„Valuable support for the critical ressource“
Interview with Dr. med. Markus Wehler
What possibilities are opened up by digitalization in the field of emergency medicine, and what role will people play? These are the questions addressed by Dr. med. Markus Wehler, senior consultant in the central accident and emergency department at the Klinikum Augsburg and chair of the Bavarian Society for Emergency Medicine (Gesellschaft für Akut- und Notfallmedizin Bayern e.V.).
b on top: It goes without saying that accident and emergency departments and emergency medicine is focused on helping patients. But what is the biggest challenge, and what does a regular admission look like?
Dr. Markus Wehler: The greatest challenge is undoubtedly the initial assessment of the urgency of the case. This determines who is treated first and who can wait and for how long. In a large A&E department such as the one at the Klinikum Augsburg, we have up to 20 arrivals per hour at peak times, with an average of 20 percent critical patients and 80 percent sick or noncritical patients. Then there are what are known as the self-admissions, of whom one in eight or one in ten can be critically ill. Internationally validated triage models that always ensure uniform assessment are used to determine the urgency of all these cases. Each case is then assigned to the correct specialist, who takes over the provision of specialist care. All this takes place within the first three minutes.
b on top: What is the current situation in emergency departments in respect of patient numbers?
Dr. Markus Wehler: The number of emergency patients has considerably more than doubled over the past ten years. And the emergency departments have to cope with these numbers with the staff and space available, even though neither have grown to the same extent. The rapid rise in patient numbers could be the result of a lack of alternatives for emergency care or of higher expectations on the part of the patients. And consultations with ‘Dr. Google’ gives rise to a lot of anxious people who come to emergency departments. Either way, the increase is not due to the fact that there are more emergencies nowadays. Of course, demographic change leads to a rise in acute illness, but this rise does not account for more than two percent of all cases per year.
b on top: What role does digitalization play in everyday hospital activities?
Dr. Markus Wehler: Connectivity and digitalization play a significant role and allow better planning in day-to-day activities. For instance, we were the first emergency service region to introduce electronic, structured advance registration for external cases. This means that paramedics and emergency doctors can send the patient parameters and estimated time of arrival directly to the clinic in advance from the scene of the accident or where the patient was taken ill. This makes it far easier for us to release the necessary capacity. Real-time GPS tracking of ambulances is of course also helpful for the control center, as it allows them to better manage their capacity and geographical availability. Modern, comprehensive monitoring is also of considerable importance. The patient’s condition is continuously displayed, a central alarm is triggered in an emergency and the whereabouts of the patient and any transfers are fully recorded. Live connections to smaller hospitals that send us digital patient records, for instance via Skype, are also becoming increasingly important. On this basis, our specialists here can then initiate further diagnostic measures and treatment. This technology save on personnel and transport and is extremely fast, which is, of course, crucial in acute emergencies such as strokes or heart attacks. Digitalized processes of this kind provide valuable support in our daily routines today. Nevertheless, the decisive resource by far in emergency medicine remains people. Manual activities that cannot be digitalized still remain necessary.
b on top: What do you see as potential future scenarios for emergency medicine?
Dr. Markus Wehler: There have been some interesting pilot studies in this area, for example in Scandinavia, where drones were used to send defibrillators to patients. The drones are simply given the coordinates and then deliver the devices, which can be used even by untrained people, at an unmatched speed. Also, the introduction of the digital health card, which has been under discussion for a long time in Germany, would of course be of immense benefit to emergency medicine, since it contains all the information relevant to further treatment, such as medication, allergies or previous illnesses. Irrespective of this, tighter integration between the various outpatient and inpatient units would be desirable here. This would involve centralization of emergency care, bringing forces together, saving resources and making emergency medicine even more efficient.
Dr. med. Markus Wehler studied medicine in Bonn and Stanford (USA) from 1982 to1989 and, after completing his doctorate degree, served as academic assistant at the Institute of Physiology at the University of Bonn. Between 1989 and 2008, he completed his specialist training for internal medicine, gastroenterology, infectious disease and intensive care at Medizinische Klinik 1 of the University of Erlangen. In 2004, he qualified to teach at the Medical Faculty at the University of ErlangenNürnberg, and since 2009, Markus Wehler has been the senior consultant at the central accident and emergency department and the IV medical clinic for general internal medicine at the Klinikum Augsburg. Markus Wehler is also chair of the Bavarian Society for Emergency Medicine (Gesellschaft für Akut- und Notfallmedizin Bayern e.V.).