The hospital is in deep crisis. And the national mobilization planned this Thursday, November 14 to “save the public hospital”, at the call of the collectives of caregivers and emergency doctors InterUrgences and InterHospitals, is announced historic in Paris, as in the province. From local hospitals to partnerships between hospitals and city health centers, as well as innovative digital solutions, many institutions, professionals and health organizations are deploying solutions to heal the wounds of the system.
• “Local hospitals” for basic care
This is one of the flagship measures of the Health Law carried by Agnès Buzyn. To remedy the shortage of doctors in certain regions, the government wants to label between 400 and 600 “local hospitals” in the coming years. With the aim of ensuring a minimum “pedestal” of care: multipurpose medicine, rehabilitation, geriatrics, specialized consultations … The hospital of Pont-Audemer, in the Eure, which the minister visited in mid-February, is a model . Following the closure of its maternity ward in 2003 and its surgical block in 2014, this facility has expanded its activities to monitor pregnant women, modern radiology, biological tests and emergency services. The hospital relies on local doctors and specialists from the hospital group of Le Havre, located 40 kilometers away. A typical organization of what the government calls “gradation of care”, with small hospitals working hand in hand with medical offices and large institutions in the region. But these restructurings are not unanimous. In the field, many elected officials and inhabitants see a new way of ratiboising small hospitals. “The whole question is to know what means will be devoted to these local hospitals, judge Frédéric Valletoux, president of the Hospital Federation of France. If the government makes them real first-level health centers, it will strengthen our bottom-up health care system. ”
© All Rights Reserved MEETING – Engulfed in the crisis, Agnès Buzyn wants to “give hope to the public hospital”
• Health centers set up in emergencies
At the origin of a concept of “small emergencies” deployed since 2014 in some of its six Parisian health centers, the association Cosem (Coordination of social and medical works), created in 1945, hosts two million patients a year. After having signed agreements in recent months with the Parisian hospitals of Tenon, Saint-Louis and La Pitié-Salpêtrière, which redirect light cases to its centers, the Cosem now plans to pick up patients directly in the emergency room. “We want to open health centers inside hospitals to offer complementary specialties,” says Dr. Daniel Dimermanas, president of Cosem. A call for tenders has just been launched by AP-HP to open these “corners” in four hospitals in the coming months: Lariboisière, Tenon, Antoine-Béclère and Bicêtre. A similar project is under discussion in Marseille. In a recent report, the court of auditors also welcomed the initiative of Robert Debré hospital, which has forged a partnership for several years with the medical center Europe. Liberal doctors provide night and weekend duty in two boxes near the emergency department. They treat a total of 12,000 of the 91,000 patients who come to the emergency room of the hospital each year …
• General Practitioners to Unclog Samu
“A Physician 116 117” is a device experienced in the Bas-Rhin since March 2019. Installed in the middle of the telephone set of the center 15 of Strasbourg, the liberal doctors answer the phone to people facing a disease or a problem of light health , now encouraged to dial 116 117 instead of 15 or 112. The goal? Unblock the Samu phone lines and hospital emergencies, refocusing patients to city medicine if possible. In the Bas-Rhin, the Samu receives between 800 and 1,200 calls a day and hospital emergencies see more than 280,000 people a year. “Our priority was to imagine a simple device and the level of constraint was acceptable for our colleagues,” says Dr. Guilaine Kieffer-Desgrippes, President of the URPS-ML of the Great East, who designed this device with the Regional Health Agency (ARS) Grand-Est. Excluding start-up investments, the annual budget planned for its operation amounts to 350,000 euros. More than 230 general practitioners (out of the 1,300 in Bas-Rhin) are now registered on the platform, which has processed to date about 13,000 cases. “A Doctor 116 117 also makes it possible to prove the effectiveness of liberal medicine in the management of unscheduled care “, congratulates himself Dr. Guilaine Kieffer-Desgrippes.
© All Rights ReservedREPORTAGE – In Paris, a night in the heart of the “ras-le bol general” of emergencies
• Predicting Unscheduled Care Activity Flows Using Artificial Intelligence
The offer of care is not the only factor of engorgement hospital emergencies. “Many patients see health as a product of consumption, and their expectations do not stick anymore with the constraints of the city medicine, like the opening hours of the cabinets,” notes Dr. Romain Hellmann, head of the unit Anticipation and regulation of unplanned care at the Regional Health Agency Ile-de-France. As a result, for unscheduled care, they often fall back on emergencies that are overwhelmed. But thanks to artificial intelligence, it will soon be possible to predict the attendance of emergencies. This is what the ARS Ile-de-France wants to believe that has embarked on a project to develop a tool for predicting unscheduled care in order to help emergency personnel to organize themselves better. How? 'Or' What ? By exploiting big datathat is, by crossing data that can influence urgent and unscheduled care requests. Emergency activity and Samu, climate and weather, air quality, social networks and even the most popular health articles on Google … A mass of information from various sources that will be passed to the mill of algorithms of prediction to anticipate peaks of activities related, for example, to the arrival of influenza, an epidemic of bronchiolitis, a heat wave, pollution peaks or calendar events such as school holidays or social movements. The development of this tool should be finalized by the end of 2019.
• The digital for save time in the hospital services
“In 2020, blood tests are always faxed to hospitals by the laboratories.” The Hematology department of Necker receives every day a hundred faxes, an internal or a medical secretary is responsible for sorting and storing in patient files This is wasting a lot of time, sighs Jérémie Neuberg, the founder of Instamed. Among other services rendered to hospitals, this platform for exchange and medical remote monitoring – created in 2016 by this mining engineer – automates this thankless task. Accessible on the web and mobile, the service is a mine of information for patients – who find both their medical file, a teleconsultation service, medication reminders, therapeutic education cards … Above all it allows them to establish a direct dialogue – by instant messaging or email – with their medical team – doctor, nurses, pharmacy, physiotherapist … – and it fluidifies the exchanges within the hospital service. Instamed is being tested in departments of four major AP-HP hospitals: Cochin, Paul Brousse, Necker and Port-Royal. In the latter, the start-up will computerize a service under the fire of the news: emergencies. In a few months, Instamed will connect to the national DMP.
By Isabelle de Foucaud, Laurent Fargues and Delphine Déchaux