title: [Quality management in emergency departments: Lack of uniform standards for fact-based controlling].
abstract: BACKGROUND
  The general high occupancy of emergency departments during the winter months of 2014/2015 outlined deficits in health politics. Whether on the regional, province, or federal level, verifiable and accepted figures to enable in depth analysis and fact-based controlling of emergency care systems are lacking.
  
  
  OBJECTIVE
  As the first step, reasons for the current situation are outlined in order to developed concrete recommendations for individual hospitals.
  
  
  METHODS
  This work is based on a selective literature search with focus on quality management, ratio driven management, and process management within emergency departments as well as personal experience with implementation of a key ratio system in a German maximum care hospital.
  
  
  CONCLUSIONS
  The insufficient integration of emergencies into the DRG systematic, the role as gatekeeper between inpatient and outpatient care sector, the decentralized organization of emergency departments in many hospitals, and the inconsistent representation within the medical societies can be mentioned as reasons for the lack of key ratio systems. In addition to the important role within treatment procedures, emergency departments also have an immense economic importance. Consequently, the management of individual hospitals should promote implementation of key ratio systems to enable controlling of emergency care processes. Thereby the perspectives finance, employees, processes as well as partners and patients should be equally considered. Within the process perspective, milestones could be used to enable detailed controlling of treatment procedures. An implementation of key ratio systems without IT support is not feasible; thus, existing digital data should be used and future data analysis should already be considered during implementation of new IT systems.
authors.affiliation: Klinikum Nürnberg - Organisationsentwicklung, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland. markus.ries@klinikum-nuernberg.de.
authors.forename: M
authors.initials: M
authors.lastname: Ries
authors.affiliation: Universitätsklinik für Notfall- und Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Nürnberg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Christ
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics / Q000458:organization & administration / Q000592:standards; D003953:Diagnosis-Related Groups / Q000191:economics / Q000458:organization & administration / Q000592:standards; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration* / Q000592:standards*; D020793:Gatekeeping / Q000191:economics / Q000458:organization & administration / Q000592:standards; D005858:Germany; D017048:Health Care Costs / Q000592:standards; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration / Q000592:standards; D006291:Health Policy / Q000191:economics; D006801:Humans; D019984:Quality Indicators, Health Care / Q000191:economics / Q000458:organization & administration / Q000592:standards; D017749:Total Quality Management / Q000191:economics / Q000458:organization & administration* / Q000592:standards*
keywords: Costs; Economics; Quality control; Quality improvement; Quality indicators