The number of visits per day at Bordeaux University Hospital has increased by 10% since the start of the new school year, while the staff are already exhausted by the health crisis.
Several explanations can be put forward to read this situation, in particular the lack of downstream beds and the problems of recruiting staff.
The CHU hopes to boost its attractiveness with an action plan to recruit nurses and nursing assistants on permanent contracts.
The ARS works to develop home support for the elderly and telemedicine for all.
Since the end of the summer, the number of visits per day to the emergency rooms of the Bordeaux University Hospital (in Pellegrin and Saint-André) has increased by 10%, from 200 to 220.
“Unfortunately some patients are in stretchers installed in the corridors, but they are not those who stay several days, ”reports Eric Tellier, head of the adult emergency department at the Pellegrin hospital, whose number of admissions varies between 150 and 170 passages these days, after peaks at 200 or even 220 during the All Saints holidays.
All the emergency services in the metropolis are currently in difficulty but that of the Pellegrin hospital, being the one with the largest reception capacity, has the particularity of being a deferral solution for other services, public and private. , also engorged.
The regulation services of Samu and Smur treat 1,200 cases per day, against 1,000 in normal times.
Elderly people without a solution
“Patient flows are much higher than before the Covid-19, estimates Dr. Eric Tellier. There are more elderly patients with multiple pathologies, who require a lot of care and take medical and paramedical time. "If all goes well, they should never end up in the emergency room but they arrive for" difficult home maintenance ", he explains, when the general practitioners who follow them" have reached the end of what they can do. ". These patients sometimes stay five to six days in the emergency room due to lack of space in other departments. "The management of the hospital is very informed and is doing everything it can with the regional health agency [ARS] to unblock these beds and admit patients where they need to go," said the head of the department. Pellegrin emergencies. Corn,it is a whole system which is undermined by the policies of the last twenty years ”.
After more than 18 months of a health crisis which severely tested understaffed nursing staff, signs of exhaustion are clearly visible.
Among them, an increase in “accidents of exposure to blood” in emergencies, points out Dr. Eric Tellier.
And overall, the CHU has seen the absenteeism rate of its teams drop from 8 to 9%.
Several explanations
“Since September 27, there has been a strike at SOS Médecins which provided 50 visits per day in Bordeaux alone,” Yann Bubien said. And, 9 times out of 10, it allowed patients to be kept at home. Another parameter, there is a postponement of support that had been postponed during the health crisis. "We combine an increase in activity due in part to the strike and a catching up of care, quite sensitive, since September of this year", summarizes the Director General of the Bordeaux University Hospital. Especially since between the summer holidays and those of Christmas, it is always a strong period of activity for the hospital services.
“There is a lack of beds, due to a lack of personnel, which has increased in recent years and a recruitment deficit, observes Dr. Eric Tellier.
It has been years since the beds for follow-up care and rehabilitation [SSR] have not been opened while the population is aging, and the offers in nursing homes are very limited ”.
Currently 9% of CHU beds are closed for lack of staff, i.e. 2,333 beds open out of a capacity of 2,580.
“Historically, the Gironde has fallen behind in the creation of SSR beds,” comments Bénédicte Motte, director of the departmental delegation of Gironde at ARS Nouvelle-Aquitaine.
We are trying to reverse the trend and we have a lot of projects in the pipeline.
"
What levers of action?
The CHU tries to adjust these resources as well as possible to the constantly changing situation. Civil protection has been called in to support and guide people who come to emergencies, for example. "We launched a medical and paramedical attractiveness plan to recruit more, in particular nurses and nursing assistants," explains the director of the CHU. We offer direct hiring on permanent contracts and access to the status of civil servants which can be faster or even immediate. "
The ARS promotes better screening of patients before emergency admissions, by first contacting 15 or their attending physician. "There is a whole battery of measures, including telemedicine, so that people, elderly or not, do not go to the emergency room", explains Bénédicte Motte. For the elderly, the watchword is home support as much as possible and targeted admissions to the services corresponding to their needs, in the event of hospitalization. A helpline dedicated to geriatrics has been set up to improve the orientation of patients from nursing homes. Experimentation with an access to care service (SAS) should also make it possible, via a unique number, to refer patients to unscheduled time slots, with general practitioners.
The opening of the emergencies of the Tondu clinic in Floirac, announced for the first half of 2022, and those of Bahia (which brings together Robert-Picqué and Bagatelle) should give a little oxygen to the other emergency services of the metropolis. .
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Emergency room
Health
Bordeaux
Hospital
Aquitaine
The elderly
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