Résumé
Introduction
Les risques de burnout sont plus importants dans les structures d’urgence. L’amélioration de la qualité des soins et de la satisfaction au travail passe par l’élaboration de stratégies organisationnelles étayées par des analyses ergonomiques.
Méthode
Dans une structure d’urgence de CHU, un modèle de recherche-action a cherché à conduire le changement avec la participation active de tous les métiers concernés. Après une formation ergonomique brève, le personnel a observé huit journées de travail des différents métiers aux différents horaires et relevé un ensemble de paramètres.
Résultats
Les personnels des urgences ont tous dépassé 100 changements de lieu pendant leur poste de travail. Les soignants changent de lieu toutes les deux à trois minutes et les médecins toutes les quatre à cinq minutes en moyenne. Les changements d’activité sont très fréquents (de 145 à 377). La durée moyenne d’une activité continue variant de 1 minute 40 à 4 minutes selon le métier. Le nombre d’interruptions était de 81 pour l’IDE de jour et de 56 pour le médecin senior. La présence auprès du malade ne représente en moyenne qu’un tiers du temps de présence.
Discussion
Le travail haché ne permet aux soignants que des échanges factuels brefs et majore le risque d’omission et d’erreur. La fréquence des interruptions retentit sur la disponibilité des soignants auprès des malades et gêne le raisonnement. Les procédures de soins destinés à prévenir les événements indésirables sont inefficaces si l’organisation et l’espace sont inadaptés. Ces données démontrent la nécessité d’un espace permettant des discussions pluridisciplinaires sectorisées.
Abstract
Introduction
The risk of burnout is more important in emergency departments. Improving care quality and job satisfaction needs the development of organizational strategies supported by ergonomic analysis.
Method
In an emergency department of a teaching hospital, a research-action model tried to lead the change with the active participation of all the teams. After a short ergonomic training, staff followed, during eight days, each professional category, at different times and recorded data.
Results
All of emergency department’s staff have done more than 100 changes of place during their turn of duty. Nurses change place every 2-3 min and doctors every 4-5 min on average. The changes of activity are very frequent (from 145 to 377). The average duration of a continuous activity varies from 1 min 40 s to 4 min according to the job. The number of interruptions was 81 for the day nurse and 56 for the emergency physician. Time spent with patients represents on average only a third of the total time.
Discussion
This kind of work allows the nurses only short and factual exchanges with patients and increases the risk of omission and error. The frequency of interruptions decreases nurses’ availability for patients and disrupt raisonning ability. Care process to avoid the unwanted events are ineffective if the organization and the space are unsuitable. These data demonstrate the necessity of a space allowing sectorized multidisciplinary discussions.
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Estryn-Behar, M., Raphael, M., Milanini-Magny, G. et al. Ergonomie participative aux urgences — Méthode d’implantation de changements. Ann. Fr. Med. Urgence 3, 217–229 (2013). https://doi.org/10.1007/s13341-013-0324-z
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DOI: https://doi.org/10.1007/s13341-013-0324-z