele. In order to provide patients with targeted care, they are usually assigned tracer diagnoses. There are specialized centers at the respective clinics for many of these (suspected) diagnoses. These serve to provide patients with tailored diagnostics and treatment in order to achieve an optimal outcome. The article lists the centers that are relevant for EMS physicians and outlines the personnel as well as diagnostic and therapeutic requirements. It aims to make it easier to decide on the appropriate target clinic and is intended to provide general and uniform understanding.

Overcrowding and exit block jeopardize patient safety in emergency departments, increase patient mortality, and lead to staff overload. Critical care situations are accompanied by numerous legal uncertainties and open questions regarding liability in the event of harm. The causes of overcrowding and exit block are complex and often not directly influenced by the emergency department itself. Nevertheless, it is essential to maintain the necessary duty of care in such situations. In this context, definitions of terms, legal foundations and risks, as well as methods for objectively documenting overload situations, are presented.