Wilfried von Eiff

• Over the last years an increase of patient demand in hospital emergency departments (ED) by at least 7–10 % per year has been observed. In a boundaryless hospital the ED plays a pivotal role as a gatekeeper and has a hub function because 30–50 % of all inpatients are admitted as emergency patients first. The ED is challenged to overcome four typical boundaries: the management boundary of being forced to enhance medical quality and contain costs simultaneously, the primary-acute care boundary, the boundary between ED management and hospital management (management level) and the boundary between ED patient service and acute care service (clinical level). Tearing down these boundaries by optimizing the process of ED patient flow can contribute to shorten average length of stay in the ED, to lower patient risks and to reduce treatment costs. In two independent randomized, prospective two-center cohort studies (with 184 and 260 patients) evidence could be verified that process optimization for the treatment of patients suffering from acute coronary syndrome (ACS) contributes significantly to both cost savings and enhanced medical quality. Moreover, point-of-care testing (POCT) technology leads to speeded up turn-around times for lab test results of critical parameters. As a consequence, crowding effects could be reduced and an exoneration of ED capacity could be stated.