Survey of staffing structures and equipment in 176 German emergency departments

Abstract

Background and research question: Adequate staffing, especially with physicians and emergency nursing staff, is essential for high-quality emergency care. The aim of this study was to compare the current staffing situation in German emergency departments with recommended standards. Methods: A questionnaire was developed based on the minimum standards of the German Interdisciplinary Association for Intensive and Emergency Medicine and the German Society for Interdisciplinary Emergency and Acute Medicine. Both the actual staffing and the perceived adequacy were assessed. The anonymous online survey was sent via the joint emergency department registry to the management of 1008 emergency departments. Results: Between 1 June and 31 July 2023, 176 emergency departments (18% response rate) participated. Annual patient numbers ranged from 17,610 to 37,251 depending on the level of care. Qualified nursing and medical leadership was mostly present (about 90%, medical leadership in level 1: 68%). Continuous physician presence was 76%, specialist presence 50%. Specialists with additional emergency medicine training were available in level 1 (one physician) and in levels 2 and 3 (two physicians each). Only 50% of hospitals offered the full 24-month training period. A nurse-to-patient ratio of 1:1200 was met in 40–63% of departments; triage nurses met requirements in 54% of cases. Conclusion: The survey shows that significant staffing deficits persist in German emergency departments at all levels of care—especially regarding the presence and qualifications of physicians, nursing staff, social services, and case management. At the same time, a positive trend in equipment, infrastructure, and staff qualifications is evident.