[Day-care hospitalisation in the dermatology departments of French university hospitals]. / Organisation et activité des hôpitaux de jour des services de dermatologie des CHU en France : étude transversale prospective.

ABSTRACT

BACKGROUND: Day hospital is a unit allowing the provision of several services together in a single day such as complex or specific therapy, or investigations requiring the services of different technical departments. This paper describes the structure and activity of dermatological day hospitals within French university hospitals (CHU). PATIENTS AND METHODS: A transverse prospective study was performed over a 2-week period in 2009 based on a first questionnaire which assessed the organisation and structure of the day hospitals (one questionnaire per day hospital unit), while the second assessed the activity of the day hospitals (one questionnaire for each patient attending day hospitals) throughout the period covered by the survey. RESULTS: Twenty-eight of the 44 dermatology French university hospital day centres responded to the survey (participation rate 63 %). Six had access to shared day hospital facilities while the 22 others had dedicated dermatology facilities. The day hospital unit was part of a national reference centre in 13 of 24 cases. The median number of beds per day-hospital structure was six for a median of eight patients admitted per day and 1500 sessions recorded each year. On average, the teams comprised two full-time doctors, two nurses, 1.25 hospital workers and one secretary. The mean number of administrative documents generated per unit each week was 57. There were 793 admissions to day hospitals throughout the survey period, for examinations in 61 % of cases and for treatment in 37 % of cases. Fifteen percent of patients were seen without prior arrangement for a variety of intercurrent events. The mean amount of doctor's time devoted to each patient was 25 min. Among the main diseases seen at dermatology day hospitals, we noted cancer (44 % of admissions, 322 cases), psoriasis (7 % of admissions, 54 cases) and chronic wounds (5 % of admissions, 43 cases). DISCUSSION: Dermatology day hospitals serve to provide treatment for complex or costly diseases requiring a variety of specialised laboratory examinations in a single unit all at one time. A considerable workload is generated, particularly in medical and administrative terms. These are well-adapted structures with their own staff, a selection of technical means and upstream scheduling allowing multidisciplinary patient management. Day hospitals meet a real need in dermatology.