Organisation of Emergency Services in German University and General Hospitals - Neurological Aspects

In Germany, more than one third of all hospital patients are emergency admissions. Little is known about the number of emergency admissions to departments of neurology and the organisation of their acute neurological care. The German Neurological Society and its commission on neurological quality management have conducted a survey on the structure and organisation of emergency facilities in German general hospitals with neurological departments in the year 2006. Of 240 neurological university and general hospital departments that were invited, almost half cooperated in the survey. About 50 % of neurological in-patients at university departments and 62 % in general hospitals were emergency admissions. One tenth of all hospital emergency admissions were admitted to neurological wards. The most common diagnoses of neurological emergency patients are stroke and seizures. In both conditions, the prognosis depends on rapid specific treatment. Almost all hospitals had implemented standard operating procedures for the admission of stroke patients. In most hospitals, emergency care was delivered by non-neurological medical personnel in a centralised emergency facility. The organisation of emergency hospital admissions is of great importance for the provision of neurological treatment in acute conditions. Hospital organisation must guarantee that that diagnosis and treatment of certain neurological emergencies are conducted by neurologists right from entry to the hospital (e. g., stroke, seizure, meningitis/encephalitis) and that neurological participation is secured in others (e. g., disorders of consciousness of unknown aetiology). Standard operating procedures have to be implemented and must be binding.