[Utilisation of emergency departments: Is the emergency level relevant?]

The directives of the Federal Joint Committee (G-BA) define tiered emergency care structures, but their influence on patient decision-making has not been sufficiently studied.

This study examined patient-related determinants of utilising emergency departments (ED) of different emergency levels in Bavaria.

From September to November 2024, we carried out a standardised, cross-sectional survey in 18 ED at basic, extended and comprehensive care levels (n = 7527 participants). Data were analysed descriptively and with multinomial logistic regression. Subjective urgency, reason for visit, travel time and mode of arrival were included as influencing factors.

15.4% of respondents who visited the ED independently (n = 5300) chose to do so because of the expected specialization. Patients in comprehensive EDs used emergency medical services significantly more often, rated their urgency higher and more frequently reported neurological, urological or ophthalmological complaints. They accepted longer travel times and were less likely to have sought outpatient care beforehand.

The choice of emergency level is chiefly influenced by subjective urgency, specialty-related complaint types, mode of arrival and institutional structure. Even the existing heterogeneity among institutions exerts a steering effect. Future management concepts-such as integrated emergency centres-should incorporate these patient preferences and regional care realities to enable need-oriented direction without undersupply.