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Annales françaises de médecine d'urgence

, Volume 5, Issue 6, pp 283–289 | Cite as

Effets de la création d’un circuit court au sein d’un service d’urgence adulte

  • K. Saidi
  • A.L. Paquet
  • H. Goulet
  • F. Ameur
  • A. Bouhaddou
  • N. Nion
  • B. Riou
  • P. HausfaterEmail author
Article Original / Original Article

Résumé

Introduction

La création d’un circuit de prise en charge rapide (circuit court) est probablement la mesure organisationnelle qui a fait l’objet du plus grand nombre d’études de validation en termes d’efficacité. La mise en place d’un circuit court nous a permis d’analyser ses effets dans une étude observationnelle de type avant/après dans un service d’urgence adulte. L’hypothèse testée était que le circuit court diminue le temps de passage des patients ambulatoires.

Méthodes

Nous avons analysé deux périodes de 12 mois avant et après (novembre 2013) la mise en place d’un circuit court ouvert de 12h00 à 24h00 tous les jours, destiné à la prise en charge de tri de faible niveau de gravité (niveaux 3 à 5 sur une échelle de 5) pour lesquels on pouvait penser ne pas avoir besoin d’examens complémentaires nécessitant un délai important (biologie, scanner). Cette création s’est accompagnée d’une augmentation de personnel médical permettant son fonctionnement.

Résultats

L’activité en termes de nombre de passages (+11 %, P<0,001) a significativement augmenté entre les deux périodes. La proportion de patients passant par le circuit court est passée de 19 % à 23 % des passages au cours de la deuxième période. Le temps de passage moyen a significativement diminué (-70 min, IC 95 % -37 à -104 min, P<0,001) et la proportion de temps de passage <4h des patients ambulatoires a significativement augmenté (+10 %, IC 95 % +6 à +14 %, P<0,001) entre les deux périodes. La proportion de patients partis sans soins a également significativement diminué (-31 %, IC 95 % -19 à -44 %, P<0,001). Le circuit court a eu également un effet réducteur significatif sur la proportion de patients ayant nécessité des examens biologiques, radiologiques, et la proportion de patients perfusés.

Conclusion

La mise en place d’un circuit court comportant une dotation de personnel médical supplémentaire, permet de diminuer significativement le temps de passage des patients ambulatoires et le nombre de patients partis sans soins.

Mots clés

Circuit court Durée de séjour Qualité 

Effects of fast track implementation in an adult emergency department

Abstract

Introduction

A fast track has been shown to be an efficient measure in numerous studies in the emergency department (ED). We have performed an observational before/after study to assess the effects of a new fast track in an adult academic ED.We tested the hypothesis that a fast track is able to significantly decrease the length of stay (LOS) of ambulatory patients in ED.

Methods

We compared two 12-month periods, before and after (November 2013) the implementation of a fast track, open from 12 a.m. to 12 p.m. every day for patients with low severity triage (3 to 5 on a 5-level scale) and expected to not require time-consuming exams (biology, CT-scan). The implementation was associated with appropriate additional medical staff.

Results

The number of patients admitted in the ED significantly rose between the two periods (+11%, P<0.001). The proportion of patients who enter the fast track rose from 19% to 23%. The LOS of ambulatory patients significantly decreased (-70 min, 95% confidence interval -37 to -104 min, P<0.001) while proportion of patients with LOS<4h increased (+10%; 95% confidence interval +6 to +14%, P<0.001) between the two periods. The proportion of patients who left without being seen also significantly decreased (-31%, 95% CI -19 to -44%, P<0.001). The fast track also significantly reduced the proportion of patients who required radiological or biological exams or who were perfused.

Conclusion

A fast track, with additional medical staff, enables to significantly decrease the LOS of ambulatory patients and the number of patients who left without being seen in the ED.

Keywords

Fast track Length of stay Quality 

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Copyright information

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

Authors and Affiliations

  • K. Saidi
    • 1
  • A.L. Paquet
    • 1
  • H. Goulet
    • 1
  • F. Ameur
    • 1
  • A. Bouhaddou
    • 1
  • N. Nion
    • 2
  • B. Riou
    • 1
    • 3
  • P. Hausfater
    • 1
    • 3
    Email author
  1. 1.Service d’accueil des urgences, groupe hospitalier Pitié-SalpêtrièreAssistance Publique des Hôpitaux de ParisParis cedex 13France
  2. 2.Pôle PRAGUES, groupe hospitalier Pitié-SalpêtrièreAPHPParisFrance
  3. 3.Sorbonne UniversitésParisFrance

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