Revue de la littérature sur les retours précoces aux urgences pour améliorer la qualité et la sécurité des soins

  • D. Lauque
  • S. Fernandez
  • N. Lecoules
  • S. Charpentier
  • O. Azéma
  • J. Edlow
  • A. Bellou
Mise au Point / Update

Résumé

Les retours précoces aux urgences peuvent être liés à un événement indésirable associé aux soins (EIAS) survenu lors du premier passage aux urgences. Cette revue de 24 études fait le point de l’utilisation des retours précoces comme indicateur qualité et comme événement sentinelle dans le cadre d’une démarche qualité de gestion des risques. La plupart des retours précoces ne sont pas dus à des erreurs mais à des facteurs liés aux patients, à l’évolution de leur maladie ou au système de soin en aval des urgences. Cependant, les patients qui reviennent pour un EIAS présentent souvent une pathologie sévère nécessitant une hospitalisation. Ils ont un âge élevé, des comorbidités, ils sont mal assurés et ont un tableau clinique sévère lors de leur premier passage. Les retours précoces ne devraient pas être utilisés comme indicateur de qualité des soins puisque la plupart ne sont pas liés à un EIAS mais comme événement sentinelle pour dépister ceux qui sont liés à un EIAS. L’analyse ciblée des dossiers de ces patients permet de caractériser ces EIAS, d’identifier les causes évitables et de mettre en place des actions d’amélioration.

Mots clés

Retour précoce Événement indésirable lié aux soins Service d’urgence 

Literature review on early return visits to the emergency department for assessing healthcare quality and safety

Abstract

Early return visits to the emergency department (ED) may be due to adverse event occurring during the first visit. We reviewed 24 publications to focus on return visits as sentinel event to detect preventable errors and adverse events in the ED. Most of returns are not related to lapses in care but to patient factors, disease progression or post-ED factors. Only 15%of early return visits are related to adverse events, but these patients often return with severe conditions and must be hospitalized. Their risk factors are age, comorbidities, poor insurance coverage, and severe conditions at the first visit. Early return visits should not be used as indicator of quality of care because most of return visits are not related to quality issues, but as a screening tool to detect deficits in care. Review of screened records characterizes adverse events for identifying preventable errors and improve healthcare.

Keywords

Return visit Adverse event Emergency department 

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Copyright information

© Société française de médecine d'urgence and Lavoisier 2017

Authors and Affiliations

  • D. Lauque
    • 1
    • 4
  • S. Fernandez
    • 1
  • N. Lecoules
    • 1
  • S. Charpentier
    • 1
    • 4
  • O. Azéma
    • 2
  • J. Edlow
    • 3
  • A. Bellou
    • 3
  1. 1.Pôle de médecine d’urgenceCHU ToulouseToulouse cedex 9France
  2. 2.Département d’information médicaleCHU ToulouseToulouse cedex 9France
  3. 3.Emergency Medicine DepartmentBeth Israel Deaconess Medical CenterBostonUSA
  4. 4.Université Paul SabatierToulouse cedex 9France

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