Maintenance Notice

Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Monday, March 11, 2019 at 4:00 PM to 4:30 PM EST. We apologize in advance for any inconvenience this may cause you.

Who will be affected?


Currently submitted to: JMIR Formative Research

Date Submitted: Feb 27, 2020
Open Peer Review Period: Feb 27, 2020 - Apr 23, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Implementation of a standardized initial assessment for demand management in outpatient emergency care in Germany: an early qualitative process evaluation

  • Catharina Roth; 
  • Amanda Breckner; 
  • Jan Paulus; 
  • Michel Wensing; 



Inadequate assessment of the severity and urgency of a medical problem is one of the factors contributing to unnecessary emergency department (ED) visits. The implementation of a software-based instrument for standardized initial assessment (SmED) aims to support healthcare professionals and steer patients to the right healthcare provider. This study aimed to explore the implementation process of SmED from a user perspective.


This study aims at evaluating the overall perception of SmED by healthcare professionals using the software, to examine to what extent SmED influences workload and work routines of healthcare professionals, and which factors are associated with the use of SmED.


An early qualitative process evaluation on the basis of interviews was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Participants were 30 healthcare professionals who work with SmED either at the joint central contact points of the outpatient emergency care service and the emergency departments of hospitals ("Joint counter", German “Gemeinsamer Tresen”) or at the initial telephone contact points of the outpatient emergency care service (116117). Matrix-based Framework Analysis was applied to analyse interview-data.


Healthcare professionals perceived that workload increased initially, due to additional time needed per patient. When using SmED more frequently, and over a longer time period, they gained routine and time need per call/patient decreased. SmED was perceived to support decision-making regarding urgency for medical treatment, but not all types of patients were eligible. Technical problems, lack of integration with other software, and lack of practicably during peak time affected the implementation of SmED.


Initial experiences with SmED were in general positive, but also highlighted organizational issues that need to be addressed to enhance sustainability. Clinical Trial: The study has been registered at the German Clinical Trial Register prior to the start of the study, registration number: DRKS00017014


Please cite as:

Roth C, Breckner A, Paulus J, Wensing M

Implementation of a standardized initial assessment for demand management in outpatient emergency care in Germany: an early qualitative process evaluation

JMIR Preprints. 27/02/2020:18456

DOI: 10.2196/preprints.18456


Download PDF

Request queued. Please wait while the file is being generated. It may take some time.

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.