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Article History

Received: 23 January 2026

Accepted: 3 April 2026

First Online: 14 April 2026

Declarations

:

: The Berlin study was approved by the ethics committee of Charité – Universitätsmedizin Berlin (EA2/037/24). For the Bavarian study, approvals were granted by the ethics committees of the Bavarian State Medical Association (mb24034), Ludwig Maximilian University (24–0453) and the Technical University of Munich (2024-230-S-CB). Informed consent was obtained from all participants.

: Not applicable.

: No formal patient or public involvement was undertaken in the design, conduct or reporting of this study. The questionnaire was piloted with ED patients to assess clarity and comprehensibility, but this did not constitute structured PPI.

: Research Group: Harald Dormann (Department of Emergency Medicine Fürth Hospital), Rene Hartensuer (Centre for Acute and Emergency Medicine Aschaffenburg-Alzenau Hospital), Thomas Händl (Department of Emergency Medicine Garmisch-Partenkirchen Hospital), Manuel Holder (Bavarian Association of Statutory Health Insurance Physicians), Marleen Pfeiffer (Department of Emergency Medicine Wertach Clinics Bobingen and Schwabmünchen), Felix Rockmann (Emergency Centre Barmherzige Brüder Hospital Regensburg), Peter Rupp (Department of Emergency Medicine Starnberg Clinic), Markus Wehler (Department of Emergency Medicine University Hospital Augsburg), Markus Wörnle (Emergency Department at Campus Innenstadt Ludwig Maximilian University of Munich).

: SO, KW, ES and JH are employees of the Central Research Institute of Ambulatory Health Care in Germany (Zi), a non-profit foundation funded by the Associations of Statutory Health Insurance Physicians. Zi collaborates with the Swiss company in4medicine to provide SmED, a certified medical device used in out-of-hours ambulatory care in Germany and receives reimbursement from the Regional Associations for software licensing. DVS serves as CEO of Zi. GK is an employee of the Bavarian Association of Statutory Health Insurance Physicians; CP is its CEO. MBF, MD, MK, VBF, SH and MZ received €5 per enrolled patient (total €2,500) from the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Bavarian Association of Statutory Health Insurance Physicians. VBF participates pro bono in clinical guideline committees of the German Medical Association. All other authors declare no competing interests.