ABSTRACT
L'évolution actuelle de la demande de soins non programmés porte autant sur une augmentation de volume que sur sa nature. Les missions assurées par les structures d'urgence se sont décentrées vers la prise en charge des complications des pathologies chroniques et des problématiques médicosociales. Une démarche collaborative entre la médecine de ville et l'aide médicale urgente (AMU) a été initiée depuis deux ans dans les Yvelines, entre le Samu 78, l'hôpital de Versailles, le Conseil de l'ordre des médecins 78 et l'Association Plateforme territoriale d'appui 78. Ses objectifs visent, par un travail de coordination multidisciplinaire, à éviter les ruptures de parcours des patients complexes, à favoriser le maintien à domicile et à réorienter les patients vers la ville après un recours à l'hôpital. La crise sanitaire liée au Covid-19 a permis d'accélérer le processus de collaboration ville– AMU avec des objectifs propres à cette crise, notamment grâce à des outils numériques dédiés. Les principaux axes de travail ont été de répondre à l'urgence de la crise sanitaire en organisant une offre de soins sécurisée, d'organiser les parcours des patients fragiles pendant le confinement puis de préparer et d'accompagner le déconfinement grâce à une cellule d'appui et de suivi des cas positifs et de leurs contacts. Les difficultés organisationnelles ou liées à l'acceptabilité de ces nouveaux outils de surveillance et de coordination ont trouvé leurs solutions grâce à un environnement institutionnel favorable et l'implication de leaders intéressés par la conduite de projets innovants. Cette expérience peut préfigurer le futur service d'accès aux soins (SAS).Alternate abstract: The type and amount of the current demand for unplanned healthcare is evolving. Tasks of emergency services moved towards chronic diseases complications, and towards the increasing amount of medico-social issues. For two years, a collaborative approach between community medicine and emergency medical communication center in the Yvelines (78) has been undertaken. The stakeholders are the Samu 78, the Versailles Hospital, the Yvelines Medical Board and the territorial coordination association. This approach aims at preventing inappropriate hospitalization, promoting home care, and redirecting patients to community medicine after a hospital stay, thanks to multidisciplinary coordination teamwork. The health crisis due to COVID- 19 boosted and strengthened community medicine—emergency medical communication center cooperation with specific goals, with the help of dedicated digital tools (among other things). The leading workstreams were to handle the health crisis urgency through the set-up of secured health care provision over the Yvelines area, to manage the course of the precarious patients during the lockdown period and finally to support the lifting of the lockdown with a dedicated backup team, and the follow-up of COVID-19 patients and their close relatives. Solutions to the organizational issues and issues related to the acceptance of the new monitoring and coordination digital tools were found, thanks to a supportive institutional environment, and to the committed leaders interested in the innovative projects. This collaboration should be a model for the new access to healthcare system.
ABSTRACT
To meet the care needs of "Covid long" patients, caregivers in the field, under the aegis of regional health agencies, have deployed multi-professional city-hospital collaborations to inform patients and their families and organize adapted care pathways. The clinical situation shared in this article illustrates the commitment of caregivers in the Occitanie region.
Subject(s)
COVID-19 , Humans , Critical Pathways , Caregivers , PatientsABSTRACT
PURPOSE: The coronavirus disease 2019 (COVID-19) epidemic continues to spread exponentially around the world. Cancer patients have a higher risk of commorbidity than the rest of the population. Radiotherapy departments are actively involved in the management of these patients, whether they have COVID or not, and it is recognized that the time taken to take charge and the continuity of treatment have a prognostic impact. The main objective was to assess the impact of the coronavirus on the treatment times of patients undergoing radiotherapy. MATERIAL AND METHODS: This retrospective study was conducted in the radiotherapy department of Gustave-Roussy institute (France) during the period from March 3, 2020 to January 12, 2021. Organizational changes, patient care times between the day of the scan and the last radiotherapy session as well as the time taken to take charge of patients between the first session and the last radiotherapy session has been studied. RESULTS: A total of 1183 patients were included, among which 60 had COVID-19. Patients were divided into four categories. Treatment times of patients who did not have COVID-19 and those of patients who did were not statistically significantly different. CONCLUSION: The organization of the radiotherapy department at the Gustave-Roussy institute is based on several points: carrying out preventive screening tests, protecting staff and patients and reorganizing the patient circuit. Thanks to the performance of diagnostic tests and the implementation of a specific workflow for patients with COVID, we ensure the continuity of patient treatment in complete safety without impacting treatment times.