The deadline is approaching: the flash mission entrusted to François Braun has until Friday, July 1 to get back on track to avoid an emergency crash this summer. Because they are confronted, in addition to the current difficulties and infeasible schedules, confronted with a seventh wave of Covid-19.
If the situation is critical, our caregivers are full of inventiveness to improve our short-term, but especially long-term care system. 20 Minutes gave the floor to five emergency specialists, doctor, paramedic or nurse, to ask them, not the miracle solution, but a good idea to relieve emergencies.
Improve working conditions
“It’s not so much the number of patients who come to the emergency room that poses a problem as the downstream concern: there are fewer and fewer beds in hospital services, but also in nursing homes and follow-up care”, analyzes Pierre Schwob, 32, night nurse in the emergency roomBeaujon Hospital (Hauts-de-Seine) and Vice-Chairman of the Inter-Emergency Collective. A finding shared by many. The problem is that to open beds or stop closing them, you need paramedics at their bedside. However, since the pandemic, a lot of nurses have left the hospital.
What can make them want to work in the hospital again? If the salary increase, especially on the night and the weekend, seems essential, better working conditions come at the top of the priorities. “We should impose a ratio of patients per carer and that we hold our position, which means that we cannot send me one day to geriatrics and the next day to the emergency room, suggests Pierre Schwob. With ten years of experience in the emergency department, I have developed a skill that I do not have in reality… No more “ode to versatility”.
Another specific claim of the collective: the replacement of all maternity leave. “Today, it takes two pregnant women for there to be a replacement. We are in an 80% female environment, that poses slight problems… Especially since they have to become pregnant in the same department and on the same shift. Pierre also wants recognition of hardship. “Nursing is no longer a trade recognized as painful since the Bachelot law of 2010. Before, the opening of pension rights began at 57 years old. Today, it is 62 years old and soon 65 years old…”
Offer on-board telemedicine in ambulances
What if, rather than sending a patient to wait for hours on a stretcher, we brought the care home? Stéphane Graton, 51, an ambulance driver in Vendée for thirty-two years, has been developing a solution since 2018: the mobile teleconsultation unit. “We serve as an umbilical cord between the place of life and the place of care, between patient and caregiver thanks to the vehicle. With new technologies, we can do assisted teleconsultation. The first mobile teleconsultation unit was created in June 2020 in the heart of Covid.
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“In short, it’s a mobile doctor’s office, with a nurse and a paramedic inside who become the doctor’s eyes and hands. We do not degrade the consultation and we use modern tools: connected stethoscope, oximeter, electrocardiogram. » The ambulance is equipped with a satellite link to avoid unbearable bugs. The patient is therefore quickly taken care of: if he can stay at home, he receives his prescription in a few clicks, is reassured by a team who often knows him. And if he needs to be hospitalized, “we can direct him to the right specialty service by skipping the waiting box in the emergency room”, specifies the paramedic.
Set up “bed managers”
The project started at the University Hospital of Poitiers in 2014 and convinced well beyond this hospital. The proof: many learned societies are interested in it. Its principle? It is no longer a doctor who negotiates with the services to have his patient hospitalized, but a “bed manager”, who can be an administrative officer or a nurse. “We don’t need to call him, we have business software that allows us to tick a box “I would like a place in gastro”. Bed managers use this software to find a place, summarizes Jérémy Guenezan, 35, head of the emergency department in Poitiers. The transmissions are made between the paramedics of the emergencies and the services and we can continue to take care of other patients. »
A very efficient system. “A study showed that from the first years, we had reduced the wait to between 1h and 1h30 per patient. But “bed management” is not just a new profession, but an entire organization. “The whole hospital is equipped with computer equipment which allows us to have a vision of the places and it took an institutional will for the doctors in the services to free up places for us. Each department knows how many beds it must dedicate to emergencies. »
Because contrary to what one imagines, the activity of emergencies is predictable. “There was a lot of statistical work to find out how many places we needed per specialty and per day. Third condition: the hospital has created an downstream hospitalization unit. “A buffer service between emergencies and services when you are waiting for a place, continues Jérémy Guenezan. Instead of sleeping in the hallways, they are in a bedroom and stay there for less than 48 hours. Everyone is benefiting. »
And caregivers too. “For the attractiveness of the profession of emergency physician, it’s a miracle solution!”, confirms Maxime Jonchier, doctor in the department. There are two things that annoy emergency physicians: treating what is not an emergency, but unfortunately we can’t do anything on this side because the supply of care is less than what is needed. Second problem: having to negotiate a place with a colleague. It’s exhausting and you become abusive. Today, it takes an average of 23 minutes between the moment when the emergency doctor decides that hospitalization is necessary and the arrival in the room… This makes other hospitals blush! “For them, no doubt, the “bed management” must be exported and be part of the tracks of the “flash mission”.
Especially since there are several stages to this rocket. Not only is the whole hospital working hand in hand, but bed management is being organized across the Territory Hospital Group (GHT), which includes the hospitals of Loudun and Châtellerault. In the latter, a paramedic has been in charge of “bed management” for a week.
And why not expand this system to the scale of the region?, suggests Nicolas Perolat, 34, emergency doctor in the provinces. “This was the case during the Covid crisis: when a patient in the emergency room needed a place in the sheave, we called the Covid cell at the Ile-de-France Regional Health Agency, which told us where the send. With the number of beds that will close this summer, one can imagine that regional cells in the ARS manage hospital beds. »
A long-term solution? “No, replies Nicolas Perolat. A patient that we go to see in Montreuil, if you hospitalize him in Boulogne, his relatives will not come to see him. However, family support is very important. But that could be an emergency solution, until the hospital becomes attractive again. »
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