[Organization of clinical emergency units. Mission and environmental factors determine the organizational concept]

Abstract

Aim: Mission and organization of emergency units were analysed to understand the underlying principles and concepts.

Methods: The recent literature (2000-2007) on organizational structures and functional concepts of clinical emergency units was reviewed. An organizational portfolio based on the criteria specialization (presence of medical specialists on the emergency unit) and integration (integration of the emergency unit into the hospital structure) was established. The resulting organizational archetypes were comparatively assessed based on established efficiency criteria (efficiency of resource utilization, process efficiency, market efficiency).

Results: Clinical emergency units differ with regard to autonomy (within the hospital structure), range of services and service depth (horizontal and vertical integration). The "specialization"-"integration"-portfolio enabled the definition of typical organizational patterns (so-called archetypes): profit centres primarily driven by economic objectives, service centres operating on the basis of agreements with the hospital board, functional clinical units integrated into medical specialty units (e.g., surgery, gynaecology) and modular organizations characterized by small emergency teams that would call specialists immediately after triage and initial diagnostic.

Conclusions: There is no "one fits all" concept for the organization of clinical emergency units. Instead, a number of well characterized organizational concepts are available enabling a rational choice based on a hospital's mission and demand.