[Organization of clinical emergency units. Mission and environmental factors determine the organizational concept].
OBJECTIVE
Mission and organization of emergency units were analysed to understand the underlying principles and concepts.


METHODS
The recent literature (2000-2007) on organizational structures and functional concepts of clinical emergency units was reviewed. An organizational portfolio based on the criteria specialization (presence of medical specialists on the emergency unit) and integration (integration of the emergency unit into the hospital structure) was established. The resulting organizational archetypes were comparatively assessed based on established efficiency criteria (efficiency of resource utilization, process efficiency, market efficiency).


RESULTS
Clinical emergency units differ with regard to autonomy (within the hospital structure), range of services and service depth (horizontal and vertical integration). The "specialization"-"integration"-portfolio enabled the definition of typical organizational patterns (so-called archetypes): profit centres primarily driven by economic objectives, service centres operating on the basis of agreements with the hospital board, functional clinical units integrated into medical specialty units (e.g., surgery, gynaecology) and modular organizations characterized by small emergency teams that would call specialists immediately after triage and initial diagnostic.


CONCLUSIONS
There is no "one fits all" concept for the organization of clinical emergency units. Instead, a number of well characterized organizational concepts are available enabling a rational choice based on a hospital's mission and demand.
Genewein
U
U
Forschungsgruppe Spitalmanagement, Institut für Chirurgische Forschung und Spitalmanagement, Universitätsspital, Basel, Switzerland.
Jakob
M
M
Bingisser
R
R
Burla
S
S
Heberer
M
M
D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005858:Germany; D017408:Guidelines as Topic; D006272:Health Facility Environment; D006801:Humans; D033183:Interdisciplinary Communication; D008511:Medicine; D009937:Organizational Objectives; D010348:Patient Care Team / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D013038:Specialization