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Organisation der Notfallstation

Umfeld und Leistungsauftrag bestimmen das Organisationskonzept

Organization of clinical emergency units

Mission and environmental factors determine the organizational concept

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Zusammenfassung

Untersuchungsziel

Organisationsformen von Notfallstationen wurden analysiert, um Gestaltungsgrundsätze abzuleiten.

Methoden

Organisation und Leistungsauftrag der klinischen Notfallmedizin wurden anhand einer Literaturrecherche verglichen. Dabei wurden organisatorische Grundmuster in Abhängigkeit von der Anwesenheit von Spezialisten (Spezialisierung) und der Einbindung in die Spitalorganisation (Integration) entwickelt und aufgrund etablierter Effizienzkriterien vergleichend bewertet.

Ergebnisse

Klinische Notfallstationen unterscheiden sich hinsichtlich Autonomiegrad, Leistungsbreite und Leistungstiefe. Vier Archetypen wurden abgegrenzt: Das Profit-Center als ertragsorientierte Wirtschaftseinheit, das Service-Center als auftragserfüllende Organisationseinheit, die funktionelle Organisation als fachlich abgegrenzte Einheit und die modulare Organisation, die sich durch eine zentrale Notfalleinheit und rasch mobilisierbare Spezialistenteams auszeichnet.

Schlussfolgerungen

Es gibt keinen Königsweg. Jede organisatorische Lösung bietet in Abhängigkeit von Umfeldbedingungen und Leistungsauftrag Vor- und Nachteile. Die organisatorischen Grundmuster bieten eine Orientierungshilfe, wobei Leistungsvolumen und -spektrum wichtige Determinanten darstellen.

Abstract

Aim

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.

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Notes

  1. Diese Zahl widerspiegelt die Situation am Universitätsspital Basel und ergibt sich aus der Anzahl der Facharzttitel (45) und der Schwerpunkttitel (30). (Entnommen aus http://www.fmh.ch/).

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Authors and Affiliations

  1. Forschungsgruppe Spitalmanagement, Institut für Chirurgische Forschung und Spitalmanagement, Universitätsspital, Basel, Schweiz

    U. Genewein, S. Burla &  M. Heberer

  2. Behandlungszentrum Bewegungsapparat, Universitätsspital, Basel, Schweiz

    M. Jakob

  3. Notfallstation, Universitätsspital, Basel, Schweiz

    M. Jakob & R. Bingisser

  4. Institut für Chirurgische Forschung und Spitalmanagement, Universitätsspital, Hebelstrasse 20, 4031, Basel, Schweiz

    M. Heberer

Authors
  1. U. Genewein
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  2. M. Jakob
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  3. R. Bingisser
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  4. S. Burla
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  5. M. Heberer
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Corresponding author

Correspondence to M. Heberer.

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Genewein, U., Jakob, M., Bingisser, R. et al. Organisation der Notfallstation. Chirurg 80, 130–137 (2009). https://doi.org/10.1007/s00104-008-1639-y

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