Emergency Department Point-of-Care Specialists - The Greek Model of Emergency Department Efficiency

Sep 30, 2026

Emergency medicine provides evidence-based emergency care across prehospital and in-hospital settings, but emergency department overcrowding has become a major obstacle to timely treatment, efficient patient flow, and safety. Specialty consultations are vital for critically ill patients, yet delayed specialist involvement can worsen diagnostic and treatment timelines. Greece addresses this by recognizing emergency medicine as a supraspecialty and embedding double-certified specialists within EDs, aiming to improve decision speed, continuity, and outpatient and admission decisions, while acknowledging higher operational costs and potential low utilization.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Emergency medicine and evidence-based emergency care

Impact of ED overcrowding on efficiency and safety

Role of specialty consultations in emergency care

Greece’s supraspecialty training model and ED staffing approach

Benefits versus operational costs and utilization concerns

Double-certified physicians and intradepartmental collaboration

| Point-of-View | | --- | | | Emergency Department Point-of-Care Specialists: The Greek Model of Emergency Department Efficiency Emergency medicine (EM) serves as the cornerstone of evidence‑based emergency care, ensuring timely and effective management of acute illnesses and injuries. It encompasses both prehospital emergency services, which provide life‑saving interventions at the site of illness or injury, and hospital‑based emergency department (ED) care, which offers specialized evaluation and treatment. Over the past several decades, advancements in both prehospital and hospital emergency care have transformed patient outcomes, reduced mortality, and enhanced the overall quality of acute medical services. This dynamic field continues to evolve with innovations in clinical practice, technology, and research, making it an integral part of modern healthcare systems.[1] In recent years, overcrowding in EDs has emerged as a critical challenge, leading to prolonged patient stays, reduced efficiency, disrupted patient flow, and compromised patient safety.[2] Specialty consultations are an essential component of the emergency care continuum, ensuring comprehensive and timely management of critically ill patients. While most hospitals maintain access to trauma surgeons, intensivists, anesthesiologists, cardiologists, and neurologists through on‑call systems, it is relatively uncommon for these specialists tobe embedded within EDs as point‑of‑care providers. Several studies have highlighted that delays in specialist input can prolong diagnostic and treatment timelines, adversely affecting patient outcomes and overall ED efficiency.[3,4] Availability of specialty consultation impacts efficiency and length of stay for patients in the ED. A Dutch tertiary care center found that approximately 24% of patients required consultation from another specialty, and these consultations were associated with an approximately 55% increase in ED length of stay.[5] In Greece, EM has been officially recognized as a supraspecialty, established in 2019, building on training in foundational specialties such as internal medicine, surgery, orthopedics, anesthesiology, and cardiology. Physicians from these specialties can acquire EM certification through a 24‑month fellowship plus a national examination or via alternative experience‑based pathways.[6] Most EDs are staffed by specialists from non‑EM backgrounds, with a smaller but growing number holding the supraspecialty. These specialists work in teams, rotating through EDs, taking consultations, and collaborating in delivering emergency care. While the aspiration is for specialists to provide point‑of‑care presence and immediate specialty advice, this is not yet universally realized in all EDs, especially outside major urban centers. Nevertheless, these developments have improved decision‑making speed, specialist input, and patient flow in many hospitals.[6] This model is distinct from merely having specialists available by phone or on call. Instead, Greece has developed a unique collaborative approach in which specialists are physically present within EDs. This approach has proven functional and effective, particularly as the country continues to define boundaries and establish structured training pathways for EM.[6] Emergency‑trained physicians are uniquely skilled in resuscitation and evaluating undifferentiated patients across all age groups. Achieving a critical mass of EM‑trained and certified physicians is therefore essential for the initial assessment and management of all incoming ED patients. In Greek EDs, once a working diagnosis is established, specialists from other disciplines are readily available to contribute to optimal outpatient treatment selection, arranging investigations, facilitating outpatient services, and making admission decisions. Although debates may occasionally arise among floor specialists regarding which service should assume care, overall ED flow remains

FAQs

Why are specialty consultations important in emergency care?

Specialty consultations support comprehensive and timely management of critically ill patients. Delays in specialist input can prolong diagnostic and treatment timelines, reducing overall ED efficiency and worsening outcomes.

What distinguishes the Greek model from on-call specialist availability?

The Greek approach embeds specialists physically within emergency departments as point-of-care providers. This enables immediate, specialty-specific advice and keeps the emergency medicine physicians continuously evaluating new arrivals.

How does Greece structure the emergency medicine supraspecialty pathway?

Emergency medicine is recognized as a supraspecialty established in 2019, with certification available through a 24-month fellowship plus a national examination or via alternative experience-based pathways. The training aims to produce double-certified physicians who can staff EDs effectively.

Sep 30, 2026

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