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Purpose: Hospitals involved in the care of severely injured patients treat a varying number of such cases per year. Large hospitals were expected to show a better performance regarding process times in the emergency room. The present investigation analyzed whether this assumption was true, based on a large national trauma registry. Methods: A total of 129,193 severely injured patients admitted primarily to one of 675 German hospitals and documented in the TraumaRegister DGU® were considered for this analysis. The analysis covered a 5 years time period (2013–2017). Hospitals were grouped by their average number of annually treated severe trauma patients into five categories ranging from 'less than 10 patients' to '100 or more'. The following process times were compared: pre-hospital time; time from admission to diagnostic procedures (sonography, X-ray, computed tomography), time from admission to selected emergency interventions and time in the emergency room. Results: Seventy-eight high volume hospitals treated 45% of all patients, while 30% of hospitals treated less than ten cases per year. Injury severity and mortality increased with volume per year. Whole-body computed tomography (WB-CT) was used less frequently in small hospitals (53%) as compared to the large ones (83%). The average time to WB-CT fell from 28 min. in small hospitals to 19 min. in high volume hospitals. There was a linear trend to shorter performance times for all diagnostic procedures (sonography, X-ray, WB-CT) when the annual volume increased. A similar trend was observed for time to blood transfusion (58 min versus 44 min). The median time in the emergency room fell from 74 min to 53 min, but there was no clear trend for the time to the first emergency surgery. Due to longer travel times, prehospital time was about 10 min higher in patients admitted to high volume hospitals compared to patients admitted to smaller local hospitals. Conclusion: Process times in the emergency room decreased consistently with an increase of patient volume per year. This decrease, however, was associated with a longer prehospital time. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the consequences of the COVID-19 pandemic on outpatient care in the German federal state of Brandenburg during the first 'lockdown' between 22 March and 4 May 2020, focusing on the burden for physicians and psychotherapists in outpatient practices and on alternative ways to provide care, in particular telehealth., Methods: We conducted an online cross-sectional survey among outpatient health care professionals. The responses of n=277 physicians and n=87 psychotherapists were included in the analysis. Frequencies are shown; the relationship between categorical variables was examined using the χ 2 test; we used a qualitative content analysis for free text answers., Results: Almost all (96 %) physicians and 59 % of the psychotherapists reported a patient volume reduction since the COVID-19 outbreak. Cancellations were most often initiated by patients rather than physician offices. Among the physicians, routine check-ups and preventive care consultations were cancelled most frequently, and patients also appeared less frequently in open consultations. 72 % of the physicians and 29 % of the psychotherapists reported economic losses. While personal patient-physician contact was reduced, the use of telehealth has increased since the COVID-19 outbreak: during the first 'lockdown', two thirds of the psychotherapists (66 %) and 14 % of the physicians used telehealth for the first time. The COVID-19 pandemic contributed to a positive change in attitudes towards telehealth; this trend was significantly stronger among psychotherapists than among physicians., Discussion: The reduction in patient volume shown in this study is confirmed by outpatient billing data analyses. Clinical routines changed due to COVID-19 and led to a growth in telehealth usage. By facilitating formal billing options, the increased use of telehealth can also be promoted after the pandemic., Conclusion: Shortly after the COVID-19 outbreak, outpatient physicians and psychotherapists were faced with various challenges: Through their spontaneous and flexible response to the COVD-19 pandemic, outpatient providers were able to maintain their work despite high stress levels. Telehealth is becoming more important as a result of COVID-19., (Copyright © 2021. Published by Elsevier GmbH.)