, Hospitalisation par admission directe : définition et contexte

, Bénéfices et risques liés à une admission directe

, Pneumopathie aigüe communautaire et hospitalisation par admission directe

.. .. Objectifs-de-l'étude,

J. K. Leyenaar, M. Shieh, T. Lagu, P. S. Pekow, and P. K. Lindenauer, Direct Admission to Hospitals Among Children in the United States, JAMA Pediatr, vol.169, issue.5, pp.500-502, 2015.

. Circulaire-n°dhos/o2/, /117 du 28 mars 2007, relative à la filière de soins gériatriques, 2007.

A. Toledano, Relations médecins généralistes -hôpital : évaluation à un an d'une filière d'admission directe dans un service de Médecine Interne au CHU de Toulouse, p.1025, 2017.

, Direction de la Recherche, des Etudes, de l'Evaluation et des statistiques

S. Statistique-annuelle-des-Établissements-de,

. Disponible-À-l'url,

, Rapport public annuel 2019 Tome II -Les urgences hospitalières

. Disponible-À-l'url,

C. Giroux, E. Proye, F. Hequet, P. Dufour, G. Gommez et al., Admission de la personne âgée en court séjour gériatrique : entrées directes versus entrées via le service des urgences, J Eur Urgences, vol.21, issue.S1, p.151, 2008.

J. Dijon, M. Sarazin, A. V. Franck, T. Gonthier, R. Célarier et al., Comparaison de deux modes d'hospitalisation en gériatrie : directement grâce à une ligne téléphonique ou après un passage aux urgences, Geriatr Psychol Neuropsychiatr Vieil, vol.16, issue.3, pp.255-62, 2018.

A. Neouze, A. Dechartres, S. Legrain, A. Raynaud-simon, M. Gaubert-dahan et al.,

, Geriatr Psychol Neuropsychiatr Vieil, Juin, vol.10, issue.2, pp.143-50, 2012.

S. Mazière, I. Lanièce, N. Hadri, C. Bioteau, C. Millet et al., Facteurs prédictifs du déclin fonctionnel de la personne âgée après une hospitalisation en court séjour gériatrique : importance de l'évolution fonctionnelle récente, Presse Med, 2011.

, Fév, vol.40, issue.2, pp.101-111

N. Ekerstad, G. Östberg, M. Johansson, and B. W. Karlson, Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care? Patient Prefer Adherence, vol.12, pp.233-273, 2018.

K. E. Kocher, J. B. Dimick, and B. K. Nallamothu, Changes in the Source of Unscheduled Hospitalizations in the United States, Med Care, vol.51, issue.8, pp.689-98, 2013.

E. Aizen, R. Swartzman, and A. M. Clarfield, Hospitalization of nursing home residents in an acute-care geriatric department: direct versus emergency room admission, Isr Med Assoc J, vol.3, issue.10, pp.734-742, 2001.

E. S. Powell, R. K. Khare, D. M. Courtney, and J. Feinglass, Lower mortality in sepsis patients admitted through the ED vs direct admission, Am J Emerg Med, vol.30, issue.3, pp.432-441, 2012.

B. Snijders, W. Van-der-ohek, I. Stirbu, M. A. Van-der-sande, and A. B. Van-gageldonk-lafeber, General practitioners' contribution to the management of community-acquired pneumonia in the Netherlands: a retrospective analysis of primary care, hospital, and national mortality databases with individual data linkage, Prim Care Respir J, vol.22, issue.4, pp.400-405, 2013.

H. Laurichesse, L. Gerbaud, O. Baud, F. Gourdon, and J. Beytout, Hospitalization Decision for Ambulatory Patients with Community-Acquired Pneumonia: A Prospective Study with General Practitioners in France, Infection, vol.29, issue.6, pp.320-325, 2001.

, Agence Française de Sécurité Sanitaire des Produits de Santé

, Antibiothérapie par voie générale dans les infections respiratoires basses de l'adulte. Antibiothérapie par voie générale dans les infections respiratoires basses de l'adultes

. Disponible-À-l'url,

T. Bauer, S. Ewis, R. Marre, N. Suttorp, and T. Welte, CRB-65 predicts death from communityacquired pneumonia, J Intern Med, vol.260, issue.1, pp.93-101, 2006.

, Direction de la Recherche, des Etudes, de l'Evaluation et des statistiques

, Les établissements de santé, 2019.

. Disponible-À-l'url,

G. Gavazzi and K. Krause, Ageing and infection, Lancet Infect Dis, vol.2, issue.11, pp.659-66, 2002.

N. R. Hoot and D. Aronsky, Systematic review of emergency department crowding: causes, effects, and solutions, Ann Emerg Med, vol.52, issue.2, pp.126-162, 2008.

R. Sikka, S. Mehta, C. Kaucky, and E. B. Kulstad, ED crowding is associated with an increased time to pneumonia treatment, Am J Emerg Med, vol.28, issue.7, pp.809-821, 2010.

S. Jo, K. Kim, J. H. Lee, J. E. Rhee, Y. J. Kim et al., Emergency department crowding is associated with 28-day mortality in community-acquired pneumonia patients, J Infect, vol.64, issue.3, pp.268-75, 2012.

C. Rodrigo, T. M. Mckeever, M. Woodhead, S. Welham, and W. S. Lim, Admission via the emergency department in relation to mortality of adults hospitalised with communityacquired pneumonia: an analysis of the British Thoracic Society national communityacquired pneumonia audit, Emerg Med J, vol.32, issue.1, pp.55-64, 2015.

J. K. Leyenaar, M. Shieh, T. Lagu, P. S. Pekow, and P. K. Lindenauer, Variation and Outcomes Associated with Direct Hospital Admission Among Children with Pneumonia in the United States, JAMA Pediatr, vol.168, issue.9, pp.829-865, 2014.

M. Woodhead, F. Blasi, S. Ewig, J. Garau, G. Huchon et al., Guidelines for the management of adult lower respiratory tract infections, Clin Microbiol Infect, 2011.

M. E. Charlson, P. Pompei, K. L. Ales, and C. R. Mackenzie, A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation, J Chronic Dis, vol.40, issue.5, pp.373-83, 1987.

M. Charlson, T. P. Szatrowski, J. Peterson, and J. Gold, Validation of a combined comorbidity index, J Clin Epidemiol, vol.47, issue.11, pp.1245-51, 1994.

H. Autorité-de-santé,

, Stratégie de prise en charge en cas de dénutrition protéino-énergétique chez la personne âgée, 2007.

. Disponible-À-l'url,

. Institut-pierre-louis-d'epidémiologie and . De-santé-publique, BiostaTGV Calcul du nombre de sujets nécessaires

. Disponible-À-l'url,

L. Grammatico-guillon, N. Thiercelin, S. Mariani, A. Lecuyer, A. Goudeau et al., Étude des séjours pour pneumopathie à Streptococcus pneumoniae entre 2004 et 2008 en région Centre. Rev Epidemiol Sante Publique, Fév, vol.60, issue.1, pp.1-8, 2012.

M. Cabre, I. Bolivar, G. Pera, and R. Pallares, Factors influencing length of hospital stay in community-acquired pneumonia: a study in 27 community hospitals, Epidemiol Infect, vol.132, issue.5, pp.821-830, 2004.

I. Suter-widmer, M. Christ-crain, W. Zimmerli, W. Albrich, and B. Mueller, Predictors for length of hospital stay in patients with community-acquired Pneumonia: Results from a Swiss Multicenter study, BMC Pulm Med, vol.12, issue.1, p.21, 2012.

M. J. Fine, M. A. Smith, C. A. Carson, S. S. Mutha, S. S. Sankey et al., Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis, JAMA, vol.275, issue.2, pp.134-175, 1996.

H. Laurichesse, A. Sotto, E. Bonnet, B. Abraham, D. Neau et al., Pre-and In-Hospital Management of Community-Acquired Pneumonia in Southern France, pp.1998-99

, Eur J Clin Microbiol Infect Dis, vol.20, issue.11, pp.770-778, 2001.

R. J. Stratton, C. L. King, M. A. Stroud, A. A. Jackson, and M. Elia, Malnutrition Universal Screening Tool" predicts mortality and length of hospital stay in acutely ill elderly, Br J Nutr, vol.95, issue.2, pp.325-355, 2006.

M. Falcone, A. Russo, F. G. Silverj, D. Marzorati, R. Bagarolo et al., Predictors of mortality in nursing-home residents with pneumonia: a multicentre study, Clin Microbiol Infect, vol.24, issue.1, pp.72-79, 2018.

G. Sanson, M. Sadiraj, I. Barbin, C. Confezione, D. Matteis et al., Prediction of early-and long-term mortality in adult patients acutely admitted to internal medicine: NRS-2002 and beyond, Clin Nutr, 2019.

S. Ewig, N. Birkner, R. Strauss, E. Schaefer, J. Pauletzki et al., New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality, Thorax, vol.64, issue.12, pp.1062-1071, 2009.

F. Gutiérrez, M. Masiá, C. Mirete, B. Soldán, C. Rodríguez et al., The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens, J Infect, vol.53, issue.3, pp.166-74, 2006.

T. Welte, A. Torres, and D. Nathwani, Clinical and economic burden of community-acquired pneumonia among adults in Europe, Thorax, vol.67, issue.1, pp.71-80, 2012.

A. C. Kalil, M. L. Metersky, M. Klompas, J. Muscedere, D. A. Sweeney et al., Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the

, Clin Infect Dis, vol.63, issue.5, pp.61-111, 2016.

W. S. Lim and J. T. Macfarlane, A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia, Eur Respir J, vol.18, issue.2, pp.362-370, 2001.

R. Cabrera, Q. Shakeel, A. Uduman, L. Watanabe, A. Vahia et al., Evaluation of Charlson Comorbidity Index as a Predictor of Adverse Outcomes in Patients Admitted with Community-Acquired Pneumonia. Abstract published at Hospital Medicine, Journal of Hospital Medicine, vol.8, issue.2, 2013.

J. De-miguel-díez, R. Jiménez-garcía, and V. Hernández-barrera,

J. M. Miguel-yanes and M. Méndez-bailón, Trends in hospitalizations for communityacquired pneumonia in Spain: 2004 to 2013, Eur J Intern Med, vol.40, pp.64-71, 2017.

T. Wesemann, H. Nüllmann, M. A. Pflug, H. J. Heppner, L. Pientka et al., Pneumonia severity, comorbidity and 1-year mortality in predominantly older adults with communityacquired pneumonia: a cohort study, BMC Infect Dis, vol.15, issue.2, 2015.

A. Natalwala, R. Potluri, H. Uppal, and R. Heun, Reasons for Hospital Admissions in Dementia Patients, Dement Geriatr Cogn Disord, vol.26, issue.6, pp.499-505, 2002.

A. Porath, F. Schlaeffer, and D. Lieberman, Appropriateness of Hospitalization of Patients with Community-Acquired Pneumonia, Ann Emerg Med, vol.27, issue.2, pp.176-83, 1996.

M. Bartolome, J. Almirall, J. Morera, G. Pera, V. Ortun et al., A population-based study of the costs of care for community-acquired pneumonia, Eur Respir J, vol.23, issue.4, pp.610-616, 2004.

I. Scott, L. Vaughan, and D. Bell, Effectiveness of acute medical units in hospitals: a systematic review, Int J Qual Health Care, vol.21, issue.6, pp.397-407, 2009.

M. Pouméroulie, Hospitalisations programmées au Centre Hospitalier Sud Gironde : état des lieux, vol.12, 2019.

H. Autorité-de-santé, Niveau de preuve et gradation des recommandations de bonne pratique, 2013.

. Disponible-À-l'url,

J. P. Metlay, Influence of Age on Symptoms at Presentation in Patients with Community-Acquired Pneumonia, Arch Intern Med, vol.157, issue.13, p.1453, 1997.

T. P. Meehan, Quality of Care, Process, and Outcomes in Elderly Patients with Pneumonia

, JAMA, vol.278, issue.23, pp.2080-2084, 1997.

N. Kulkarni and M. Williams, Patient Safety Network. Is It Safe to Be Direct?, 2008.

. Disponible-À-l'url,

B. M. Singal, J. R. Hedges, E. W. Rousseau, A. B. Sanders, E. Berstein et al., Geriatric patient emergency visits part I: Comparison of visits by geriatric and younger patients, Ann Emerg Med, vol.21, issue.7, pp.802-809, 1992.

F. Aminzadeh and W. B. Dalziel, Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions, Ann Emerg Med, vol.39, issue.3, pp.238-285, 2002.

S. C. Bergeson and J. D. Dean, A Systems Approach to Patient-Centered Care, JAMA, vol.296, issue.23, pp.2848-51, 2006.

M. Andronikof and A. Thalmann, Programmation d'une hospitalisation sur appel d'un médecin généraliste, Presse Med, vol.34, issue.12, pp.847-50, 2005.

N. Goolsarran, L. Huang, and L. Ottaviano, Improving transitions of care: a resident-driven approach to address delays in patient care during the direct admission process, BMJ Open Qual, vol.6, issue.2, p.182, 2017.

J. K. Leyenaar, M. Shevenell, P. A. Rizzo, V. L. Hill, and P. K. Lindenauer, Multi-Stakeholder Informed Guidelines for Direct Admission of Children to Hospital, J Pediatr, 2018.

, Au moment d'être admis à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité

, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux, individuels et sociaux

, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte

, J'informerai les patients des décisions envisagées, de leurs raisons et de leurs

, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité

, Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses : que je sois déshonoré et méprisé si j'y manque