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The organization of Danish emergency departments

Moellekaer, Andersa,b,d,e; Duvald, Ibenb,c; Obel, Borgeb; Madsen, Bof; Eskildsen, Jacobb; Kirkegaard, Hansa,d

European Journal of Emergency Medicine: June 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MEJ.0000000000000554
Original article: PDF Only
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Introduction Twenty-one new Danish emergency departments (EDs) were established following a 2007 policy reform that included ED autonomy to self-organize. The aim of this study was to describe the organization of the 21 departments and their organizational challenges.

Participants and methods We used a qualitative design based on COREQ guidelines. All 21 EDs participated, and 123 semi-structured interviews with hospital and ED leaders, physicians, nurses, and secretaries were performed between 2013 and 2015. We used the framework matrix method to investigate the ED goals, setting, structure, staff, task coordination, and incentive structure.

Results We identified three generic models (virtual, hybrid, and independent). All had goals of high quality of care and high efficiency. The virtual model was staffed by junior physicians and tasks were coordinated by other departments. The hybrid model was staffed by junior physicians and senior physicians according to other departments and the ED. The ED coordinated all activities. The independent model was staffed by junior physicians and senior physicians, and activities were coordinated by the ED. Of the EDs, 19 utilized different organizational models at different times during a 24-h period and on weekdays and weekends. The main challenge of the virtual and hybrid models was high dependency on other departments. The main challenge of the independent model was establishing a high level of quality of emergency medicine.

Discussion and conclusion We identified three organizational ED models (virtual, hybrid, and independent). Nineteen EDs used more than one organizational model depending on the time of day or day of the week.

Departments of aClinical Medicine, Research Center for Emergency Medicine

bManagement, Interdisciplinary Center for Organizational Architecture

cBusiness Development and Technology, School of Business and Social Sciences, Aarhus University

dDepartment of Emergency Medicine, Aarhus University Hospital, Aarhus

eDepartment of Emergency Medicine, Hospital Unit West, Denmark

fDepartment of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Correspondence to Anders Moellekaer, MD, MBA, Research Center for Emergency Medicine, Aarhus University Hospital, Noerrebrogade 44, Bygning 30, 1. sal, DK-8000 Aarhus, Denmark Tel: +45 20 848 304; e-mail: anders.moellekaer@ki.au.dk

Received January 7, 2017

Accepted April 13, 2018

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