Steg A
Service d'Urologie, CHU Cochin-Port Royal, Hôpital Cochin, Paris.
Bull Acad Natl Med. 1994 Nov;178(8):1475-84; discussion 1485-92.
More than 7,000,000 cases have been treated each year in the emergency care units of the french Hospitals. The majority of them have been properly treated. However complaints of unsatisfactory treatment were noted and in some cases very serious complications were reported. The main cause of the weakness of some care units rests in the qualitative and quantitative "under medicalisation". First care is often administered by students without control by the staff. Frequently also, the senior members of these units have an insufficient medical curriculum. A National Commission to reform the emergency care units (Commission Nationale de Restructuration des Urgences on CNRU) has been set up by the Government in order to define ways to reorganize these units. The Commission has established 3 conditions which are required for an emergency care unit: high medical skill which implies that the patients have to be treated by a senior physician; permanent reception: which requires a sufficient number of physicians to allow the presence of seniors 24h/24; responsibility: the function of every member of the team has to be clearly defined. The Commission has suggested the reception of emergency patients to be organised in two structures of different level: 1) the Department of Emergency (Service d'Accueil des Urgences or SAU) in which all the medical and technical requirements allow the reception and treatment of all types of emergency cases; 2) the reception and orientation units (Antennes d'Accueil et d'Orientation or ANACOR) which is a light structure assigned for the patients whose troubles are not surgical and who do not require major treatments. Such an organisation in a double structure requires a clear information of the population, an improvement of the medical regulation of the emergency cases and an the adaptation of the medical studies. Finally the aim of the reform is to improve the quality of care, to increase the safety of patients and to limit the inequality of patients facing an emergency situation.
法国医院的急诊科室每年接待超过700万病例。其中大多数都得到了妥善治疗。然而，仍有对治疗不满意的投诉，并且在某些情况下还报告了非常严重的并发症。一些护理单位薄弱的主要原因在于质量和数量上的“医疗不足”。初始护理通常由学生进行，且缺乏工作人员的监督。这些单位的高级成员通常也缺乏足够的医学课程培训。政府设立了一个国家急诊科室改革委员会（CNRU），以确定重组这些科室的方法。该委员会确定了急诊科室所需的三个条件：高超的医疗技能，这意味着患者必须由主任医师治疗；随时接待，这要求有足够数量的医生，以便主任医师能24小时在岗；职责明确，团队中每个成员的职责必须明确界定。该委员会建议将急诊患者的接待安排在两种不同级别的机构中：1）急诊部（SAU），其所有医疗和技术条件允许接待和治疗各类急诊病例；2）接待和分诊单位（ANACOR），这是一个轻型机构，负责接待那些病情不属于外科范畴且不需要重大治疗的患者。这种双重结构的组织需要向公众提供清晰的信息，改善对急诊病例的医疗管理，并调整医学研究。最后，改革的目的是提高护理质量，增强患者安全，并减少患者在面对紧急情况时的不平等现象。
