Image Credit: Divi
24 July 2025
On Intensive Care Medicine Day, DIVI calls for ‘strong teams, social responsibility and clear prospects!’
The results of a survey conducted by the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) and the German Society for Emergency Medicine (DGINA) on staffing levels in German emergency departments show that the required minimum standards are not being met across the board, either for doctors or nursing staff. ‘Above all, the number of doctors with additional training in clinical acute and emergency medicine is still far too low, as is the proportion of nursing staff with specialist training in emergency care,’ comments DIVI President Professor Florian Hoffmann on the survey, which has now been published in open access.
‘The figures show that considerable efforts are still needed to meet the structural and staffing requirements we have set for emergency rooms in the near future,’ said the study’s lead author, DIVI Secretary General Prof. Uwe Janssens. After all, the aim is to continue to ensure high-quality care for all patients, especially in the future.
There is also room for improvement in interdisciplinary care. Many emergency departments lack staff for social services, crisis intervention or case management – services that are indispensable, especially for vulnerable patient groups. ‘Emergency medicine does not end with the stabilisation of vital functions,’ says Dr Torben Brod, spokesperson for the DIVI section on structures in acute and emergency medicine and co-author of the study. ‘Psychosocial support and the coordination of further care pathways are also essential!’
Figures and data from 176 emergency rooms at all levels of care documented
The DIVI and DGINA inventory is based on a nationwide online survey of the heads of 1,008 emergency departments in Germany. A total of 176 hospitals of all care levels, from basic to comprehensive emergency care, participated. The focus was on personnel structure and qualifications, available diagnostic and therapeutic procedures, quality management and structural design.
The survey was conducted anonymously in the summer of 2023. The questions were based on a joint proposal by DIVI and DGINA on minimum staffing levels in emergency departments.
Specialists are lacking – even during core working hours in emergency departments
A key finding: in around half of emergency departments, the continuous presence of specialists is not guaranteed. The situation is particularly critical in basic emergency care facilities, where permanent medical presence was only 76 percent in some cases. Hospitals providing higher levels of care also showed gaps in the presence of medically qualified specialists during core working hours.
The situation is no better for nursing staff. Although around 90 percent of emergency rooms have professionally qualified nursing management, the recommended staffing ratio – one full-time employee per 1,200 patient contacts – is only achieved in 40 to 63 percent of clinics.
Structural bottlenecks also in the initial assessment of emergency patients
‘The important patient management that is so often discussed in the context of hospital reform cannot be guaranteed in many cases due to a lack of and insufficiently qualified personnel in the emergency room,’ emphasises DIVI Secretary General Janssens, Director of the Clinic for Internal Medicine and Internal Intensive Care Medicine at St. Antonius Hospital in Eschweiler. Structural bottlenecks are evident in the initial assessment of emergency patients – these can lead to delayed treatment in life-threatening conditions and a lack of prioritisation with ineffective processes.
DIVI calls for more effort in training staff in German emergency rooms
Accordingly, DIVI is calling for the standards for emergency rooms developed by professional associations years ago to be implemented across the board.
‘The survey was conducted almost two years ago,’ points out section spokesperson Torben Brod. ‘The momentum of the announced reforms in emergency care may have already led to further improvements in staffing structures, but we can only speculate at this point.’ ‘The fact is,’ adds DIVI President Florian Hoffmann, ‘that even more efforts must be made to further improve the training of all staff in German emergency departments! This also includes providing emergency departments with adequate financial and infrastructural resources.’
The inventory of staffing structures and equipment in 176 German emergency departments was published on 21 July 2025 in the open access journal Medizinische Klinik Intensiv- und Notfallmedizin.