Annales françaises de médecine d'urgence

, Volume 5, Issue 5, pp 231–239 | Cite as

Visit to the emergency services in California and a report on a group of French emergency specialists

Article Original / Original Article

Abstract

Introduction

Improving the quality of care in Emergency Departments (ED) is a priority. Benchmarking and qualitative methods have been applied as health quality improvement tools. Our goal is to describe the application of these methods.

Method

University EDs located in California were visited. Semi-structured questionnaires were used for interviews with ED managers and staff members, on the organizational aspects, including triage and care pathways; human resources; equipment; quality and performance indicators; transverse links between ED and hospital wards; bed management; and patients-centered care. District health officials were also interviewed.

Results

Three adult and two pediatric EDs were visited; 56 ED leaders and staff members were interviewed. We have identified many innovative organizational and management aspects such as the role of nurse-practitioners, the importance of fast-track in the organization of ED, and the critical care area project. The architecture, organization, and care projects are at the service of the ED quality project. Security has emerged as a priority in reducing waiting times. Bed management and ED–hospital culture reflect a growing priority and provided the through-ED pathway.

Conclusion

Visit to the EDs abroad as a part of structured visits by managerial and scientific methods allows us to find new quality development paths of care and to improve the working conditions of our ED teams.

Keywords

Emergency department Benchmarking Semistructured questionnaires Quality Quality indicators 

Visite de services d’urgences en Californie. Rapport d’un groupe d’urgentistes français

Résumé

Introduction

Améliorer la qualité des services d’urgences (SU) est une priorité. Le benchmarking et les méthodes qualitatives ont été proposés comme des outils d’amélioration de la qualité en santé. Notre objectif est de décrire l’application de ces méthodes aux SU.

Méthode

Des SU universitaires situés en Californie ont été visités. Des questionnaires semi-structurés ont été utilisés pour les entretiens avec les responsables et les personnels des SU, sur les aspects organisationnels, dont le triage et les filières de soins internes; les moyens humains; les équipements; les projets qualité et performance; les indicateurs qualité et de tension; les liens transversaux des urgences avec le reste de l’hôpital; la gestion des lits; les soins axés sur les patients. Des responsables régionaux de santé ont été également interviewés.

Résultats

Trois SU adultes et deux SU pédiatriques ont été visités; 56 responsables et personnels des SU ont été interviewés. Nous avons identifié de nombreux aspects organisationnels organisationnels et de gestion innovants, parmi eux le rôle des nurse-practitionners (NP), l’importance des filières courtes dans l’organisation des SU et l’organisation des filières pour les urgences vitales. L’architecture, l’organisation et les projets de soins sont au service du projet qualité. La sécurité est apparue comme une priorité tout comme la réduction des délais d’attente et l’information. La gestion des lits et l’organisation de celle-ci traduisent une culture hospitalière accordant la priorité aux filières non programmées.

Conclusion

La visite de SU à l’étranger dans le cadre de visites structurées, en utilisant des méthodes managériales et scientifiques validées, a permis d’identifier des pistes d’amélioration de la qualité des soins et des conditions de travail des équipes des SU.

Mots clés

Urgences Benchmarking Questionnaires semistructurés Qualité Indicateurs qualité 

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Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2015

Authors and Affiliations

  • E. Casalino
    • 1
    • 2
  • C. Choquet
    • 1
    • 2
    • 3
  • R. Hellmann
    • 1
    • 2
    • 4
  • M. Wargon
    • 1
    • 2
    • 5
  1. 1.Service d’accueil des urgences, hôpital Bichat–Claude-BernardAssistance publique–Hôpitaux de ParisParisFrance
  2. 2.Study Group for Efficiency and Quality of Emergency, Departments and Non-Scheduled Activities, DepartmentsParisFrance
  3. 3.Université Paris-Diderot, Sorbonne–Paris-Cité, EA 7334ParisFrance
  4. 4.Agence régionale de santé Île-de-FranceParisFrance
  5. 5.Service d’accueil des urgenceshôpital Saint-CamilleBris-sur-MarneFrance

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