Hospital: access to emergencies soon to be limited, which will change for you

Soon, it will no longer be possible to push the door of the emergency room to obtain a medical consultation, at any time of the day or night, and whatever their pathology. It’s been a long time since emergency physicians no longer want to play “bobologists”. But now that the crisis is here, that doctors and nurses are throwing in the towel and that many teams are wavering, there hardly seems to be any alternative. “The scientific literature is clear: the over-frequentation of services entails a risk of morbidity and mortality for patients. Emergencies can no longer be ‘open bar'”, hammered Professor Karim Tazarourte, head of the department’s SAMU du Rhône, during a press conference organized on the sidelines of the annual Emergencies 2022 congress, which is being held these days in Paris. And as the man participates in the “flash mission” mandated by the President of the Republic Emmanuel Macron to respond to the critical situation of these services, we say that inevitably, his speech prefigures the announcements expected for the end of the month.

The objective is clear: to avoid “avoidable deaths” this summer. In other words, to avoid that patients in vital emergency are not taken care of in time, because of the embolism of such or such service, or worse, of its closing. “Obviously, for non-urgent unscheduled care, it will be a little more complicated”, continues Professor Tazarourte, who also chairs the French Society of Emergency Medicine. However, assures the doctor, the challenge will remain not to leave a request for care unanswered. The proposed reform is therefore based on two pillars: regulation by the 15, and the participation of all healthcare players – including Red Cross first aiders! – to cover these “unscheduled treatments” which are not life-threatening emergencies.

A problem, the lack of “effectors”

It will of course be necessary to reinforce the 15th, then to launch a communication campaign for the general public to encourage the French to no longer present themselves at the doors of hospitals for a yes or a no. In an ideal world, patients requiring medical care but not urgent would then be referred to city medicine. To do this, the health authorities have imagined a “care access service” (SAS) where, at the level of each territory, hospitals and liberals coordinate to welcome patients without an appointment. Currently in experimentation in 22 pilot sites, these SAS should be generalized to the whole territory very soon. With all the same a problem: “the lack of effectors”, summarized Dr. François Braun, responsible for the “flash mission” on emergencies, during the same press briefing. Clearly, the lack of GPs available to accommodate consultations without an appointment. A major problem.

“Resume the organizations put in place during the health crisis”

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To remedy this, the flash mission should propose that the Health Insurance get their hands on the wallet. “This is the blocking point currently: the liberal doctors are asking for an increase of fifteen euros for the acts carried out at the request of the 15th. This does not seem absurd”, confirms Dr. Braun. Because, in fact, meeting a new patient always takes a little longer, and keeping free consultation slots for these requests also represents an organizational effort. But what to do where some doctors refuse to get involved, or when there are simply not enough of them?

Administrative blockages

“By taking over the organizations set up during the health crisis”, answers Dr Agnès Ricard-Hibon, former president of the French Society of Emergency Medicine. And cite two examples. Sending home nurses with teleconsultation equipment, currently being tested in a few departments. “A mobile unit of this type means six to seven visits to the emergency room avoided per day”, says Dr Ricard-Hibon. Another track, partnerships with volunteer rescuers from the Red Cross and civil protection to “secure home support”. “An elderly person calls for palpitations: it could be an anxiety attack, or a heart condition. In agreement with a doctor from 15, these teams can carry out some examinations and, depending on the results, take the patient to the hospital , or on the contrary, reassure him and prevent him from moving”, continues Dr Ricard-Hibon.

For these professionals, this is in no way a degraded response: with medical regulation and supervision of these teams, the essentials remain preserved, according to them. But when asked if this will be enough to get through the summer without major difficulties, the tone is less optimistic. For example, the partnership with the civil protection is not yet acquired: “It is not the responsibility of the Ministry of Health but of that of the Interior, to which these teams are attached, and for the moment, this is blocking”, breathes Agnès Ricard-Hibon. A few other ideas, mentioned here and there in recent days, also make them shudder. Like the possibility of closing certain branches of Smur, these medical teams which move on vital emergencies, to reinforce the reception of unscheduled care in hospitals: “We are going to delay the management of the infarction to better treat the ‘sprain’, they choke in heart.

Coordinate hospitals and clinics

It will also remain to streamline the hospitalizations of patients admitted to the emergency room. The difficulty of finding beds in establishments has long been the other recurring problem that emergency physicians hope to see finally resolved. In the medium term, this requires a profound reorganization of the operation of hospitals: investing in “bed managers” (caregivers dedicated to this task) and creating “scheduling cells” to impose the opening of beds with dedicated staff , depending on forecasts of unscheduled activities. “Depending on the time of year and the weather forecast, we are quite capable of anticipating the number of patients who will present themselves, assures Karim Tazarourte. But today, there are no bed managers. everywhere, and the unscheduled care commissions do not speak with the human resources departments!”.

In the meantime, as the new Minister of Health Brigitte Bourguignon announced, the crisis units used during the Covid “to coordinate hospitals, private doctors and clinics” will be reactivated. Understood: to force private establishments to take in unscheduled patients, when the hospital is no longer able to do so. In addition, the ministry has already announced a first series of revaluation of overtime worked in the hospital for the summer – before, perhaps, new, more structural and highly anticipated announcements, on the remuneration of night hours for example .

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For the most optimistic, the major crisis that the emergency services are going through today could therefore finally be an opportunity to review our health system in depth. A reform that caregivers have been hoping for for years. Unless corporatism, lobbies and old habits once again take over. It would then be our health to all who would suffer.