[Maternal mortality and health care organization in France 2016-2018]

Organization of care is one of the elements examined when assessing cases. Organization of care is a factor, which is considered in addition to the content of care when assessing mortality cases. The factors related to the organization of care concern the suitability of the place of care, the completion of a necessary transfer, the adequacy of human and material resources, and the communication between caregivers. For the 2016-2018 triennium these preventability factors are the subject of a dedicated chapter. Overall, one or more preventability factors linked to the organization of care were reported in 51 cases, i.e. 24% of all assessed cases. The field of communication was the most frequently reported (32/51), followed by inappropriate place of care (20/51), insufficient human resources (13/51), transfers not performed or performed late (11/51) and insufficient material resources (9/51). An overall analysis can be made along two dimensions: organization within the maternity unit, and coordination with other sectors or outpatient medicine. Areas for improvement within the maternity unit relate to the ability to deal with life-threatening emergencies, to organize the call for specialized and/or trained human reinforcements, to organize intensive monitoring of patients in the event of organ failure, and to facilitate good communication between caregivers. Regarding coordination with other units, it is proposed to improve collaboration between the maternity unit's emergency department and the general emergency department, and to improve the transfer of information required by all those involved, including primary care physicians, in the pre-, per- and postpartum period. Finally, the place of care for patients presenting with a psychiatric and somatic pathology is a situation that requires careful consultation.

Organization of French outpatient psychiatric clinics and delay to appointment

OBJECTIVES

The goals of the study were to obtain a glimpse of the several types of organization of outpatient psychiatric clinics, as well as an overview of delays between a request for and the first appointment. We also look at geographical variability of appointment scheduling delays and assess the impact of the number of new applications on delays.

METHODS

We analyzed information collected from a phone survey conducted with the 103 adult outpatient psychiatric clinics of the French region Hauts-de-France. This survey had a one-week inclusion period in November 2022 and focused on the organization and delays before obtaining an appointment.

RESULTS

This study indicates that organizations seem to be homogeneous. Eighty-one outpatient psychiatric clinics (96.4%) receive with scheduled appointments. The initial evaluation by a nurse followed with a proposal for the organization of care seems to be the common practice. It also appears that primary psychiatric structures were capable of providing a response within a reasonable time frame in making a first appointment with a mental health professional. On the other hand, delays were much longer and heterogeneous for first appointments with psychiatrists and psychologists.

CONCLUSIONS

The organizations of the outpatient psychiatric clinics of the French region Hauts-de-France seem homogeneous. The evaluation by a nurse followed with a care proposal is the common practice. Primary psychiatric structures are able to provide a response within a reasonable time, with half the centers proposing an appointment with a nurse within 10.0 days.

[Follow-up strategies for lung transplant recipients in France]

BACKGROUND

Lung transplantation (LT) requires sustained care for a frequently polypathological condition. Follow-up is focused on three main issues: 1/stability of respiratory function; 2/comorbidity management; 3/preventive medicine. About 3000 LT patients in France are treated in 11 LT centers. Given the increased size of the LT recipient cohort, follow-up might be partially shared with peripheral centers.

METHODS

This paper presents the suggestions of a working group of the SPLF (French-speaking respiratory medicine society) on possible modalities of shared follow-up.

RESULTS

While the main LT center is tasked with centralizing follow-up, particularly the choice of optimal immunosuppression, an identified peripheral center (PC) may serve as an alternative to deal with acute events, comorbidities and routine assessment. Communication between the different centers should be free-flowing. Shared follow-up may be offered from the 3rd postoperative year to stable and consenting patients, whereas unstable and non-observant patients are poor candidates.

CONCLUSION

These guidelines may serve as a reference for any pneumologist wishing to effectively contribute to follow-up, even and especially subsequent to lung transplant.

[Recommendations and management in Home Blood Transfusion: Levers, brakes and prospects]

In our roles as regional coordinator for haemovigilance and transfusion safety (RCHTS - CRHST), Correspondant for haemovigilance in a medical and surgical obstetrics/hospital home care centre (MSO/HHCC-MCO/HAD) and a doctor responsible for haemovigilance in HHC, we shared our interdisciplinary viewpoints and compared our practices in an attempt to gain a better understanding of the factors that hinder and facilitate the development of blood transfusion in HHC. Despite the revaluation of tariffs for blood transfusion in HHC (effective since March 2018), and the widespread circulation of recommendations for good practice in the transfusion of packed red blood cells in HHC (April 2018), this sector is still struggling to develop. On completing our analysis, we were able to demonstrate that while our institutional and regional work continues to be essential, the power to move things forward now lies in the hands of a national authority. In our opinion, using this power would give strong, national recognition of the vital role which HHC played at a nationwide level throughout the recent health crisis.

[COVID-19 and patients with cancer: Experiment of a French comprehensive cancer center]

The emergence of the Coronavirus Disease 2019 (COVID-19) has caused profound upset in health systems around the world. As cancer patients seem to be at greater risk, the organization of oncological care had to be adapted. We first report the progress of the "first wave" of COVID-19 at the Institut Curie, a French comprehensive cancer center, by describing the measures implemented to limit the risk of transmission of COVID-19 while ensuring as much as possible the continuation of anticancer treatments. Then, we present the results of a prospective institutional database in which the characteristics and outcome of our patients with cancer and suffering from COVID-19 were collected. From March 13 to April 25, 2020, 141 patients followed at Institut Curie for cancer developed COVID-19, of which 26 (18%) died from it. The minimum incidence of COVID-19 in Institut Curie is estimated at 1.4% over this period. No risk factors for developing a severe form of COVID-19 related to cancer have been identified. Cancer patients do not appear to be at greater risk of developing COVID-19, nor of having a more severe form than the general population. With the current increase of COVID-19 cases, it seems essential to share the experience already acquired to minimize the impact of this crisis on the long-term outcome of patients followed for cancer.

[Responsiveness and sustainability of psychiatric care in France during COVID-19 epidemic]

OBJECTIVES

The sudden changes of healthcare system due to COVID-19 particularly affect the organization of psychiatry. The objective of this review is to examine the adaptations of psychiatric care in France during this pandemic.

METHOD

This narrative review is based on the observation of changes made in French psychiatric hospitals and on an analysis of the literature.

RESULTS

Regarding psychiatric hospitalization, the COVID-19 epidemic required rapid measures that profoundly modified the conditions of patients' reception, forcing the medical staffs to adapt their methods of care. The authors noted the creation of at least 89 wards specifically dedicated to patients with COVID-19 needing psychiatric hospitalization, allowing dual care of general medicine and psychiatry. Regarding ambulatory care, maintaining patients with long-term follow-up was a priority. Patients recalling and teleconsultation have been precious resources but cannot entirely replace face-to-face consultations.

DISCUSSION

COVID-19 epidemic created unprecedented situation of large-scale upheavals in the healthcare system and in society. Despite the absence of previous recommendations on the subject, French psychiatry has shown great adaptability. Some changes could inspire post-COVID-19 care.

[Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]

OBJECTIVE

To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology.

MATERIALS AND METHODS

Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO).

RESULTS

Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%.

CONCLUSION

These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.

[Care pathway diversity of patients with multiple sclerosis between French regions]

BACKGROUND

The aim of this study is to analyze and to compare data from 2015, focusing on hospital care for patients with multiple sclerosis from three French regions with different characteristics in terms of prevalence, size and number of multiple sclerosis competencies and resource centers.

METHODS

All hospital admissions from the PMSI MCO 2015 database, with a principal or related diagnosis (PD-RD) of G35* ("multiple sclerosis") were extracted. We also extracted chemotherapy treatments administered in hospital, during admissions with a significant associated diagnosis (SAD) of G35*, if the PD or RD was coded Z512 ("non-tumor chemotherapy"). The analyzed regions corresponded to those of 2015, some of which have since merged.

RESULTS

There were 95,359 hospital admissions for multiple sclerosis in France in 2015 among a total cohort of 21,102 patients, resulting in a total cost of € 54.1m. Patients with MS were managed mainly in the ambulatory setting, which accounted for 88.5 % of all admissions. The Rhône-Alpes region represented 7.6 % of national admissions for MS, 9.6 % of patients, and 14 % of inpatient days, contributing 10.4 % of the national cost of MS care. 58.4 % of stays were managed by the two main multiple sclerosis centers. The Nord-Pas-de-Calais region represented 9.8 % of national admissions, 10 % of patients, 6.6 % of inpatient days, and 9.1 % of the national cost. 29.8 % of stays were managed by the main multiple sclerosis center. The Centre region represented 2.7 % of stays, 2.8 % of patients, 3.1 % of inpatient days, and 2.8 % of the national cost. 28.4 % of stays were managed by the main multiple sclerosis center.

CONCLUSION

This study highlights the diversity of multiple sclerosis hospital management and care between these three regions.

[Home blood transfusion in France: Benefits and development terms]

OBJECTIVES

Patients with cancers or malignant homeopathies can suffer from chronic anemia and be regularly transfused in hospitals. Most of the time, their performance status is low. Few local structures currently provide blood transfusion services and patients have to go under difficult and costing transportation to the hospital. The objective of this work is to evaluate benefits and development terms of home blood transfusion for patients with chronic anemia and having to get transfused regularly.

METHODS

A field investigation-mixing observations and interviews and a literature review were conducted.

RESULTS

Home blood transfusion represented a little part of home health care activity. When it was practiced, its organization was heterogeneous: it was sometimes performed by a doctor, sometimes by a nurse. Home blood transfusion was benefic for patients: it was more comfortable and it allowed them to avoid harmful transportation to the hospital. Few adverse events occurred during various experiments, all were mild. Before its revaluation in March 2018, home blood transfusion was not enough funded by National health insurance. Home blood transfusion also suffered from a lack of framework until the publication of recommendations in April 2018.

CONCLUSIONS

Lack of a framework and sufficient funding prevented home blood transfusion development until changes that occurred in 2018. Therefore, this activity should develop in years to come. Allowing reducing unnecessary hospitalizations, home blood transfusion fit into French health national strategy.

[Human resources allocated to kidney transplantation in 2016 in France: A national survey]

Following the publication of the ministerial action plan setting goals for the next five years, we performed a survey regarding the human resources and work organizations in the French renal transplant centers (n=33) on behalf of French speaking society of nephrology dialysis and transplantation (SFNDT). While the renal transplantation activity has been raising last years, we describe that the most active centers frequently resorted to an on-site nephrology guard and a surgeon dedicated to the transplantation activity, whereas only eight centers have a non restricted access to an operating room. Since 2002, the number of transplantations and follow-up visits performed by one nephrologist (full-time equivalent) have increased by 20 and 11%, respectively, while patient monitoring after transplantation is claimed to be shared with partner health centers in 94% of the transplant centers. Thus, the number of patients per nephrologist has increased when the active list exceeds 1150 patients in a center, e.g., 45% of centers in 2016 and 70% of centers in 2021 if the objectives are achieved. This survey also showed the stagnation of the specialized paramedical staff. Finally, the survey shows that the two main hurdles to the development of living donor transplantation are the availability of operating rooms and the lack of paramedical employees. In conclusion, this survey shows that an increase in the number of medical, surgical and paramedical staff will be necessary to achieve departmental objectives.

["SOS SEIN 84" accelerated breast disease management: Patients satisfaction survey]

In case of a new breast symptom or an abnormal result of breast imaging, some women have a problem finding a quick answer to allay their anxiety. The Institut Sainte-Catherine in Avignon has set up a new form of accelerated disease management through the opening of a new dedicated consultation called SOS SEIN 84. We present the result of a prospective quality study of our first new patients.

[Lung cancer, how to deal with critical situations?]

The management of a patient with cancer, including lung cancer requires the investment of many health caregivers. The development of surgical techniques as well as targeted therapies requires a specialization of each. In order to optimize the actions of each, coordination of support is required from the diagnosis of cancer. This coordination can reduce iatrogenic toxicity and improve quality of life during the disease. It may also enhance quality of accompaniment of the patient, his family and a fortiori the health care team. The development of this coordination of supportive care in oncology, as part of a department of cancerology including care of patients with lung cancer is described. This organization allows to limit the toxicities of cancer treatment, but also to improve the suffering of patients by focusing on maintaining the patient at home.