Clinical trial NCT05392829: Reorientation of Tripped Patients 4 and 5 in Emergency Department
Official title: Reorientation of Tripped Patients 4 and 5 in Emergency Department to the City Medicine
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Emergency Department
Lead sponsor: Centre Hospitalier de Saint-Denis
Sponsor class: OTHER
First posted: 2022-05-26
Enrollment: 368
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: patients over 18 years of age sorted 4 and 5 at the IAO present during the survey, at the hours of working days and the permanence of ambulatory care

Brief summary: The increase in emergency room visits is partly related to the growing increase in unscheduled care, paradoxically associated with a decrease in the outpatient supply in the city. The "avoidable" passing rate is estimated at 43% in the last major DREES survey on hospital emergencies. Emergency services have been facing this challenge for years, but there is an urgent need to rethink its organizational model with the liberal system to meet this growing demand. Reorientation from the reception of emergencies is one of the avenues envisaged to face this challenge. It offers a different course from that of emergencies, provided that there are care structures equipped and adapted to unscheduled care. The Hospital in Saint-Denis is particularly faced with these challenges given a particular social ecosystem.

Methodology :

This single-center prospective observational study includes all adult patients sorted 4 and 5 by the reception organizing nurse, present during the survey.

The reorientation is one of the solutions proposed in the context of reorganizing access to care throughout the territory, appearing as one of the major public health issues in the coming years, it is appropriate to ask the question on a local scale. particularly exposed to the problem of unscheduled care, if patients are eligible for reorientation The non-medical factors identified as limiting the reorientation are: the absence of social cover, the language barrier, the patients referred by the samu or the fire brigade or a doctor, the patients who came by ambulance (because considered in theory as in the impossibility to move or having already been the subject of a "regulation")

Each 4 or 5 redirected patient is included and completes a questionnaire allowing the collection of information relating to their care pathways.

Primary endpoint :

Determine the proportion of patients not eligible for reorientation on non-medical criteria via a questionnaire, and identify the distribution of factors complicating reorientation

Secondary endpoints :

Identify the needs of patients re-orientated towards city medicine via the analysis of their passage to the emergency room, the reasons for their recourse to the emergency room (reasons, means and modes of arrival) their knowledge of the health system, and their relationship to general medicine


Eligibility criteria: Inclusion Criteria:

* patients tripped 4 and 5 at the IOA
* patients aged 18 years or older
* patients presenting to the emergency room every day of the week during the day and in the evening

Exclusion Criteria:

* patients triaged 1, 2, 3 at the IOA
* consulting patients for reasons requiring psychiatric advice
* unaccompanied minor patients
* patients brought by the police
* refusal or impossibility to participate
* protected adult patients

Primary outcomes:
measure: socio-demographic characteristics
timeFrame: Day 1
measure: reason for consultation
timeFrame: Day 1
Secondary outcomes:
measure: care pathway
timeFrame: Day 1
Other outcomes:
Locations:
city: Saint-Denis
country: France
facility: Hôpital DELAFONTAINE
state: Ile de France
Study officials:
affiliation: Centre Hospitalier de Saint-Denis
name: Aurélie GIRARD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ. 2011 Jun 1;342:d2983. doi: 10.1136/bmj.d2983.
citation: Marchetti M, Lepape M, Lauque D. La réorientation à l'accueil des services d'urgences : évaluation des pratiques professionnelles françaises. Ann Fr Médecine Urgence. 2014;4:349-353. doi:10.1007/s13341-014-0411-9
citation: Gilbert A, Brasseur E, Ghuysen A, D'Orio V. [New method to regulate unscheduled urgent care : the ODISSEE interactive self-triage platform]. Rev Med Liege. 2020 Mar;75(3):159-163. French.