“A real acknowledgement of receipt from us”: what findings and what measures following the report to the emergency department of Montpellier hospital

The director: “During the holidays, we received up to 180 patients per day in the emergency room, including 50 elderly people who needed to be hospitalized.” Midi Libre – RICHARD DE HULLESSEN

The unions had launched a report on the emergencies, followed by a mobilization this Wednesday, January 15. Anne Ferrer, the hospital director, says she heard this alert, and even that she had anticipated it. She presents measures.

The director will meet a delegation again this week. She will present her wishes on Tuesday, on the occasion of the laying of the first stone of Balmès 2. Midi Libre – JEAN-MICHEL MART

Last week, the CGT reported serious and imminent danger to the emergency room of the Montpellier University Hospital, followed by a social mobilization this Wednesday. What is the situation for you? ?

When they made the report, I had already gone to the emergency room. Because we had had feedback since December 23-25, during the very special period of the end-of-year holidays, with many bed closures throughout the city. Everyone takes their vacation, both in the hospital and outside. General practitioners too. And that's normal. At that time, we suddenly saw a very significant increase in the number of elderly people, over 75, presenting with respiratory problems. It was the flu epidemic, everywhere in France. Incidentally, for the record, those who were vaccinated coped much better. So we received up to 180 patients per day in the emergency room, including 50 elderly people who needed to be hospitalized afterwards. In fact, the problem was actually broader: a problem upstream and downstream of the emergency rooms. And that, over an extremely short period of time.

But the holidays and the flu are things that come back every year…

Usually, we have bronchiolitis. We are used to it, we do not close. But when you look at the figures, the explosion of activity is striking. We talk about a critical day when two days in a row, we have more than 180 visits to the emergency room at the same time. And once again, there is an influx of over-75s, who we must keep by protocol.

The report of serious and imminent danger was therefore justified ?

No. A DGI, for imminent serious danger, is there, right now, when a professional reports a danger that threatens their own health and we must stop it immediately. That's what a DGI is, it's a case law. But this DGI was more to say: watch out, something is happening. And there, it's a real acknowledgement of receipt on our part. On the evening of January 3, I was in the emergency room with the president of the doctors, with the site director, with all the managers, the doctors, the liaison nurses and I triggered the first crisis unit. And all week, the deputy director general had done the same thing. On January 3, we decided to give the emergency room a bit of breathing space by taking cubicles from pediatrics, which is adjacent. We freed up places in pulmonology, in medicine, to facilitate downstream and streamline the pathways. Here again, I pay tribute to the teams: everyone was remarkable. The goal was that there would be no danger to patients or staff, but activity remained very high.

The report came later, on January 9.

We are going down from 180 to 150 per day and, for elderly patients, from 50 to 20. The challenge for us is the downstream. We have to put all this into perspective to ask ourselves what sustainable solutions we are bringing for the future. And we have already started working on it. We have to put the real estate master plan into perspective. We suffer from cramped emergency rooms, the stretchers are playing touch-and-touch. The priority is to have more space, a large room, where we can put the stretchers next to each other. But we do not suddenly decide to increase the square meters.

Based on this observation, what do you intend to do?

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We accelerated the implementation of the real estate master plan. And there was to be a building built on the other side of the emergency passage, dedicated to endocrinology activities, etc., on the current helipad side. There, we reviewed this project last April and decided to put in a footbridge. No need for an ambulance anymore, it's easy with a stretcher. We're going to expand the current emergency room and this footbridge will connect the current emergency room to this building, it's super easy. With lots of post-emergency beds. And we have another building that is due to be built in 2028. Except that when we say 2028, in the middle of a crisis, it's a long way off. But initially, it wasn't planned. Furthermore, in April, we took stock of the aging process together. In two ways: the laying, this Monday, for the wishes, of the first stone, of Balmès 2, dedicated to geriatrics, palliative care, algology… In a week, we lay the first stone. And there, for once, the delivery is earlier: 2027. It is real, it is concrete. With devices that will make it possible to anticipate visits to the emergency room for the elderly. With an offer of reinforced palliative and geriatric care.

What will happen to the staff ? There is more space, more beds ? And personnel-wise ?

The workforce will increase of course. The entire project I am talking about on medical and pediatric post-emergency units is ready. We are presenting it this Thursday (past, Editor's note), to our entire community. Behind this, we will be able to equip these beds by 2028 and we have already started to equip Balmès 2 by 2027. But we still want to accelerate about fifteen post-emergency beds on the other side of the footbridge and there again, recruit the staff required to equip this new unit as quickly as possible. All this dates from spring to now and it is the challenge of aging. When we look at the demographics of the territory, we see that, gradually, many people will enter a state of dependency. We are strengthening our offer to anticipate: we are in a development strategy and not a redeployment strategy. We are not closing beds, on the contrary we are going to open beds and create teams. We have a desire to develop the CHU.

However, these solutions do not prevent patients from waiting up to seventeen hours in the emergency room today ? And how can we reduce this treatment time ?

Seventeen hours, fortunately, is not everyone. If the seriousness requires it, patients are taken care of very quickly. What we experienced was an arrival in a very dense upstream channel and a downstream channel that was not fluid enough. Placement in the CHU services must also be facilitated, accelerated. The emergency teams must also have the results of the additional examinations quickly… There are many measures to take into account. But once again, we experienced a period of crisis that was the last straw. We tried to provide additional and visible solutions, with more timely responses, by committing to follow-up. We will meet again this Tuesday with all the union organizations to prioritize and classify the various actions to be implemented in a sustainable manner.

You arrived at the head of the CHU in April 2023. The crux of the matter is the budget. In 19 months, have the CHU budget and the emergency budget increased??

Both have increased. When I arrived, the budget was in deficit by €15.9 million. The overall budget was €1.3 billion. In that, we had €711 million in personnel costs. For 2024, we stayed at €1.3 billion but with personnel costs at €740 million, because we have more staff. There is zero impact on personnel. Efforts are focused on purchases, consumption, spending on the medicines we transport… We are paying attention.

This also weighs on the dilapidated state of the premises and equipment…

No, look at the single biology site that we are going to open in March. Our investments are around €80 million per year. It was important that we have our Ségur subsidies promised by the State at the beginning of the period. We have almost received the €230 million. We should be at €191 million by now. Behind the single biology site, there will be economies of scale. The projects are moving forward.

You are presenting your wishes to the 12,000 employees this Tuesday. What are you going to wish them and what should we wish the hospital ?

I am extremely proud of my hospital. We think what we want about the Le Point ranking but it is a mixture of activity, notoriety and over-expertise. Being ranked 4th, we are super proud of it. It really demonstrates the dynamic activity of the teams at our university hospital. We must continue to provide quality care as our professionals do, to be able to continue to develop. Find me a university hospital that has acquired three latest generation surgical robots in one year. We had one old one, now we have three new ones. The cost ? A little under €4 million. I hope that we continue to develop as we are doing today. We will also announce every month what is launched and what we receive. The teams will start to see what has been announced.

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