Abstract
Since its early beginnings in the 1950s, emergency medicine (EM) in the UK has come of age and has long been a recognized clinical specialty in its own right. The late 1990s and the early part of the millennium saw an expansion of the previously mainly surgical- and trauma-orientated workload of emergency departments (EDs) into a more and more acute medical and critical care case-mix with increasing levels of acuity and complexity. A recent national trainee survey conducted by the General Medical Council in 2010 revealed a trend towards above-average overall trainee satisfaction scores for core EM trainees. UK EDs operate with relatively fewer consultant whole-time equivalents than comparable EDs in North America and Australasia. As of April 2011 a revised Health Resource Group 4.0 tariff came into effect, and it is expected that most UK EDs will see an increase in income generation by up to 40% as a result of this. With the development of EM as a specialty, the primary care sector has progressively withdrawn from urgent and emergency care provision, although this trend has seen a slight reversal since the restructuring of general practice commissioning. Early data seem to suggest, however, that EDs are clinically safer, more effective and more cost-efficient when compared to primary care-run urgent care centres.
Zusammenfassung
Die Notfallmedizin („emergency medicine“) in Großbritannien ist seit ihrer Entstehung in den 50er-Jahren des vorigen Jahrhunderts erwachsen geworden und längst als eigenständiger klinischer Fachbereich anerkannt. Zwischen den späten 1990er- und frühen 2000er-Jahren haben sich die „emergency departments“ (EDs) verändert. Während damals hauptsächlich Traumapatienten chirugisch behandelt wurden gibt es heute einen Case Mix: mehr internistische und intensivmedizinische Patienten mit akuteren und komplexeren Problemen. Eine Umfrage des General Medical Council im Jahr 2010 zeigte, dass Assistenzärzte in der Weiterbildung im Fach Notfallmedizin im Vergleich mit Assistenzärzten in anderen Weiterbildungsfächern überdurchschnittlich zufrieden sind. Im Vergleich mit nordamerikanischen und australischen EDs arbeiten diese in Großbritannien mit weniger Facharztzeit. Die im April 2011 in Kraft getretenen Tarifbestimmungen (Health Resource Group 4.0) lassen für den Großteil aller EDs bis zu 40%ige höhere Erträge erwarten. Parallel zur Entwicklung der Notfallmedizin als eigene klinische Spezialisierung wurde vom Primärsektor immer weniger Notfallversorgung geleistet, auch wenn seit Umstrukturierungen im Bereich der an der Primärversorgung beteiligten Praxen eine diskrete Umkehr dieses Trends zu beobachten ist. Ersten Ergebnissen zufolge scheinen EDs jedoch klinisch sicherer und sowohl effektiver als auch kosteneffizienter zu sein als Notfallpraxen.
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Brown R (2011) Registrar, College of Emergency Medicine. [interv.] Dr Patrick D Dissmann
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Dissmann, P. Emergency medicine in the UK. Notfall Rettungsmed 14, 361–366 (2011). https://doi.org/10.1007/s10049-011-1457-5
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DOI: https://doi.org/10.1007/s10049-011-1457-5