Process analysis and optimization in Emergency Medicine

Abstract

Time-critical emergencies occur by the hundreds every day. Overall, there are about 6,000 emergency physician missions in Germany each day -- twice as many as 20 years ago. Germany has a nationwide Emergency Medical Services (EMS) System with rather short response times that is internationally well acknowledged. Nonetheless, there are many cases where an efficient EMS mission cannot be guaranteed. It must be noticed that short response intervals and rapid treatment on the scene are useless unless the patient is not transported in a timely manner to a hospital capable to immediately deliver the necessary level of care. Today valuable minutes often pass in the dispatch center until a suitable hospital can be found. Furthermore, either out of ignorance or as a makeshift solution, patients are transported to hospitals that are located close by, but do not have the optimal equipment for the diagnosed problem. The reasons for this vary: It is hard to estimate transport times, it costs time to check on other available hospitals, and the information received then is often incomplete or not reliable. Experiences made during missions are also rarely used to close gaps identified in the emergency service processes. Since documentation usually only consists of hand-written notes on paper, there is hardly any standardized analysis of missions from the perspective of quality management. Many of these critical "gaps" could be closed almost seamlessly if up-to-date information technology were used systematically. In the optimized rescue chain from the dispatch center receiving the emergency call to the hospital, information and communication technology is of utmost importance. Therefore the German Center for Emergency Medicine and Information Technology (DENIT) has been established at Fraunhofer IESE in order to study reliable process chains, highly dependable system architectures, as well as high-performance infrastructures for logistics and communication in EMS services and to transfer these into practice in emergency medicine. This talk explores the application of different information systems along the rescue chain and the respective contribution to enhance the efficiency of our EMS systems. The focus will be set on site-planning of EMS bases, dynamic geo-referential dispatch of EMS units, coupling of dispatch centers, mobile digital documentation systems and information systems that provide real-time access to available hospital capacities. Finally examples of different information systems established and introduced by DENIT will be presented.