Centralized emergency department as the hub for future emergency medical services

At the end of 2008 the previously negotiated budget for payment of inpatient services will expire. With completion of the convergence phase, the new system of remuneration based on diagnosis-related groups (G-DRG) will take effect in 2009 and will have considerable impact on the hospital environment. Aspects of a market economy will exert a dominant influence on the reorientation of hospitals. Interdisciplinary activities and structures will blur the boundaries between existing departments. Many clinics are currently establishing centralized interdisciplinary emergency departments for initial management of emergency patients and after providing primary care should prevent these patients from traveling a circuitous route before reaching the appropriate department. The creation of these centralized emergency departments gives the field of emergency medicine the chance to combine out-of-hospital and inhospital services in terms of organizations, personnel, and specialty and thus the opportunity to fortify its position as a clinical discipline. The emergency physicians and medical technicians will become members of the centralized emergency department staff and the medical director will simultaneously become the chief of the emergency physicians' base station. There would be a smooth transition of inhospital therapy concepts and treatment strategies for acute care into the workings of initial out-of-hospital management, the problems involved in an interface would to a large extent be resolved, and there would be only one command center for EMS. Whether emergency medicine will continue to be organized following an interdisciplinary concept or whether it will evolve into an independent specialty is subject to future developments.