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Master Thesis

Évaluation de la pertinence des hospitalisations aux urgences du centre hospitalier de Chambéry

Abstract : Nowadays, we observe a constant increase of the attendance and of the number of unplanned hospitalizations at hospital emergency departments, and a constant lack of inpatient beds. The management of hospital beds has become a priority for emergency physicians. Assessing the appropriateness of hospital admissions in emergency departments is necessary to ensure the quality of care. Objectives: The aims of this study were to evaluate the rate of appropriateness of hospital admissions in the emergency department of the hospital center of Chambery, and to identify the causes of unjustified hospitalizations. This work should enable the establishment an action plan to reduce the number of inappropriate hospitalization in this department. Methods: To determine the appropriateness of hospital admissions, a retrospective analysis was performed using the French version of the Appropriateness Evaluation Protocol (AEP). The survey refers to the week of June 27 to July 3, 2011. Data needed for the AEP was extracted from the medical records of each patient. Results: A total of 213 patients were hospitalized via the emergency department over this period. Inappropriate admissions accounted for 24% of all hospitalizations, including 17.5% of justified hospitalizations and 6.5% of unjustified hospitalizations. The most frequent causes of inappropriateness were: the waiting period before a diagnostic test, the waiting period before a specialized diagnostic opinion, the need for clinical surveillance, and the need for psychological support. The highest percentage of inappropriateness was found for females. Among the inappropriate and unjustified hospitalizations, 45% were due to organization care (mostly waiting period before a medical opinion), 44% were due to the patient or his family (the patient's explicit request, late arrival), and 11% were due to an explicit request of the general practitioner. Conclusion: The emergency department of Chambery's hospital has a rate of inappropriate hospital admissions comparable to those observed in France and abroad (5 to 31% according to previous studies). An action plan could reduce this rate, but it remains difficult to impact on the hospitalizations due to the patient or his family, or due to an explicit request of the general practitioner. To be effective and durable, such an action plan represents a significant financial cost and the benefit in the quality of cares remains to be shown.
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Master Thesis
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Submitted on : Friday, August 17, 2012 - 3:23:02 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:16 AM
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  • HAL Id : dumas-00724111, version 1

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Diane Fournier. Évaluation de la pertinence des hospitalisations aux urgences du centre hospitalier de Chambéry. Médecine humaine et pathologie. 2012. ⟨dumas-00724111⟩

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