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Background During the COVID-19 pandemic and associated public health and social measures, decreasing patient numbers have been described in various healthcare settings in Germany, including emergency care. This could be explained by changes in disease burden, e.g. due to contact restrictions, but could also be a result of changes in utilisation behaviour of the population. To better understand those dynamics, we analysed routine data from emergency departments to quantify changes in consultation numbers, age distribution, disease acuity and day and hour of the day during different phases of the COVID-19 pandemic. Methods We used interrupted time series analyses to estimate relative changes for consultation numbers of 20 emergency departments spread throughout Germany. For the pandemic period (16-03-2020 – 13-06-2021) four different phases of the COVID-19 pandemic were defined as interruption points, the pre-pandemic period (06-03-2017 – 09-03-2020) was used as the reference. Results The most pronounced decreases were visible in the first and second wave of the pandemic, with changes of − 30.0% (95%CI: − 32.2%; − 27.7%) and − 25.7% (95%CI: − 27.4%; − 23.9%) for overall consultations, respectively. The decrease was even stronger for the age group of 0–19 years, with − 39.4% in the first and − 35.0% in the second wave. Regarding acuity levels, consultations assessed as urgent, standard, and non-urgent showed the largest decrease, while the most severe cases showed the smallest decrease. Conclusions The number of emergency department consultations decreased rapidly during the COVID-19 pandemic, without extensive variation in the distribution of patient characteristics. Smallest changes were observed for the most severe consultations and older age groups, which is especially reassuring regarding concerns of possible long-term complications due to patients avoiding urgent emergency care during the pandemic.

The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.

Background Clinical trials have shown the benefits of lung cancer screening (LCS) in certain high-risk groups using low-dose high-resolution computed tomography (LDCT). Risk groups are usually defined by age and tobacco use. Exposure to asbestos dust is an important occupational risk factor for lung cancer. Since 2014, the German Social Accident Insurance (DGUV) has introduced annual LCS for high-risk groups (EVA-LCS). In addition to occupational asbestos dust exposure, the population at risk is defined by age (≥ 55 years) and tobacco consumption (≥ 30 pack-years). The health services research project EVALUNG aims to evaluate the EVA-LCS using a combination of quantitative and qualitative methods. Methods The quantitative part will be based on a secondary data analysis of routine administrative and medical data from the EVA-LCS. The results of the individual screening rounds will be analysed in a cross-sectional design. Primary endpoints are participation patterns, the rate of findings requiring further diagnostic investigation, the detection of lung cancer including tumour stage and characteristics, and the notification and recognition of asbestos-related occupational diseases. Secondary endpoints include false-positive and false-negative findings, incidence of other cancers, and all-cause and cancer-related mortality. To avoid selection bias, a complete set of anonymised data (approximately 22,200 individuals as of 12/2021) from the EVA-LCS will be transmitted for use in EVALUNG. A sub-sample will be used to perform longitudinal analyses and explore a linkage with cancer registry data. Another component is the development and piloting of quality indicators. Qualitative interviews will be conducted to analyse the perceptions, satisfaction, and potential psychological effects of EVA-LCS participants. Interviews with participating physicians will focus on their attitudes and knowledge regarding LCS. A further aim is to develop an evidence-based decision aid. Discussion The EVALUNG concept is based on various complementary approaches, enabling a comprehensive evaluation of the EVA-LCS and the identification of optimization potentials. The quality of the data is crucial for the validity of the quantitative analyses. One way to address potential limitations is to link the data with cancer registry data. The results may contribute to the planning and development of a national LDCT lung cancer screening programme in Germany.

ObjectiveEvidence suggests interventions targeting low-acuity attendances have been hampered by insufficient characterisation of potential target groups. This study aimed to estimate the frequency of low-acuity emergency department (ED) attendances and to provide an overview of their demographic, diagnosis and consultation patterns.DesignObservational analyses of routine healthcare data.SettingGerman EDs.ParticipantsAdult patients with statutory health insurance who visited the ED of 16 participating hospitals in 2016.Main outcome measuresFrequency, demographics, diagnoses and consultation patterns of low-acuity and high-acuity attendees.Main resultsOf the 454 747 ED visits, 370 756 visits (50.1% female) were included for analysis. Four participating hospitals had to be excluded due to the lack of data that were necessary for the stepwise approach to define low and high acuity. We identified 101 337 visits as low acuity (27.3%) and 256 876 as high acuity (69.3%), whereas 12 543 (3.4%) could not be classified. The proportion of attendees classified as low acuity decreased with age (highest at 40.6% in the age group <35 years). The proportion of women and men was 50% in both acuity categories, respectively (50 654 of all low-acuity and 128 427 of all high-acuity contacts). The highest proportion of low-acuity presentations was observed during the weekend (average of 18.6% per day), compared with an average of 12.5% on weekdays. The most common diagnoses (back pain, abdominal and pelvic pain) were similar in both low-acuity and high-acuity groups.ConclusionOur study provides further evidence that younger age is associated with low-acuity presentation in German EDs. Age-specific intervention strategies are needed to ease the burden on urgent care facilities. The similar spectrum of diagnoses between low-acuity and high-acuity patients suggests a so far under-recognised higher importance of severity.Trial registration numberDRKS00022969.

Background Compelling data on clinical emergency medicine is required for healthcare system management. The aim of this survey was to describe the nationwide status quo of emergency care in Germany at the healthcare system level using the Utstein reporting template as the guideline to measure the data collected. Methods This cross-sectional survey collected standardized data from German EDs in 2018. All 759 of the EDs listed in a previously collected ED Directory were contacted in November 2019 using the online-survey tool SoSci Survey. Exclusively descriptive statistical analyses were performed. Absolute as well as relative frequencies, medians, means, ranges, standard deviations (SD) and interquartile ranges (IQR) were reported depending on distribution. Main Results A total of 150 questionnaires of contacted EDs were evaluated (response rate: 19.8%). Hospitals had a median of 403 inpatient beds ( n =147). The EDs recorded a median of 30,000 patient contacts ( n =136). Eighty-three EDs (55%) had observation units with a median of six beds. The special patient groups were pediatric patients (< 5 years) and older patients (> 75 years) with a median of 1.7% and 25%, respectively. Outpatients accounted for 55%, while 45% were admitted (intensive care unit 5.0%, standard care unit 32.3%, observation unit 6.3%) and 1.2% transferred to another hospital. Conclusions The use of the Utstein reporting template enabled the collection of ED descriptive parameters in Germany. The data can provide a baseline for upcoming reforms on German emergency medicine, and for international comparisons on admission rates, initial triage categories, and patient populations.

IntroductionQuality of emergency department (ED) care affects patient outcomes substantially. Quality indicators (QIs) for ED care are a major challenge due to the heterogeneity of patient populations, health care structures and processes in Germany. Although a number of quality measures are already in use, there is a paucity of data on the importance of these QIs on medium-term and long-term outcomes. The evaluation of outcome relevance of quality indicators in the emergency department study (ENQuIRE) aims to identify and investigate the relevance of QIs in the ED on patient outcomes in a 12-month follow-up.Methods and analysisThe study is a prospective non-interventional multicentre cohort study conducted in 15 EDs throughout Germany. Included are all patients in 2019, who were ≥18 years of age, insured at the Techniker Krankenkasse (statutory health insurance (SHI)) and gave their written informed consent to the study.The primary objective of the study is to assess the effect of selected quality measures on patient outcome. The data collected for this purpose comprise medical records from the ED treatment, discharge (claims) data from hospitalised patients, a patient questionnaire to be answered 6–8 weeks after emergency admission, and outcome measures in a 12-month follow-up obtained as claims data from the SHI.Descriptive and analytical statistics will be applied to provide summaries about the characteristics of QIs and associations between quality measures and patient outcomes.Ethics and disseminationApproval of the leading ethics committee at the Medical Faculty of the University of Magdeburg (reference number 163/18 from 19 November 2018) has been obtained and adapted by responsible local ethics committees.The findings of this work will be disseminated by publication of peer-reviewed manuscripts and presentations as conference contributions (abstracts, poster or oral presentations).Moreover, results will be discussed with clinical experts and medical associations before being proposed for implementation into the quality management of EDs.Trial registration numberGerman Clinical Trials Registry (DRKS00015203); Pre-results.

Several indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods.

Objective The complexity of dengue symptomatology makes accurate clinical diagnosis difficult. This study aimed at identifying signs and symptoms associated with laboratory-confirmed dengue among febrile patients suspected of having a vector-born infection. Methods This was a secondary analysis of surveillance data collected for a period of six years by the Mexican Ministry of Health in the north-central state of San Luis Potosí. All health facilities reported clinical data and obtained blood samples for any patient with a febrile condition of unknown origin, and who also presented at least two of the following symptoms: headache, myalgia, arthralgia, and exanthema. The final sample of 23,983 individuals was analyzed using multinomial logistic regression to compute crude and adjusted odds ratios with 95% confidence intervals (OR; 95% CI). The dependent variable was the outcome of final laboratory diagnosis: dengue fever (DF), dengue hemorrhagic fever (DHF), and no dengue as reference category. Results Eleven variables were statistically significant in crude analyses, but only 7 remained in the final adjusted model; four were positively associated with both DF and DHF: Exanthema (DF 2.92; 2.38-3.58, DHF 1.71; 0.72-4.03), retro-ocular pain (DF 1.24; 1.13-1.36, DHF 1.58; 1.09-2.28), being non-indigenous (DF 1.50; 1.25-1.80, DHF 5.69; 1.74-18.5) and adulthood (DF 1.44; 1.31-1.59, DHF 2.73; 1.75-4.26). Hemorrhage (79.3; 48.3-129.7), abdominal pain (2.50; 1.35-4.63) and arthralgia (3.23; 1.53-6.79) were also predictive, but only for DHF. Conclusion We recommend health authorities worldwide to consider these findings when producing guidelines for clinical diagnosis to reduce over- and underdiagnosis. Objetivo La complejidad sintomatológica del dengue dificulta el diagnóstico clínico preciso. Este estudio buscó identificar signos y síntomas asociados al dengue confirmado por laboratorio en pacientes febriles con sospecha de infección transmitida por vector. Métodos Análisis secundario de datos de vigilancia recolectados en un periodo de seis años por la Secretaría de Salud de México en el estado norcentral de San Luis Potosí. Todos los establecimientos de salud reportaron datos clínicos y obtuvieron muestras de sangre de pacientes con fiebre de origen desconocido que presentaron al menos dos de los siguientes signos/síntomas: cefalea, mialgia, artralgia y exantema. La muestra final de 23 983 personas se analizó con regresión logística multinomial para calcular razones de momios (RM) crudas y ajustadas con intervalos de confianza (IC) de 95%. La variable dependiente fue el diagnóstico por laboratorio: fiebre de dengue (FD), dengue hemorrágico (DH), y no dengue como referencia. Resultados Once variables fueron estadísticamente significativas en los análisis crudos, pero solo siete permanecieron en el modelo ajustado; cuatro se asociaron positivamente con FD y DH: exantema (FD 2,92; 2,38-3,58, DH 1,71; 0,72-4,03), dolor retroocular (FD 1,24; 1,13-1,36, DH 1,58; 1,09-2,28), ser no indígena (FD 1,50; 1,25-1,80, DH 5,69; 1,74-18,5) y ser adulto (FD 1,44; 1,31-1,59, DH 2,73; 1,75-4,26). La hemorragia (79,3; 48,3-129,7), el dolor abdominal (2,50; 1,35-4,63) y las artralgias (3,23; 1,53-6,79) también fueron predictoras, pero solo de DH. Conclusión Se recomienda a las autoridades sanitarias tener en cuenta estos hallazgos al elaborar directrices para el diagnóstico clínico con el fin de reducir el sobre e infradiagnóstico.

The permanent magnetic linear contactless displacement (PLCD) sensor is a new type of displacement sensor operating on the magnetic inductive principle. It has many excellent properties and has already been used for many applications. In this article a Micro-PLCD sensor which can be used for microelectromechanical system (MEMS) measurements is designed and simulated with the CST EM STUDIO® software, including building a virtual model, magnetostatic calculations, low frequency calculations, steady current calculations and thermal calculations. The influence of some important parameters such as air gap dimension, working frequency, coil current and eddy currents etc. is studied in depth.