title: In-hospital organization of primary care of patients presenting a life-threatening emergency: A French national survey in 32 university hospitals.
abstract: BACKGROUND
  The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients.
  
  
  METHODS
  A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients.
  
  
  RESULTS
  Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals.
  
  
  CONCLUSIONS
  This survey is the first to assess the in-hospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices.
authors.affiliation: Medicosurgical Unit, Saint-Roch Hospital, University Hospital of Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France. Electronic address: quintard.h@chu-nice.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Quintard
authors.affiliation: Medicosurgical Unit, Saint-Roch Hospital, University Hospital of Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Severac
authors.affiliation: Anesthesiology-Emergency-Intensive Care Unit Department, Hospital Nord, University hospital of Aix-Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
authors.affiliation: Medicosurgical Unit, Saint-Roch Hospital, University Hospital of Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France; IRCAN (Inserm U1081, CNRS UMR7284), Nice-Sophia-Antipolis University, 06000 Nice, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
mesh_terms: D003422:Critical Care; D016638:Critical Illness; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005602:France; D019538:Health Care Surveys; D006784:Hospitals, Teaching; D006785:Hospitals, University / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Emergency medicine; First care; Intensive care unit; University center