At the end of May, the pediatric emergencies of the Clermont-Ferrand University Hospital were on strike. The reason: a lack of medical staff, but above all paramedical staff. While the hospital is experiencing one of the most serious crises in its history, pediatric emergencies come out of their reserve, denouncing a lack of resources in the face of an increasingly large influx of young patients.
As part of the Flash mission proposed by President Emmanuel Macron in June 2022, pediatric organizations have “self-seized” the problem of pediatric emergencies, which represent nearly 30% of the 22 million annual visits in France. Christèle Gras-le Guen, head of the pediatrics department at the Nantes University Hospital and president of the French Society of Pediatrics (SFP), discusses the need to reform the health system.
L’Express: In your press release published on June 15, you mention a “degraded situation” in pediatric emergencies. How does it feel on a daily basis?
Christèle Gras-le Guen: It is difficult for the healthcare teams, whether medical or paramedical. There is this impression that it will be very difficult to maintain the quality of care for the children who consult in our emergency rooms. We are in a critical situation marked by a lack of means. Added to this is the health crisis which has exhausted our teams: they were mobilized very quickly to help the intensive care units and other sectors affected by Covid-19. All our caregivers have been reassigned to care services that needed additional hands.
You say you lack means, concretely, what does that mean?
Historically, pediatric emergencies have developed alongside adult emergencies. For years, we stuck to the idea that these were “little children”, “little illnesses” and therefore they needed “little means” and “little funding”. Today, our premises are too small and our teams find themselves undersized.
On top of that, we have been receiving an incredible influx of children over the past few weeks. Mental health problems have led the youngest to consult the emergency room, although they are not the only ones. At the Nantes University Hospital, there is a 22% increase in the number of children at the end of April 2022, compared to last year. Never seen. If nothing changes, a real threat places on the quality of care. You should know that the situation is the same in all establishments. We are the poor relations of emergencies.
How does this imbalance between pediatric emergencies and adult emergencies translate?
In our department at the Nantes University Hospital, we receive 40,000 children every year. Depending on the time slots, our teams of nurses are made up of three or four people. In adult emergencies, which receive twice as many patients, the teams of nurses are rather multiplied by three or four. Concretely, when we have three or four nurses, they have nine, even sixteen. This imbalance has always existed, but today the situation is becoming untenable.
Not only have the nursing teams been exhausted, but nursing recruitment is complicated: a certain number have retrained, so we have to manage with gaps in schedules. Normally, three nurses are present at night, but sometimes there are only two. It is possible that we did not mobilize enough before. For a long time, we made do with the means at hand. In the world of pediatrics in general, caregivers are not very vindictive and belligerent. Today, we are reaching our limits.
In your press release, you mention the reform of emergency funding. Why did she cause harm topediatric emergencies?
This is a very sensitive point. At first, we were all convinced of the need to reform the system, because you don’t manage a hospital like you manage a business. However, the people who worked on this reform of emergency funding realized that the passage times in adult emergencies were longer than in pediatrics – because we try to organize ourselves so as not to make children wait. And what’s really unfair is the payment for emergency room times, so the pediatric service becomes less profitable. At equal gravity, when we take care of a 16-year-old child who comes for a sprained ankle, it will be less well paid than a 20-year-old who comes for the same sprain. This will have the effect of reducing the funding of our services, which are already experiencing great difficulties.
In the reflection and implementation of this reform, pediatric emergencies have been “forgotten”. Only adult ER colleagues worked on it. We were integrated into the loop very late, once things were validated. The general direction of the offer of care (DGOS) does not want to go back.
You also denounce the lack of alternatives in town in the provision of child care….
We wanted to highlight what differs from pediatric emergencies and adult emergencies. One of the major points is that there are very few alternatives and liberal offers. Pediatric emergencies remain the only places where children of all ages and for any reason are welcomed, and at all hours of the night. For the question of child psychiatry, we felt the parents helpless in the face of these children who were going badly, and they were all received in pediatric emergencies.
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We want to be able to distinguish children whose state of health is really an emergency, such as respiratory distress, meningitis… On the other hand, we have seen an influx of poor families with children who have fever, unable to find an unscheduled consultation. So it is absolutely necessary that, as in adults, we organize care pathways for these families who need a consultation and not an emergency service, so as to relieve the latter.
WhatWhat are your expectations of the new government?
We want to be able to thoroughly reform a care system which today is no longer adapted to the situation of 2022. Today, caregivers have changed: for the most part, they are tired and Generation Z does not want to be forced to thank you with indecent wages. The demands of our fellow citizens have also changed. Mission Flash is a patch on the sinking Titanic. If we spend the summer, that will already be good, but that will not solve the rest of the problem on which I hope that the government will give us the means to work at the start of the school year.