Temps et satisfaction aux urgences

Peu d études traitent spécifiquement du temps d attente aux urgences. L objectif principal de l'étude a consisté en l'évaluation de la satisfaction du délai de prise en charge médicale.Patients et Méthodes293 patients des Urgences du CHU d Angers ont été inclus du 18 au 24 novembre 2013 après avoir répondu à un premier questionnaire avant de voir un médecin. Un deuxième questionnaire était complété par téléphone à J+7 de la sortie des urgences par le même Interne. 181 patients ont répondu au deuxième questionnaire. Le critère de jugement principal a été évalué sur la notation (de 0 à 10) de la satisfaction concernant le délai de prise en charge médicale.Résultats Les satisfactions moyennes concernant le délai de prise en charge médicale et la durée de prise en charge sont respectivement de 6,77 et 6,08/10. Les délais de prise en charge moyens envisagé, acceptable, réel et ressenti étaient respectivement de 63, 62, 74 et 86 minutes. 67 % des patients auraient mieux vécu leur attente si on leur avait annoncé le délai prévisionnel de prise en charge médicale dès l arrivée aux Urgences. Seulement 10 % des patients interrogés ont correctement estimé leurs délais de prise en charge médicale. Les examens biologiques, la réalisation de scanner ou la demande d'avis spécialisés allongent la durée de prise en charge de manière significative. Conclusion L obtention de l information concernant le délai de prise en charge médicale prévisionnel après évaluation par l infirmière d'accueil pourrait être un moyen d'améliorer la satisfaction des patients consultant aux urgences.Only few studies deal specifically with waiting time in emergencies departments. The main objective of the study consisted in evaluating the physician waiting time satisfaction. Patients and Methods We conducted this study from November 18th to 24th at Angers university hospital center. 293 Emergency department patients were included. They answered a first questionnaire from an Intern before seeing a doctor. The second questionnaire was completed by the same Intern on the phone seven days after the patient went out from the Emergency department. 181 patients answered the second questionnaire. The main assessment criterion was the rating (from 0 to 10) of the physician waiting time satisfaction Results The average satisfactions concerning the physician waiting time and total waiting time are respectively 6,77 and 6,08/10. The average physician waiting time imagined, acceptable, real and felt were respectively 63, 62, 74 and 86 minutes. Were they announced the projected waiting time at the moment of admission, 67 % of the patients would have had a better experience of their hospitalization. Only 10 % of the patients estimated correctly their physician waiting time. The biological examinations, the realization of scanner or the specialized requests lengthen significantly the duration of Emergency total waiting time. ConclusionThe obtaining of the information concerning the physician waiting time after evaluation by the nurse could be a way to improve patient satisfaction.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Vers une prescription "réfléchie" du bilan d'hémostase aux urgences

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Validation d'une formation à la technique du flash-écho deux points dans les suspicions d'événement thrombo-embolique (expérience du CHU de Caen)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Réflexions sur les sorties prématurées et refus de soins à partir d'un travail observationnel au sein d'un service d'urgence. Proposition d'un état des lieux, d'une caractérisation des acteurs et discussion sur une démarche de sensibilisation à la prise en charge de ces patients.

ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Prise en charge diagnostique de la maladie thromboembolique aux urgences (revue de la littérature, état des lieux au CHU de Caen, validation d'une formation des urgentistes à un flash écho deux points et perspectives)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial

BACKGROUND: Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines. OBJECTIVE: To assess the effectiveness of a handheld clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department. Design: Cluster randomized trial. Assignment was by random-number table, providers were not blinded, and outcome assessment was automated. (ClinicalTrials.gov registration number: NCT00188032). SETTING: 20 emergency departments in France. PATIENTS: 1103 and 1768 consecutive outpatients with suspected pulmonary embolism. Intervention: After a preintervention period involving 20 centers and 1103 patients, in which providers grew accustomed to inputting clinical data into handheld devices and investigators assessed baseline testing, emergency departments were randomly assigned to activation of a decision-support system on the devices (10 centers, 753 patients) or posters and pocket cards that showed validated diagnostic strategies (10 centers, 1015 patients). MEASUREMENTS: Appropriateness of diagnostic work-up, defined as any sequence of tests that yielded a posttest probability less than 5% or greater than 85% (primary outcome) or as strict adherence to guideline recommendations (secondary outcome); number of tests per patient (secondary outcome). RESULTS: The proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the preintervention period in both groups, but the increase was greater in the computer-based guidelines group (adjusted mean difference in increase, 19.3 percentage points favoring computer-based guidelines [95% CI, 2.9 to 35.6 percentage points]; P = 0.023). Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines group (mean tests per patient, 1.76 [SD, 0.98] vs. 2.25 [SD, 1.04]; P < 0.001). LIMITATION: The study was not designed to show a difference in the clinical outcomes of patients during follow-up. CONCLUSION: A handheld decision-support system improved diagnostic decision making for patients with suspected pulmonary embolism in the emergency department