A report from the Social Affairs Committee makes some twenty proposals to improve the functioning of emergency services.
“Hospital emergencies, a mirror of the dysfunctions of our health system”. The title of the Senate Social Affairs Committee report says a lot about its content. While taking great care to underline “the high quality and resilience of the French public emergency service” and the “dedication” of its healthcare teams, the rapporteurs insist on the need for a reform of its organization.
” [Ses] difficulties result in fact less [son] own organization than [son] original positioning, at the confluence of the shortcomings of city medicine upstream and hospital rigidities downstream. The rapporteurs thus note that these services offer an inadequate response to the shortcomings of city medicine.
Misguided patients
The observation is clear, and the city doctors interviewed admit it: they have withdrawn from the payment of unscheduled care, following the end of the individual on-call duty, decided in 2003.
The report recalls that, according to the Court of Auditors, 43% of emergency visits are the result of a simple medical consultation, in the majority of cases with a general practitioner. And the patients are not always at fault: 32% of patients admitted to the emergency room have, in the 24 hours preceding their admission, initiated procedures with health professionals, most often with a doctor.
Symbol of this dysfunction between liberal and hospital emergencies: the influenza epidemic of winter 2016 which engulfed hospitals. Patients, finding the doctors’ offices closed during the school holidays, ended up in the waiting rooms of hospital emergencies. The same is true for unscheduled pediatric care.
20 concrete proposals
For city doctors, the management of unscheduled care has been encouraged since the last medical agreement dating from the summer of 2016. But this measure is qualified as “too timid” by the rapporteurs.
In order to streamline the organization of care in emergency services, and to better integrate it into the care organization system, the committee drafted 20 proposals, relating to the internal functioning of the services, and the general response to emergency room.
Among these proposals, some are directly intended for emergency services. They therefore recommend that a pricing system be put in place to encourage services to refocus their activities on their core business: emergencies. A fixed price could be created to redirect other pathologies towards city medicine.
Material and personnel management could be improved by developing short care circuits or by creating bed manager positions. Geriatrics, often managed as a first-line emergency, should benefit from special care, with the possibility, when cases allow it, of direct admission to the departments concerned.
Promote health centers
Among the proposals made, several relate to liberal medicine, and in particular the development of possibilities for unscheduled care, without advance payment, outside of hospital emergency services. The report recommends in particular to “strengthen the network of the territory in health centers”, and to “ensure their wider openness to the reception of emergencies, in particular by the extension of their working hours”, whether it is during the week or the weekend. He also wants home visits to be better valued.
This is one of the important points, which the report underlines: if many people go to the emergency room rather than to liberal doctors, it is also by the lack of availability of these practitioners early in the morning, or in the evening.
Timid proposals
“The report is interesting, and the finding is correct,” said Dr Christophe Prudhomme, spokesperson for the Association of Emergency Physicians of France, contacted by Why actor. The proposals are interesting, but they are still a little timid. They do not tackle an essential problem, that of the lack of doctors, in particular general practitioners, and their distribution on the territory. “
The emergency physician recalls the seriousness of the situation: this summer, the system has reached its limits. SMURs had to close for lack of resources. A 43-year-old man died of a heart attack. The arrival of the resuscitation team was very late, due to the closure that day.
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