THE ACCIDENT AND EMERGENCY DEPARTMENT AT THE POITIERS CHU

The vocation of the accident and emergency department is to provide treatment, without discrimination, to any patient in a state of actual or perceived distress, and to do so 24h/24, 365 days a year.

Each year, the accident and emergency department admits more than  40000 persons.

It receives on the average 120 to 130 patients a day and treats all (medical and surgical) adult emergencies.

Gynecological, obstetrical and cardiological emergencies are addressed directly to the relevant specialized departments or referred to them by the emergency department.

In order to avoid compromising treatment of “true emergencies”, painstaking branch-by-branch organization has been put into place.

First step : RECEPTION AND TRIAGE

The reception team : first link in the health care chain.

The “Reception” section represents an essential stage preceding admission to the emergency department. It is staffed by an organizing reception nurse (IOA) and a medico-administrative agent.

This area is fundamental to the functioning of incoming flow management.

After initial contact with the IOA, and after having fulfilling the administrative formalities required prior to consultation or hospitalization, the patient is placed under the responsibility of the IOA, who has a key role in evaluation of the patient’s need for treatment according to potential, vital or functional risk, and in prioritizing, using the nurse’s classification of patients in emergency wards.

This initial step is designed to prioritize patients and their pathologies and to determine maximum tolerable waiting time before according access to one of our branches: absolute urgency, medical and surgical branch, non-urgent, psychiatry.

 

Second step : ORIENTATION AND TREATMENT

For each pathology and degree of severity, a separate branch.

The reception unit of the emergency department is divided into 3 branches that are determined by the pathology and the severity of the situation.

The division into branches is a time saver, and of the patient needs to be reoriented to another branch, this is possible.

• the “short”  (non-urgent) branch deals with small-scale trauma and organizes medical consultation.
• the medical and surgical branch,
• the “absolute urgency” branch or critical emergency department for the patients with the most severe pathologies.

The short branch for treatment of ambulatory patients

During an audit carried out by the hospital expertise and audit commission (MeaH) in 2008, it was found that close to 40% of the patients admitted to our department presented a pathology justifying a simple consultation necessitating or not necessitating further examination. In order to ease congestion in the unit, a “short” branch was created.

The short branch deals with small-scale traumas and benign pathologies possibly necessitating rapid examination (radiography test, urine test, ECG, blood glucose).

A nurse, an intern and an emergency physician are dedicated to this activity.

The medical and surgical branch for “heavy-duty” treatment

The accident and emergency department has a medical and surgical branch that treats patients with a pathology necessitating emergency medical or traumatological care: a medical examination, primary and supplementary treatments (radiology, biology…).

The “examination and treatment” section consists in 14 examination rooms, a suture room, a specific care room and a splinting/casting room. The objective is to provide rapid treatment for surgical and/or medical problems leading almost inevitably to hospitalization.

The “absolute urgency” branch for critical emergencies

The critical emergency reception section (SAUV) immediately admits patients necessitating extremely urgent care; priority access is given to patients accompanied by the SMUR emergency medical service or by firefighters in a medically equipped ambulance (multiple traumatic injuries, state of shock, acute respiratory failure…). .

Reception in the emergency ward of severely ill or injured patients is a priority that must be respected without penalizing or being penalized by the flow of patients present in this area.

In four “crash” or shock treatment rooms, SAUV team members carry out the first steps of emergency care: biological and morphological testing and, if necessary, intubation and resuscitation maneuvers. The nearness of the technical platforms (scanner, operating rooms) facilitates initial treatment. Once the first steps have been carried out, the emergency physicians contact the departments in the best position to provide quality care (surgical or medical intensivists, surgeons…).

Hospitalization in the emergency department

Some patients will not be directed to the intensive care unit, nor to any other specialized department. However, their condition necessitates specific monitoring. With this in mind, the emergency services  of the Poitiers CHU contain 8 boxes of which 3 are scope-equipped, and 2 beds in the short-stay hospital unit (UHCD).

This section also facilitates psychosocial monitoring in liaison with the medical and psychological assistance team (UAMP), which depends on the Centre hospitalier Henri Laborit and has an individualized structure carrying on its activities in the emergency department.

In general, this section admits patients for at most 24 hours so as to monitor their evolution.

This department is addressed to patients requiring close supervision before being oriented, following which they can be hospitalized in a specialized department or allowed to return home.