Will going to the emergency room spontaneously soon be impossible? After Bordeaux, Cherbourg, Laval or Orléans, it is the turn of the emergencies of the CHU of Grenoble to restrict their nocturnal activity, for lack of arms. Since June 27, only vital emergencies and patients previously “sorted” by the 15th are admitted between 8 p.m. and 8 a.m. Pediatric, gynecological and obstetrical emergencies are not affected, specifies the management.
Shaken by a staff strike, the emergencies of the University Hospitals of Rennes and Toulouse also refer the population to the Samu, private hospitals or the attending physician. “We are also not immune to occasional closures of emergencies in Strasbourg, warns Doctor Sébastien Harscoat, emergency doctor at the CHU. For the moment, we are holding on, but we are continuously working in degraded mode. At the slightest work stoppage, there is a risk of disorganization. »
An unprecedented situation, according to Fabien Paris, member of the Collectif inter-urgences. “Already last summer, some emergency services had reduced their activity, but these were outlying hospitals, not large university hospitals”, worries this nurse in Saint-Nazaire (Loire-Atlantique).
22 million emergency visits in 2021
Could this restricted operation, based on upstream regulation of patients, be generalized beyond the summer? The idea, still taboo a few months ago, is now favored by a large part of the medical world. In a press release published Monday, June 27, around twenty organizations representing liberal and hospital doctors plead to extend this solution.
A paradigm shift that should also be defended by Professor François Braun, charged by the government with a “flash mission” on access to unscheduled care and whose conclusions are expected on Tuesday 28. “Emergencies can no longer be open bar”, had already launched the president of the Samu-Emergency union of France, at the beginning of June, while at least 120 services are or will be forced to reduce reception this summer.
For Doctor Philippe Revel, ” There is no other solution “. At the head of the emergency department of the Bordeaux University Hospital, the doctor has already set up a filtering system by 15. “Given the major difficulties we have in terms of human resources, both medical and paramedical, it was better to reduce rather than continue like this, with the risk that the staff will burn out, he explains. The remaining means should be used for patients who really need it. » Civil security volunteers are nevertheless posted in front of the hospital“in case a patient in an acute situation presents itself”.
In Bordeaux, “we will not go back after the summer”
According to him, this organization, set up a month ago, is proving satisfactory. “Regulation has reduced activity by 25 to 30%. There are no more impossible queues, working conditions for staff have improved and, to my knowledge, there has been no loss of opportunity for patients,” summarizes the doctor, who recognizes it: what was first conceived as a palliative could be brought to perpetuate. Or even become the model to follow? “It happens that in crisis situations, ideas appear. Unless we have 30% more doctors tomorrow, we will not go back after the summer. »
Enough to make the Collectif inter-urgences jump, for whom this filtering goes against the values and mission of the public service. “We make the patient feel guilty for coming to use a service that is no longer able to receive him, chokes Fabien Paris. Most often, it is by default that people go to the emergency room, because they have no possibility of consulting a liberal. »
In France, 6 million people have no attending physician, ie 11% of the population. “In Loire-Atlantique, it is very complicated to find treating doctors to whom to refer patients. Sometimes I make 40 phone calls to no avail. And SOS Médecins is at its maximum capacity. Whether we like it or not, the disorganization of the health system is such that emergencies have become places of primary care.. »
A risk of loss of chance
The risk of filtering? That patients hesitate to consult. “We discover stomach cancers on hiccups that drag on a bit and heart attacks behind chest pains. In order not to saturate the emergencies, these people will tell themselves that it will eventually pass. These lost chances will not necessarily be seen immediately, but we will have to monitor this in the months and years to come. »
“We will count the dead”, bluntly strikes Doctor Sébastien Harscoat, who assures him: the difficulties of the sector are not linked to the excessive use of emergencies. « The real problem is not the people who wait in the emergency room when they have nothing to do there. The problem is those who are there to a real reason and for which there is no endorsement, that is to say no hospital bed. »
Limited service but no closure
Like many, the doctor does not expect a “miracle” from François Braun’s report. “It is a mistake to believe that you just have to spend the summer. The crisis in the emergency room is a symptom of the crisis in the entire hospital, and it is not yet another report that will solve it”, he gets annoyed.
“This will perhaps raise awareness, and help to harmonize certain practices at the national level”, nuance Caroline Brémaud, head of emergencies at the Laval hospital center (Mayenne). Here, “sorting” has been a reality since November. “We are missing two thirds of the target numbers of emergency physicians. Improving regulation, better paying overtime, calling retired doctors, we have already done all that », warns the doctor, all the more worried that the recommendations of François Braun could be slow to materialize, the Minister of Health, Brigitte Bourguignon, being on the departure after her defeat in the legislative elections.
In the meantime, hospitals are trying to reassure the population. “Emergencies are reducing their activity, but they are not closed, insists Doctor Revel, in Bordeaux. Anyone who really needs to get in will get in, without limitation. » This does not prevent user associations from worrying. “We cross our fingers so that there is no drama this summer, loose Gérard Raymond, president of France Assos Santé. Mr. Braun may come up with some good ideas, but he alone will not be able to rebuild the health care system, and that is what it is all about. This project will take time. »
Increase in emergency room visits continues
According to the DREES, 629 establishments host an emergency service, the majority of which (77%) in the public sector.
At their side, 100 Samu (emergency medical aid services) and 387 Smur (mobile emergency and resuscitation structures) provide orientation, pre-hospital care and transport of patients.
22 million emergency visits were recorded in 2019, i.e. 54% more than in 2002, but the increase has tended to slow down in recent years.
Trauma and somatic problems (particularly pain) are the first cause of consultation.
According to the Court of Auditors, the majority of patients arrive during working hours and in the early evening, with peaks in the middle of the morning and between 6 p.m. and 10 p.m.