ABSTRACT Objectives: The aim of this study was to evaluate hospital and emergency department (ED) preparedness in France facing the coronavirus disease 2019 (COVID-19) rapid growth epidemic-phase, and to determine the link between preparedness and responsiveness. Methods: In this cross-sectional study, from March 7 to March 11, 2020, all heads of ED departments in France were contacted to answer an electronic survey, including 23 questions. Quality, Organization, Training, Resources, Management, Interoperability, and Responsiveness were evaluated by calculating scores (10 points). Multivariate analysis of variance was used to compare scores. Spearman’s correlation coefficient and multifaceted regression analysis were performed between Responsiveness and dimensions scores. Results: A total of 287 of 636 French EDs were included (45.1%). Calculated scores showed (median): Quality 5.38; Organization 6.4; Training 4.6; Resources 4.13; Management 2.38; Interoperability 4.0; Responsiveness 6.25; seasonal influenza score was 5. Significant differences between scores as a function of hospital and ED main characteristics were found. Furthermore, we found significant correlations ( P < 0.01) between Responsiveness and all preparedness dimensions. Organization (adjusted-R 2 0.2897), Management (aR 2 0.321), and Interoperability (aR 2 0.422) were significantly associated with Responsiveness. Conclusions: Preparedness in all its dimensions is low, indicating vulnerability. Preparedness and responsiveness face a certain and ongoing risk are close linked, and that Organizational, Management, and Interoperability dimensions are main determinants.

Since January 2020, the SARS-CoV-2 pandemic has severely affected hospital systems worldwide. In Europe, the first 3 epidemic waves (periods) have been the most severe in terms of number of infected and hospitalized patients. There are several descriptions of the demographic and clinical profiles of patients with COVID-19, but few studies of their hospital pathways. We used transition matrices, constructed from Markov chains, to illustrate the transition probabilities between different hospital wards for 90,834 patients between March 2020 and July 2021 managed in Paris area. We identified 3 epidemic periods (waves) during which the number of hospitalized patients was significantly high. Between the 3 periods, the main differences observed were: direct admission to ICU, from 14 to 18%, mortality from ICU, from 28 to 24%, length of stay (alive patients), from 9 to 7 days from CH and from 18 to 10 days from ICU. The proportion of patients transferred from CH to ICU remained stable. Understanding hospital pathways of patients is crucial to better monitor and anticipate the impact of SARS-CoV-2 pandemic on health system.

Background: Vaccination is one of the most effective ways to fight the influenza epidemic and the coronavirus disease 2019 (COVID-19) pandemic, which represent a major public issue. The objective was to investigate the adherence of heads of French emergency departments (ED) and nursing departments on a potential vaccination campaign of healthcare workers (HCW) and patients in ED. Method: In February 2021, ED and nursing department heads were asked to answer a national survey. It included 24 questions designed to cover some dimensions, including characteristics of the hospital and emergency departments (ED) and questions on vaccination. Results: 414 responses out of 800 questionnaires (51.8%) were collected. Scores out of 10 were, respectively, 7 (6–8) and 8 (6–9) for vaccination against influenza and COVID-19 for HCW and 2 (2–3) and 2 (2–4) for ED patients (H = 989.3; p < 0.0001). Multivariate logistic regression found that the existence of a vaccine program in the hospital and the use of point of care influenza PCR in ED were positively associated with the acceptance of influenza vaccination campaign for HCW (p = 0.003) and patients (p = 0.015). Factors limiting adherence to a vaccination program of HCW and patients were lack of medical staff (p = 0.041 for HCW and p < 0.0001 for patients), overcrowded ED (p < 0.001), and the inability to follow up with patients after the ED visit (p < 0.0001). Conclusions: There have been many missed opportunities for influenza vaccination, and there is pressure to vaccinate against COVID-19 as soon as possible. Vaccination campaigns in ED could help to improve vaccination coverage. ED staff are more likely to vaccinate HCW than patients. There are factors that support the implementation of such programs, which can be grouped into a culture of diagnosis, control, and prevention of viral infectious diseases within the hospital and ED. On the other hand, there are limiting factors, such as overcrowding and lack of personnel.

OBJECTIVES:Hospital length of stay (days) and revenues per day (euros) could be different depending on admission mode. To determine the impact of admission mode as a function of clinical pathway, we conducted the present study. Data sources: We included 159,206 admissions to three academic hospitals during a four-year period. Data were obtained from the electronic system of the hospital trust. STUDY DESIGN:A case (through-emergency department)-control (elective (EA)) study was conducted (77,052), matched by age, stay severity and type, disease-related group, and discharge mode. Principal findings: Through-emergency department were significantly elderly, more severe, had more intensive care stays, a higher mortality rate, longer length of stay (days) (9.5 ± 12 vs. 6.8 ± 9.5; p < 0.0001), and lower revenues per day (647 ± 451 vs. 721 ± 422; p = 0.01). In case-control study, mean differences between cases and controls were: longer length of stay -0.64 and revenues per day -75.6; for ≥75 years -1.2 and -102.1; medical -0.9 and -90.4; and discharge to facilities care centers -1.5 and -81.8. Among cases, 40% had a stay in observation unit before being admitted in hospital ward. Differences were strongly reduced for patients who did not go to observation unit before being admitted. Differences were reduced from 0.64 to 0.2 days for length of stay and from 79 to 41 euros for revenues per day when patients did not stay in observation unit before being admitted. CONCLUSIONS:We conclude that admission mode is associated with length of stay and revenues. However, as differences are weak, elective admissions should not be prioritized on economic arguments. Otherwise, our study indicates that among through-emergency department admissions, observation unit stay is associated with longer length of stay and lower revenues.

We use discrete event simulation to model and analyze a real-life emergency department (ED). Our approach relies on the appropriate integration of most real-life ED features to the simulation model in order to derive useful practical results. Data is supplied from the ED of the urban French hospital Saint Camille. Our purpose is to optimize the human resource staffing levels. We want to minimize the patient average length of stay ([Formula: see text]), by integrating the staffing budget constraint and a constraint securing that the most severe incidents will see a doctor within a specified time limit. The second constraint allows to avoid the perverse effect of only considering the [Formula: see text] metric that would delay the treatment of the most urgent patients. We use simulation-based optimization, in which we perform a sensitivity analysis expressing [Formula: see text] as a function of the staffing budget and also the average door-to-doctor time for urgent patients ([Formula: see text]). We show that the budget has a diminishing marginal effect on the problem solution. Due to the correlation between [Formula: see text] and [Formula: see text], we also observe that the [Formula: see text] constraint may significantly affect the feasibility of the problem or the value of the optimal solution.

BACKGROUND:Predictors of unscheduled return visits (URV), best time-frame to evaluate URV rate and clinical relationship between both visits have not yet been determined for the elderly following an ED visit.METHODS:We conducted a prospective-observational study including 11,521 patients aged ≥75-years and discharged from ED (5,368 patients (53.5%)) or hospitalized after ED visit (6,153 patients). Logistic Regression and time-to-failure analyses including Cox proportional model were performed.RESULTS:Mean time to URV was 17 days; 72-hour, 30-day and 90-day URV rates were 1.8%, 6.1% and 10% respectively. Multivariate analysis indicates that care-pathway and final disposition decisions were significantly associated with a 30-day URV. Thus, we evaluated predictors of 30-day URV rates among non-admitted and hospitalized patient groups. By using the Cox model we found that, for non-admitted patients, triage acuity and diagnostic category and, for hospitalized patients, that visit time (day, night) and diagnostic categories were significant predictors (p<0.001). For URV, we found that 25% were due to closely related-clinical conditions. Time lapses between both visits constituted the strongest predictor of closely related-clinical conditions.CONCLUSION:Our study shows that a decision of non-admission in emergency departments is linked with an accrued risk of URV, and that some diagnostic categories are also related for non-admitted and hospitalized subjects alike. Our study also demonstrates that the best time frame to evaluate the URV rate after an ED visit is 30 days, because this is the time period during which most URVs and cases with close clinical relationships between two visits are concentrated. Our results suggest that URV can be used as an indicator or quality.

Objective We aimed to determine the trends in numbers and percentages of sexually exposed persons to HIV (SE) consulting an ED for post-exposure prophylaxis (PEP), as well as predictors of condom use. Study Design We conducted a prospective-observational study. Methods We included all SE attendances in our Emergency Department (ED) during a seven-year study-period (2006–2012). Trends were analyzed using time-series analysis. Logistic Regression was used to define indicators of condom use. Results We enrolled 1851 SE: 45.7% reported intercourse without condom-use and 12.2% with an HIV-infected partner. Significant (p<0.01) rising trends were observed in the overall number of SE visits (+75%), notably among men having sex with men (MSM) (+126%). There were rising trends in the number and percentage of those reporting intercourse without condom-use in the entire population +91% (p<0.001) and +1% (p>0.05), in MSM +228% (p<0.001) and +49% (p<0.001), in Heterosexuals +68% (p<0.001) and +10% (p = 0.08). Among MSM, significant rising trends were found in those reporting high-risk behaviours: anal receptive (+450% and +76%) and anal insertive (+l33% and +70%) intercourses. In a multivariate logistic regression analysis, heterosexuals, vaginal intercourse, visit during the night-shift and short time delay between SE and ED visit, were significantly associated with condom-use. Conclusion We report an increasing trend in the number of SE, mainly among MSM, and rising trends in high-risk behaviours and unprotected sexual intercourses among MSM. Our results indicate that SE should be considered as a high-risk population for HIV and sexually transmitted diseases.

We propose a Discrete Event Simulation (DES) model for an emergency department (ED). The model is developed in close collaboration with the French hospital Saint Camille, and is validated using real data. The objective of this model is to help ED managers better understand the behavior of the system and to improve the ED operations performance. The most essential features of an ED are considered in the model. A case study is conducted in order to allow decision makers select the most relevant investment in the human staffing budget. A simulation-based optimization algorithm is adopted to minimize the average Length of Stay (LOS) under a budget constraint. We conduct a sensitivity analysis on the optimal average LOS as a function of the staffing budget, and derive useful recommendations to managers on how the budget can impact the performance of the system.