Clinical crisis intervention in emergency departments of German university hospitals-a nationwide evaluation study

Background: Confrontation with extreme medical situations is part of daily work of emergency physicians and emergency nurses in emergency rooms. For the affected patients and their relatives, as well as the treating medical staff, the resulting stress potential is high, up to and including potential traumatization. Aim: This work examines for the first time the structure of clinical crisis intervention in clinical acute and emergency medicine at German university hospitals. In addition to evaluation of the current situation, needs and indications are identified in order to prospectively derive possible developments for this important subject area. Materials and methods: Nationwide multicenter prospective evaluation study. Results: The response rate was 83% with 30 out of 36 facilities queried. As expected, the results do not paint a homogeneous picture of the current situation of structured clinical crisis intervention in German emergency departments. In all, 23% (n = 7) of the facilities have no structured offer for support in crisis situations. This is mainly due to the lack of a sustainable concept, accompanied by scarce financial and human resources. However, 86% of the facilities without clinical crisis intervention see the need for structured crisis intervention in their area. The greatest need for additional crisis intervention is quantified in cases of death or serious injury in children. 77% (n = 23) of the facilities surveyed stated that they had a structured support program, which in almost half of them was characterized by a completely independent organizational structure with the involvement mainly of pastoral counselors and psychologists. Conclusion: Due to the lack of quality standards and guidelines for clinical crisis intervention, it is necessary for clinics to independently develop appropriate structures. It is therefore very important to continue working on quality, standardized training and an expansion of individual availability in hospitals.