[Patient navigation to cooperation practices : Experiences from pilot projects on redirecting emergency department...

Germany's Emergency Care Reform Act envisions integrated emergency centers (INZ) in which a central initial assessment assigns patients to the emergency department, an affiliated out of hours practice or contractually linked cooperation practices (CP). Pilot projects were carried out to examine under which conditions referrals to CP can succeed.

Lessons-learned synthesis based on final reports and publications from seven projects conducted by the Central Research Institute for Ambulatory Health Care (Zi) in cooperation with hospitals and regional associations of statutory health insurance physicians. The content was extracted in a standardized manner along predefined process categories, documented in an extraction matrix and synthesized (framework-based synthesis).

The synthesis shows that patient navigation to CP depends less on the assessment instrument than on the process transitions between stakeholders. Key prerequisites include defined roles at first contact, time-based disposition pathways, transparent CP capacity profiles, confirmed acceptance and standardized feedback. A lack of appropriately matched acute care capacity proved to be a recurring barrier. Within the feasibility studies, no evidence of patient safety concerns was identified.

Off-campus navigation (referral to practices outside the hospital site) to CP poses requirements beyond those of the on-campus models (care provided at the hospital site) studied in the international literature. What matters is not individual instruments but the reliability of the entire process chain, from patient information through disposition to feedback. Without consistent reimbursement, procedural commitment is at risk in routine operations.