Abstract
The reduction of financial resources for health care during recent years has put great pressure on emergency care and emergency ward staff for financial restraint. To maintain quality and medical safety the care needs to be reorganised and rationalised. In order to map today's emergency care in Sweden, a questionnaire was sent to all 81 hospitals with emergency care units in December 1996. Swedish emergency care of today is organised in a few big and several small units. More than half of the hospitals answering the questionnaire (n=70) had a catchment area of less than 100.000 inhabitants (median 66.000). Primary health care was integrated in the emergency care round the clock in less than half of the hospitals, and in another 23 percent between 5 p.m.-7 p.m. The emergency care in Sweden of today is a direct extension of in-hospital care with traditional subspecialisation but no specialisation in emergency care. Only in a few of the smallest hospitals the physicians worked over the boarders between traditional nonemergency specialities. In only half of the cases the person responsible for the first contact with the patients when arriving to an emergency unit, making the initial diagnosis and giving the patient priority, was a registered nurse, in other instances a person with lesser education. In one third of the hospitals with a catchment area of > 200.000 inhabitants the primary evaluation was done by someone with very little or no medical education for the purpose, i.e. a secretary. In today's organisation the person responsible for the primary reception is a key-person, directing the patients to the optimal level and type of care. The introduction of specially trained triage team may increase both efficiency and medical safety. Also, in order to improve the utilisation of today's resources within the units increased collaboration between specialists with special emphasis on emergency care is necessary.
This is in accordance with the experience from other countries, for example USA and UK, where special emergency care physicians have been introduced.