Reorientation of Tripped Patients 4 and 5 in Emergency Department

Reorientation of Tripped Patients 4 and 5 in Emergency Department to the City Medicine

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

Study Overview

• Status: Completed
• Conditions: Emergency Department

• Study Type: Observational
• Enrollment (Actual): 368

Contacts and Locations

Study Locations

• France
  • Ile de France
    • Saint-Denis, Ile de France, France, 93200
      • Hopital DELAFONTAINE

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• 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

Description

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

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
socio-demographic characteristics	medical history, social security coverage, french language	Day 1
reason for consultation	emergency assessment	Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
care pathway	time spent in the emergency room, additional examinations, diagnosic, becoming	Day 1

Collaborators and Investigators

• Sponsor: Centre Hospitalier de Saint-Denis
• Investigators: Principal Investigator: Aurélie GIRARD, Centre Hospitalier de Saint-Denis

Publications and helpful links

General Publications

• 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.
• 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
• 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.

Helpful Links

• healthcare facilities 2020
• triage in emergency structure
• ensuring first access to care
• National Survey of Hospital Emergency Structures, June 2013
• survey and results DREES 2013
• Information report by Mr. Philippe Boënnec tabled by the Delegation of the National Assembly for the Planning and Sustainable Development of the Territory on the permanence of care
• health professionals as of January 1, 2018

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2022
• Primary Completion (Actual): June 30, 2022
• Study Completion (Actual): August 15, 2022

Study Registration Dates

• First Submitted: May 20, 2022
• First Submitted That Met QC Criteria: May 25, 2022
• First Posted (Actual): May 26, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 21, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: CHSD_0016_URGENCES; 2021-A01989-32 (Other Identifier: IDRCB)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No