[Nursing coordination in chronic diseases: The situation of activities in the Assistance Publique-Hôpitaux de Paris adult medicine units]. / Coordination infirmière et maladies chroniques : état des lieux des activités en médecine adulte à l'Assistance Publique-hôpitaux de Paris.

INTRODUCTION: The transformation of nurse's profession can be an opportunity for the organization of personalized care pathways for patients with chronic diseases. OBJECTIVE: Our objective was to identify and describe the activities of the coordinating nurses (IDEC) working with patients with chronic diseases in adult medicine services at the Assistance Publique - Hôpitaux de Paris (AP-HP). METHOD: An e-mail survey of department heads identified the IDEC. Semi-structured interviews were conducted with IDEC and referring physicians in order to know IDEC's activities « in practice ¼. RESULTS: Forty-eight IDEC were identified in 115 adult medicine departments contacted at AP-HP. IDEC mainly engaged in expertise and coordination activities. IDEC help to free up medical time, patients are satisfied to have a dedicated contact to whom to turn in case of problems. DISCUSSION: IDEC are involved in many chronic diseases. Their expertise serves primarily patients but also health professionals who intervene in the course of care. This work will feed reflection on the transformation of nursing professions, especially since the recognition of nursing practice in advanced practice.

[Consultations of hospital physicians in community health centers: Actors' identified impacts and difficulties]. / Consultations avancées de médecins hospitaliers en centres de santé : impacts et difficultés identifiées.

OBJECTIVE: In 2016 different types of cooperation were identified between "Assistance publique - Hôpitaux de Paris" and community-based healthcare professionals, including consultations from hospital practitioners in community health centers. This work aims to study the advantages and difficulties of this type of cooperation. METHODS: Interviews were conducted with hospital physicians, heads of hospital units and of community health centers. Data were collected by physicians for seven consultations. RESULTS: Regarding patients, these consultations gave access to specialists' expertise in deficit areas at no extra cost; the community health center is a more human-size structure and appointments were sometimes more quickly attributed. For physicians, consulting in the community health center afforded a more diversified activity and permitted to discover community practice. For the hospital unit, it could bring new patients and lead some patients living closer to the community health center to delocalize the follow-up consultations. This type of cooperation strengthened the relation between hospital and community-based practitioners but the relations remained informal. Amongst mentionable difficulties: the lack of information systems interoperability, the struggle in raising the interest of some physicians and an increased workload. CONCLUSION: If this type of consultation can be a first step in organizing hospital-community relations, it does not enable by itself a territorial coverage. Partnerships should include several community health centers but also physicians in independent practice. Larger partnerships can integrate the formalization of care pathways refocusing each actor on its field of expertise.

[Cooperation between hospital teams and community-based healthcare professionals]. / Coopération des équipes hospitalières avec les médecins et paramédicaux de ville.

OBJECTIVE: To identify and classify hospital-community cooperation activities between Greater Paris University Hospitals (GPUH) and community health professionals. METHODS: A declarative survey was conducted in GPUH clinical departments, which were asked to describe their activities with community health professionals, the type of community professionals involved (e.g. general practitioners, nurses) and a full description of the activity. Activities were classified by the three authors with consistency checks. RESULTS: 261 activities were reported by 138 departments (39 medical specialties). Paediatrics, psychiatry and geriatrics reported the highest number of activities. 37% of activities covered access to hospital care, 25% concerned training of health professionals, 22% concerned continuity of care after hospitalization, 13% shared follow-up and 3% corresponded to public health interventions in the general population. Access to hospital care included facilitating appointments, access to hospital expertise and specific organizations. Continuity of care included either information transmission or patient referral. Follow-up was shared over specific patients or over a predefined patient population. Training was organized by hospital professionals, community health professionals or as a collaborative initiative. CONCLUSION: The proposed classification can be used for research studies, or to define a strategy for hospitals initiating collaborations with community health professionals. It describes the concept of "hospital-community medical relations" from a pragmatic health professional point of view.

[The National Authority for Health and new cooperation]. / La Haute Autorité de Santé et les nouvelles coopérations.

The concept of new forms of cooperation between healthcare professionals was introduced by the "Hospital, patients, health and territories" law and clarified by the relevant implementing provisions. The French National Authority for Health has recently established guidelines for healthcare professionals in order to help them in drawing up cooperation protocols.

[Harmonizing indications for emergency radiological examinations for adults]. / Harmoniser les indications des examens radiologiques dans les situations cliniques urgentes de l'adulte.

INTRODUCTION: The "Collégiale des radiologistes" of the Paris public hospital system (Assistance Publique-Hôpitaux de Paris, AP-HP) has participated since 1998 in a collaborative quality improvement program for the 49 radiology departments. They work together with the AP-HP college of emergency physicians on one part of this program, which focuses on emergency radiologic work-ups. Analysis of the dysfunctions in this sector underlined the lack of agreement between clinicians and radiologists on the examinations required. OBJECTIVE: The aim of this project was to establish operational and consensual guidelines for physicians, radiologists and emergency teams for the use of diagnostic radiology in emergency situations in adults. METHOD: The working group of radiologists and emergency physicians drafted this document, largely from documentary sources. A large panel of physicians validated the draft during successive review sessions, and the two colleges then approved them. RESULTS: The guidelines are presented in 3 columns: clinical situations, quality aims (type of imaging, time within which the examination should be performed) and comments. The clinical situations were regrouped by anatomical area or system: head, neck, thorax, heart, gynecology, abdomen, urinary, non-traumatic bone and spine disorders, multiple trauma, and isolated trauma of the spine and limbs and of the head, trunk, abdomen, and pelvis. CONCLUSION: These guidelines based on consensus within the institution make it possible to harmonize the requests for and practices of radiologic examinations in emergency situations. Their implementation is an integral part of the ongoing development of operating agreements between the radiology and emergency departments.