{"id":4504,"date":"2021-09-09T09:48:37","date_gmt":"2021-09-09T07:48:37","guid":{"rendered":"https:\/\/sceaux-lagazette.fr\/?p=4504"},"modified":"2021-09-09T09:49:38","modified_gmt":"2021-09-09T07:49:38","slug":"garder-raison-sur-la-fermeture-des-lits-dhopitaux","status":"publish","type":"post","link":"https:\/\/sceaux-lagazette.fr\/index.php\/2021\/09\/09\/garder-raison-sur-la-fermeture-des-lits-dhopitaux\/","title":{"rendered":"Garder raison sur la fermeture des lits d\u2019h\u00f4pitaux"},"content":{"rendered":"\n

Sur les r\u00e9seaux sociaux, on peut r\u00e9guli\u00e8rement lire que les probl\u00e8mes d\u2019hospitalisation avec le Covid ont \u00e9t\u00e9 aggrav\u00e9s \u00ab parce qu\u2019on a ferm\u00e9 des lits depuis des ann\u00e9es \u00bb. Cela n\u2019a en r\u00e9alit\u00e9 pas grand-chose \u00e0 voir, mais c\u2019est l\u2019occasion d\u2019aborder cette question.<\/p>\n\n\n\n

Des effectifs en hausse constante<\/h2>\n\n\n\n

Les gens l\u2019ignorent souvent, mais les effectifs <\/a>de la fonction publique hospitali\u00e8re sont en augmentation constante comme le montre le graphique ci-dessous :<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Ceux qui s\u2019indignent de la fermeture de lits ici ou l\u00e0 oublient que des lits sont ouverts ailleurs dans la m\u00eame p\u00e9riode<\/p>\n\n\n\n

Alors, pourquoi fermer des lits ?<\/h2>\n\n\n\n

A partir des ann\u00e9es 60, quand la tuberculose a recul\u00e9 gr\u00e2ce au vaccin, on a ferm\u00e9, r\u00e9duit ou transform\u00e9 les sanatoriums du plateau d\u2019Hauteville<\/a>. En 1973, le nombre de bless\u00e9s<\/a> sur la route a \u00e9t\u00e9 de 388 363. En 2020, il n\u2019a plus \u00e9t\u00e9 que de 55 836. Forc\u00e9ment, les besoins hospitaliers correspondants ont fortement diminu\u00e9 et les h\u00f4pitaux sp\u00e9cialis\u00e9s de la r\u00e9gion de Berck ont \u00e9t\u00e9 ferm\u00e9s, r\u00e9duits ou r\u00e9orient\u00e9s. L\u2019h\u00f4pital maritime de Berck<\/a>, qui d\u00e9pend de l\u2019APHP, a ainsi une unit\u00e9 de 60 lits pour personnes en ob\u00e9sit\u00e9 morbide, un probl\u00e8me inexistant il y a 50 ans.<\/p>\n\n\n\n

Mais bien entendu, la disparition d\u2019une situation ancienne n\u2019explique pas \u00e0 elle seule la r\u00e9duction du nombre de lits d\u2019une sp\u00e9cialit\u00e9 donn\u00e9e. Face \u00e0 l\u2019\u00e9volution rapide de la demande globale, alors que leurs moyens n\u2019augmentaient pas au m\u00eame rythme, les \u00e9tablissements hospitaliers ont cherch\u00e9 \u00e0 r\u00e9duire la dur\u00e9e de s\u00e9jour pour une intervention donn\u00e9e. En 40 ans, la dur\u00e9e moyenne pour un accouchement a \u00e9t\u00e9 divis\u00e9e par deux. Le mouvement n\u2019est pas nouveau : en 1995, une \u00e9tude dans un \u00e9tablissement de province montrait une dur\u00e9e moyenne de s\u00e9jour divis\u00e9e par deux en 20 ans. Le mouvement a continu\u00e9 depuis avec le d\u00e9veloppement de l\u2019hospitalisation partielle et de ce qu\u2019on nomme l\u2019hospitalisation \u00e0 domicile, comme le montre ce graphique, issu d\u2019une \u00e9tude<\/a> de la DREES[1]<\/a> :<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

MCO : m\u00e9decine, chirurgie et obst\u00e9trique. Nombre de s\u00e9jours pour l\u2019hospitalisation compl\u00e8te et nombre de journ\u00e9es pour l\u2019hospitalisation partielle<\/em><\/p>\n\n\n\n

Le d\u00e9veloppement de l\u2019hospitalisation s\u2019est accompagn\u00e9 d\u2019un maintien global de l\u2019hospitalisation compl\u00e8te, pour r\u00e9pondre \u00e0 de nouveaux besoins, notamment li\u00e9s \u00e0 l\u2019augmentation de l\u2019esp\u00e9rance de vie.<\/p>\n\n\n\n

Cette \u00e9volution a notamment \u00e9t\u00e9 permise par les progr\u00e8s techniques, en particulier ce qu\u2019on appelle les m\u00e9thodes non invasives. Celles qui permettent par exemple de poser un sten sur une aorte pr\u00e8s du c\u0153ur en partant d\u2019une l\u00e9g\u00e8re incision au bras !<\/p>\n\n\n\n

A la fin, ce type de mouvements s\u2019accompagne, \u00e0 un niveau national, de fermetures des services dont l\u2019activit\u00e9 n\u2019augmente pas (par exemple le nombre d\u2019accouchements) au profit de ceux dont l\u2019activit\u00e9 augmente plus vite que la moyenne.<\/p>\n\n\n\n

Et on ne parle m\u00eame pas ici des villes, d\u00e9partements ou r\u00e9gions qui voient leur population diminuer alors qu\u2019elle augmente rapidement dans d\u2019autres.<\/p>\n\n\n\n

Les fermetures temporaires<\/h2>\n\n\n\n

Toujours sur les r\u00e9seaux sociaux, il s\u2019est trouv\u00e9 des intervenants pour se scandaliser qu\u2019on ferme des services hospitaliers l\u2019\u00e9t\u00e9. Peut-\u00eatre trouvent-ils scandaleux qu\u2019on puisse accorder des cong\u00e9s au personnel m\u00e9dical ou soignant. Une partie importante de l\u2019activit\u00e9 hospitali\u00e8re est programmable. La programmation est donc faite de mani\u00e8re \u00e0 permettre au personnel de prendre ses cong\u00e9s. Ce qui pose quelques probl\u00e8mes d\u2019organisation : comment transf\u00e9rer du personnel entre l\u2019activit\u00e9 programmable et celle qui ne peut pas l\u2019\u00eatre !<\/p>\n\n\n\n

Et demain ?<\/h2>\n\n\n\n

Il n\u2019y a aucune raison que le mouvement de fermetures de lits s\u2019arr\u00eate. Il refl\u00e8te la capacit\u00e9 du syst\u00e8me hospitalier \u00e0 s\u2019adapter aux \u00e9volutions d\u00e9mographiques, sociales, techniques. Et c\u2019est tant mieux, car des moyens laiss\u00e9s sur des besoins devenus obsol\u00e8tes sont autant de moyens en moins pour le reste du syst\u00e8me.<\/p>\n\n\n\n

\n\n\n\n

[1]<\/a> La DREES (Direction de la recherche, des \u00e9tudes, de l’\u00e9valuation et des statistiques) d\u00e9pend du minist\u00e8re des Solidarit\u00e9s et de la Sant\u00e9.<\/p>\n","protected":false},"excerpt":{"rendered":"

Sur les r\u00e9seaux sociaux, on peut r\u00e9guli\u00e8rement lire que les probl\u00e8mes d\u2019hospitalisation avec le Covid ont \u00e9t\u00e9 aggrav\u00e9s \u00ab parce qu\u2019on a ferm\u00e9 des lits depuis des ann\u00e9es \u00bb. Cela n\u2019a en r\u00e9alit\u00e9 pas grand-chose \u00e0 voir, mais c\u2019est l\u2019occasion d\u2019aborder cette question. Des effectifs en hausse constante Les gens l\u2019ignorent…<\/p>\n","protected":false},"author":11,"featured_media":4511,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[53],"tags":[],"class_list":["post-4504","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-analyses","entry","simple"],"yoast_head":"\nGarder raison sur la fermeture des lits d\u2019h\u00f4pitaux - La Gazette<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sceaux-lagazette.fr\/index.php\/2021\/09\/09\/garder-raison-sur-la-fermeture-des-lits-dhopitaux\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Garder raison sur la fermeture des lits d\u2019h\u00f4pitaux - La Gazette\" \/>\n<meta property=\"og:description\" content=\"Sur les r\u00e9seaux sociaux, on peut r\u00e9guli\u00e8rement lire que les probl\u00e8mes d\u2019hospitalisation avec le Covid ont \u00e9t\u00e9 aggrav\u00e9s \u00ab parce qu\u2019on a ferm\u00e9 des lits depuis des ann\u00e9es \u00bb. 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