Letters to the Editor
No Improvement
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We welcome the publication of a methodologically well planned and correctly conducted evaluation of the decision aid system SmED-Kontakt+ for redirecting/further referring patients who primarily presented to a hospital emergency department (1). This study allows for the first time scientifically based conclusions about the patient safety of SmED-Kontakt+.
As regards the assessment concerning the time and place of further care, only in 19% of cases was agreement observed between the treating physicians and SmED-Kontakt+; in 66% of cases, SmED-Kontakt+ assessed the situation more critically and in 14% of cases less critically.
As far as patient safety is concerned, the assessment of SmED-Kontakt+ resulted in a notably higher proportion of patients with potentially risky undertriage (2.7%) than the quality assurance threshold of <1% that was defined a priory by the study authors. Especially in the SmED-Kontakt+ recommendation category “time of further care >24 h”, the quality assurance threshold was clearly exceeded, at 17%.
These results lead us to conclude—in contrast to the study authors—that SmED-Kontakt + in its current version cannot be used reliably for the onward referral of patients who primarily presented to a hospital emergency department. Especially the onward referral of emergency department patients into delayed care somewhere else is associated with a high risk for the patient. For this reason, SmED-Kontakt+ does not constitute an improvement compared with the traditional structured initial medical evaluation systems. The German Society for Interdisciplinary Emergency and Acute Medicine (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin, DGINA) invites a public discussion regarding the question of which error rate should be used as a benchmark in evaluating medical decision aid systems for emergency department patients.
DOI: 10.3238/arztebl.m2025.0008
Wilhelm Behringer, Klinik für Notfallmedizin, Medizinische Universität Wien, und Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA), wilhelm.behringer@meduniwien.ac.at
Harald Dormann, Zentrale Notaufnahme, Klinikum Fürth, und DGINA
Martin Pin, Klinik für Akut- und Notfallmedizin, Florence-Nightingale-Krankenhaus Düsseldorf, und DGINA
Christoph Dodt, Klinik für Akut- und Notfallmedizin, München Klinik Bogenhausen, und DGINA
Bernhard Kumle, Klinik für Akut- und Notfallmedizin, Schwarzwald-Baar Klinikum Villingen-Schwenningen, und DGINA
Ulrike von Arnim, Rettungsstelle Neukölln, Vivantes Klinikum Neukölln, und DGINA
Conflict of interest statement
CD is a board member in DGINA.
MP is the president of DGINA.
The remaining authors confirm that no conflict of interest exists.
| 1. | Slagman A, Bremicker A, Möckel M, Eienbröker L, Fischer-Rosinský A, Gries A: Evaluation of an automated decision aid for the further referral of emergency room patients—a prospective cohort study. Dtsch Arztebl Int 2024; 121: 703–9 VOLLTEXT |
