Structure of Neurological Departments in Germany: Results of the 12th Survey by the German Society for Neurology

The German Neurological Society has conducted a survey of the structure of neurological in-patient care every other year. The present survey covers the year 2015. With a response rate of 62 %, the questionnaire allowed meaningful comparisons to former surveys covering the years 2013, and 2011.Only a minority of departments has intensive care units of their own. By contrast, 24/7 presence of neurological physicians has become standard in interdisciplinary emergency rooms. Stroke management has involved neurology more and more in emergency care. In 2015, thrombectomy became state of art therapy for a subgroup of stroke patients, raising special demands for the availability of CT and MRI on a 24/7 basis. However, infrastructure did not improve as compared to former surveys. Numbers of beds, case mix, and case mix index have remained roughly unchanged. However, case numbers increased, and average length of stay robustly decreased within 2 years by 17% to 5.4 days.Structures of staff were heterogeneous and were involved in variable duties apart from inpatient care covered by the German diagnosis- related groups (DRG) system. Departments did not succeed in differentiating proceeds related to the DRG system from other proceeds. Shortage of nursing staff forced 22% of departments to temporarily cut down services, 6% of departments did so because of shortage of physicians, and at 2% of departments, both types of cutbacks occurred. Departments were confident in certifications as means of quality management, and a couple of suggestions were provided for more meaningful parameters for outcome-oriented quality management in future.