Introduction Some major changes have occurred in emergency department (ED) organization since the early 2000s, such as the establishment of triage nurses and short-track systems. The objectives of this study were to describe the characteristics of French EDs organization and users, based on a nationwide cross-sectional survey. Methods The French Emergency Survey was a nationwide cross-sectional survey. All patients presenting to all EDs during a 24-hr period of June 2013 were included. Data collection concerned ED characteristics as well as patient characteristics. Results Among the 736 EDs in France, 734 were surveyed. Triage nurses and short-track systems were respectively implemented in 73% and 41% of general EDs. The median proportion of patients aged > 75 years was 14% and median hospitalisation rate was 20%. During the study period, 48,711 patients presented to one of the 734 EDs surveyed. Among them, 7% reported having no supplementary health or universal coverage (for people with lower incomes). Overall, 50% of adult patients had been seen by the triage nurse in less than 5 minutes, 74% had a time to first medical contact shorter than one hour and 55% had an ED length of stay shorter than 3 hours. Conclusion The French Emergency Survey is the first study to provide data on almost all EDs in France. It underlines how ED organization has been redesigned to face the increase in the annual census. French EDs appear to have a particular role for vulnerable people: age-related vulnerability and socio-economic vulnerability with an over-representation of patients without complementary health coverage.

/pdf/the-french-emergency-national-survey-a-description-of-1e0zs1gc60.pdf

The French Emergency National Survey: A description of emergency departments and patients in France

La Societe francaise de medecine d’urgence (SFMU) a recommande la creation d’une echelle specifique, unique au niveau national, pour le triage des patients a l’accueil d’une structure d’urgences, prenant en compte les specificites de l’adulte et de l’enfant. La commission de l’evaluation et de la qualite de la SFMU a cree, a l’instar des echelles de tri internationales, une echelle de tri avec cinq niveaux de priorite croissante (tris 5 a 1, du moins urgent au plus urgent) auxquels correspondent des motifs de recours aux soins de complexite/severite croissante. Le tri 3 a ete subdivise en deux groupes pour distinguer (et prioriser) les patients qui ont au moins une comorbidite en rapport avec le motif de recours aux soins ou qui sont adresses par un medecin (3A) des autres patients (3B). L’echelle de tri FRENCH (FRench Emergency Nurses Classification in Hospital) a donc six niveaux de priorite. A chaque niveau de tri correspondent des motifs de recours aux soins frequents en medecine d’urgence, des modulateurs de tri, une repartition rationnelle des circuits patients et un delai maximum d’attente avant prise en charge medicale, apres evaluation par l’infirmier(iere) d’accueil. Une premiere evaluation de la FRENCH a montre qu’elle repondait aux objectifs du triage en facilitant le reperage de l’urgence complexe/severe de facon fiable et reproductible. De nouvelles evaluations sont necessaires dans d’autres structures d’urgences pour confirmer sa performance et favoriser son evolution.

/pdf/triage-des-patients-a-l-accueil-d-une-structure-d-urgences-5aoiz2ly7m.pdf

Triage des patients à l’accueil d’une structure d’urgences. Présentation de l’échelle de tri élaborée par la Société française de médecine d’urgence : la FRench Emergency Nurses Classification in Hospital (FRENCH)

Aims Pain is underestimated and insufficiently treated in Emergency Departments (ED). The primary objective of this multicenter, prospective, observational, and interventional study is to analyze the clinical impact of a simulation-based training for Emergency Nurses on pain assessment and management. Secondary objectives are to measure instructed staff's satisfaction with the simulation training and to evaluate the progress of participants as well as studying the clinical impact of this course: level of correlation between accuracy of analgesia and level of pain, assessment of patient and caregiver satisfaction. Design this study will be undertaken in EDs at two university hospitals (Paris, France: Bichat and Beaujon) with randomly selected experimental and control groups. Methods During the first phase, inventories in the EDs of current professional practice will be realized. Then, the control group will have theoretical classes and the experimental group will have both the theoretical class and simulation courses for all the nurses (with simulated patients in trauma pain scenarios). Post course assessment will be established of triage nurses' and other nurses’ practice changes concerning trauma pain management in EDs. Moreover, this study will include an assessment of the impact on patient and caregiver satisfaction. All patients over 18 years old who are admitted to the ED for a non-vital trauma are included. Exclusion criteria are patients who are admitted by an EMS ambulance. Clinical implication this study seeks to demonstrate that the implementation of a theoretical course combined with a simulation session will improve pain management in EDs by Emergency Nurses.

A multicenter randomized control trial evaluating professional practice assessment of patient pain management after simulation training course: Study protocol.

Aims
The simultaneous visits of patients to the pediatric emergency department (ED) requires the use of a triage process to determine the priority of care for incoming patients based on the severity of their illnesses. To date, there is no data on the different triage methods used in the pediatric ED in France. The main objective was to describe triage practices in the pediatric ED in France.

/pdf/enquete-nationale-sur-les-methodes-de-triage-aux-urgences-4grvlvv448.pdf

Enquête nationale sur les méthodes de triage aux urgences pédiatriques

Introduction : La surcharge est au coeur des problematiques des structures de medecine d’urgence et connait une augmentation continue depuis plusieurs annees. Elle est responsable d’une degradation de la qualite des soins et d’une augmentation de la morbi-mortalite. L’objectif de ce travail est d’ameliorer la qualite de la prise en charge des patients par l’intermediaire d’un protocole visant a adapter les ressources aux besoins: le PLUS (Plan de Lutte Contre les Urgences en Surcharge). Materiel et methode : Nous avons etudie l’efficacite du PLUS par une etude prospective au sein de la structure d’urgences de l’hopital de Mercy. Le recueil de donnees a dure 4 jours du 23 au 27 aout 2017 et a ete compare aux valeurs de reference observees a la meme periode au cours de l’ete 2016 qui constitue la periode controle. L’ensemble des patients pris en charge au sein du service adulte ont ete inclus. Le critere de jugement principal etait la diminution du temps de passage moyen. Ont egalement ete evalues le temps de passage des patients hospitalises et les taux d’occupation ponctuels moyens (TOPM). Resultats : 520 patients ont ete pris en charge pendant la periode PLUS, 3253 pendant la periode CONTROLE. Il n’y avait pas de difference significative entre les populations en termes de nombre de passages quotidiens, de proportion de personnes âgees, d’hospitalisation ou de patients consideres comme graves. L’analyse des durees de passage montre une diminution significative (p=10-5) des temps de passage global et en cas d’hospitalisation avec une augmentation de la proportion de patients pris en charge en moins de 6 heures. Le TOPM est significativement affecte par le PLUS (0,02) qui permet une amelioration des flux patients. Conclusion : Une meilleure utilisation des ressources du service en s’adaptant a l’activite ponctuelle semble permettre d’ameliorer la qualite de la prise en charge. L’effet sur la morbi-mortalite devra etre evalue avec l’utilisation d’un tel protocole.

https://hal.univ-lorraine.fr/hal-01932066/document

Evaluation de l’efficacité d’un plan de lutte contre la surcharge de patients dans une structure d’urgences

Le triage en structure des urgences

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Le triage en structure des urgences