Visite de services d’urgences en Californie. Rapport d’un groupe d’urgentistes français

Abstract

Improving the quality of care in Emergency Departments (ED) is a priority. Benchmarking and qualitative methods have been applied as health quality improvement tools. Our goal is to describe the application of these methods. University EDs located in California were visited. Semi-structured questionnaires were used for interviews with ED managers and staff members, on the organizational aspects, including triage and care pathways; human resources; equipment; quality and performance indicators; transverse links between ED and hospital wards; bed management; and patients-centered care. District health officials were also interviewed. Three adult and two pediatric EDs were visited; 56 ED leaders and staff members were interviewed. We have identified many innovative organizational and management aspects such as the role of nurse-practitioners, the importance of fast-track in the organization of ED, and the critical care area project. The architecture, organization, and care projects are at the service of the ED quality project. Security has emerged as a priority in reducing waiting times. Bed management and ED–hospital culture reflect a growing priority and provided the through-ED pathway. Visit to the EDs abroad as a part of structured visits by managerial and scientific methods allows us to find new quality development paths of care and to improve the working conditions of our ED teams.