“Sorting of patients”, “loss of chance” … A collective warns about the “catastrophic” situation in pediatrics

The Inter-hospital Collective (CIH) is sounding the alarm. “Children in emergency situations can no longer be taken care of by the competent services”, denounced this organization of caregivers, Thursday, October 28.

“The difficulties we are currently encountering are completely new”, said Oanez Ackermann, of the pediatric hepatology service of the university hospital center (CHU) Bicêtre (Assistance publique-Hôpitaux de Paris), of which 10 out of 24 beds are closed today. “In this month of October, we were unable to welcome five children in a vital emergency situation” and we had to cancel “25 hospitalizations scheduled for several months”, detailed the pediatrician during a press conference organized by the CIH and rebroadcast on YouTube.

Reread the opinion piece of a collective of pediatricians (2019): Article reserved for our subscribers “Pediatric hospital care is totally inactive”

“Loss of luck”

“It’s sorting”, said Véronique Hentgen, pediatrician at the Versailles hospital center, evoking the postponement of surgery for a lymph node infection, the non-hospitalization of a child requiring an electroencephalogram for twenty-four hours, another suffering from joint pain or the inability to put on insulin pumps “Because there is no more room for hospitalization”. “We are therefore today at the crossroads of two paths: either the politician decides to abandon the public hospital, or he finally takes the problem head-on and initiates a fundamental reform (funding, recruitment, governance ) which will guarantee access to quality care for all ”, a jugé Mme Hentgen.

The situation is all the more « grave » for Christophe Marguet, head of department at Rouen University Hospital, that “The public hospital is the only recourse in pediatric medicine”. “Ultimately, we see a loss of opportunity for the child who needs care, for parents confronted with chronic disease, and the exhaustion of caregivers”, explained Isabelle Desguerre, head of the pediatric neuropediatrics department at the Necker-Enfants Malades hospital.

Elisabeth Ouss, child psychiatrist in the same establishment, reported “Unethical conditions, giving rise to a mental load, a terrible responsibility, which do not arouse vocations and help to keep young practitioners away from the hospital”. Laurent Rubinstein, emergency and intensive care nurse, says he arrives at the hospital “The ball in the stomach because [les soignants] not all[ent] don’t go[ils sont] in sufficient number “.

Minister’s response

This alert was relayed, in the evening, to the Senate, by Senator Sylviane Noël (Les Républicains) to the Minister for Autonomy, Brigitte Bourguignon.

“On pediatrics, of course, there are tensions, we do not deny it”, recognized the minister, in the government bench for the examination of the bill on “Various health vigilance provisions”.

“But there is no sorting, especially in emergencies”, said Mme Bourguignon, adding that“It is out of the question not to take a child in a vital emergency”.

Read also (2019): Article reserved for our subscribers “We came close to a health catastrophe”: the pediatric services of Ile-de-France on the verge of collapse

The collective cry of alarm comes as an epidemic of bronchiolitis is raging in France. In mainland France, all regions are in the epidemic phase, with the exception of Brittany and Corsica, which are in the pre-epidemic phase. During the week of October 18, 3,342 children under the age of 2 were seen in the emergency room for bronchiolitis, a third of whom (1,138) subsequently had to be hospitalized. In both cases, 9 out of 10 were less than 1 year old.

Arrival “Earlier” this year, this one “Puts in difficulty” pediatric services at Necker hospital in Paris, explains Professor Sylvain Renolleau, head of the pediatric intensive care unit. “We cannot open up our entire reception capacity, whether in critical care, general pediatrics or other specialties”, he adds.

Common and highly contagious, bronchiolitis causes babies to cough and difficult, rapid, wheezing. Most of the time benign, it may however require a visit to the emergency room, or even hospitalization.

Read also Article reserved for our subscribers With the return of bronchiolitis, hospitals are under pressure again

Closure of more than 5,700 hospital beds

This press conference also comes the day after a interview published in Release, in which the Minister of Health, Olivier Véran, outlined the reasons for the closure of more than 5,700 full hospital beds in 2020 (“Lack of caregivers, especially lack of being able to recruit”).

In addition to the lack of personnel, the Minister of Health noted an increase in absenteeism as well as resignations. Results : “In sixteen CHUs, [on constate] an increase of nearly a third of vacant positions in paramedics compared to fall 2019. ” The new recruitments are not enough to compensate for the needs. Between 2018 and 2021, just over a thousand nursing students in training have “Resigned before the end of their studies”.

In its opinion of 5 October, the scientific council made it“A significant percentage of closed beds, estimated at around 20%”, despite a “Already significant and increasing use of overtime and temporary work”.

Read also Article reserved for our subscribers Hospital bed closures: concern rises among caregivers

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“Sorting of patients”, “loss of chance” … A collective warns about the “catastrophic” situation in pediatrics