Long-stay inpatients in short-term emergency units in France: A case study

Gansel, Yannis; Danet, François; Rauscher, Catherine

doi:10.1016/j.socscimed.2009.10.045

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…Three of the quantitative studies were deemed to have high methodological quality, 4 moderate quality and 3 low quality (Table ). Two of the eight qualitative studies were removed due to low reliability and usefulness, as determined using the 6 criteria for assessing study quality (Table ).…”

Section: Resultsmentioning

confidence: 99%

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Impact and experiences of delayed discharge: A mixed‐studies systematic review

Rojas-García

Turner

Pizzo

et al. 2017

Health Expectations

209

205

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BackgroundThe impact of delayed discharge on patients, health‐care staff and hospital costs has been incompletely characterized.AimTo systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients’ outcomes and costs.MethodsFour of the main biomedical databases were searched for the period 2000‐2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included.ResultsThirty‐seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well‐being. Extra bed‐days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients.ConclusionsThe poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.

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Section: Resultsmentioning

confidence: 99%

“…Moreover, some procedures for addressing delayed discharge were perceived by staff to have “systematized” or dehumanized patients . Finally, some health professionals reported negative reactions towards patients, including “blame” for contributing to delays . This exacerbated patients’ negative feelings about delays.…”

Section: Resultsmentioning

confidence: 99%

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Rojas-García

Turner

Pizzo

et al. 2017

Health Expectations

209

205

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“…35 Scholars in France have proposed a societal-level solution involving the procedural and financial restructuring of ultraspecialized medicine, coupled with a revival of historic values combining medicine and social work to address the needs of an increasingly frail and socially complex population. 36 …”

Section: Discussionmentioning

confidence: 99%

Managing “socially admitted” patients in hospital: a qualitative study of health care providers’ perceptions

Mah,

Stilwell,

Kubiseski

et al. 2024

CMAJ

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Background: Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as “socially admitted” patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as “social admissions.” Methods: This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with “socially admitted” patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. Results: We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female ( n = 11) and White ( n = 13), and were in their mid to late career ( n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for “socially admitted” patients, perceptions and assumptions underlying “social” presentations, system barriers to care delivery, and suggestions of potential solutions. Interpretation: Health care providers viewed “socially admitted” patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for “socially admitted” patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients.

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“…These trends of specialization and professionalization both converged towards new problems regarding the articulation of these sectors and the discontinuity of public action. They raised the issue of intractable subjects, representing the inevitable ‘scraps’ (or remnants), produced by the specialized craftwork of the organization (Gansel, Danet and Rauscher, 2010). Focusing on the treatment of a marginal population and putting adolescents’ exclusion as the pinnacle of their problem, the difficult adolescents category gives shape to these problems.…”

Section: Discussionmentioning

confidence: 99%

Managing difficult and violent adolescents (adolescents difficiles) in France: a genealogical approach

Gansel

2018

Hist Psychiatry

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'Difficult adolescent' is a clinical category defined by psychiatrists' expertise. Since the end of the 1990s, it has been extensively used to describe a population of disruptive, violent yet vulnerable adolescents, at the margins of public institutions that manage youth deviancy in France. For the present study, an interconnected network of 49 documents was analysed using a genealogical method in order to provide comprehensive elements in the results. This category found its ecological niche in the 1960s, revealing a moral tension in the use of constraint. It addressed new problems of intractable individuals, whose dangerousness and vulnerability require coordination between penal, social and psychiatric institutions. It defines an ambiguous condition, suspended between the trouble experienced by the caregivers and an adolescent's individual disorder.

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Long-stay inpatients in short-term emergency units in France: A case study

Cited by 11 publications

References 15 publications

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Managing “socially admitted” patients in hospital: a qualitative study of health care providers’ perceptions

Managing difficult and violent adolescents (adolescents difficiles) in France: a genealogical approach

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