Emergency management, unfollowed audit… The regional audit chamber criticizes the Rouen University Hospital

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Some good, and some not so good. A report published on December 12, 2024 by the Normandy regional audit chamber examines the Rouen University Hospital, and more particularly management of hospital emergencies.

In this document, the Court of Auditors recalls in the preamble that “the adult emergency service provides the main unscheduled care provision in the region”. If this document highlights efforts undertaken to establishhe also observes gaps. We take stock.

The emergency problem

On the subject of emergencies, the Normandy regional audit chamber notes that the CHU does not sufficiently take into account several orientations.

The regional health project, the shared medical project of the regional hospital group, the multi-year contract of objectives and means and the establishment project converge on two priorities: on the one hand, avoiding the passage to the emergency room of patients in cases non-urgent and develop the reorientation of patients, and on the other hand, ensure the fluidity of downstream care which remains to be structured, thanks in particular to dialogue with hospital partners and city professionals. However, an examination of the available data demonstrates that, for the moment, these guidelines have little impact on the reality of patients' territorial journeys.

Thus, the Court of Auditors points the finger at the Saint-Julien site. “The vocation of this secondary site (20% of total passages [aux urgences]), raises questions, because its profile close to an 'unscheduled care center' calls for initiating reflection on its future,” underlines the chamber. She thus underlines that the structuring internal organizational strategy must “be reinforced”, but nevertheless notes an improvement.

In response to the report, the Rouen University Hospital sent a press release on Friday December 20. The establishment simply welcomes the fact that “the CRC indicates that significant efforts have been made to streamline internal care, in particular through the creation of a temporary hospitalization unit and a bed management unit” .

The recommendations of the 2017 audit insufficiently followed

Throughout this report, which comprises nearly 70 pages, the Court of Auditors mentions several times an audit carried out in 2017 following “internal tensions [nées] between certain doctors in the service and their supervision following the application of the instruction of July 10, 2015.

The recommendations of the audit on this organization were therefore not followed in part and are no longer supported by the establishment.

“It appears that part of the audit recommendations, which the CHU had nevertheless endorsed in 2017-2018, by including them in an “action plan” were not implemented and no longer appear to be relevant. “news”, tackles the Court of Auditors.

On this subject, the Rouen University Hospital did not make any comments in its press release.

The difficulty of recruiting

Next comes the question of recruitment. This subject is not new, and is obviously not specific to Rouen University Hospital, but this difficulty concerns the entire world of health. The Court of Auditors thus underlines “a problem with the recruitment of emergency doctors, which the CHU compensates for by maintaining specialist guards in the emergency room”.

The attachment of the SAMU within another “resuscitation, anesthesia, SAMU” center divides emergency doctors. This isolation of the SAMU is seen as unattractive for the service, although a certain number of emergency doctors have this dual practice despite everything. This particularity was considered a defect by the service's audit mission, carried out in 2017.

For its part, the CHU responds that its attractiveness policy “has made it possible to reduce the temporary closures of hospitalization beds which complicated the organization of emergencies. »

The Rouen University Hospital has never recruited as much as in 2024, which allowed it, between March and October 2024, to reopen 96 beds out of the 123 which were still closed at the start of the year due to post-covid recruitment difficulties .

The chamber calls for better monitoring

Finally, the Court of Auditors makes another request, calling for more monitoring indicators. “This need for monitoring indicators also concerns internal functioning (flow by sector of the emergency department, waiting times or transmission times of results), which was questioned in 2017 by an external audit, but whose recommendations have only been partially implemented,” takes the chamber as an example.

The University Hospital was not able to produce data on patients treated in the emergency department, then referred to other, more suitable health establishments. […] The University Hospital should expand its monitoring of indicators, based on data collection, to enable it to identify and analyze patient flows.

Thus, the Court of Auditors indicates that the emergency re-consultation rate is not monitored by the CHU, and deplores that “this indicator is nevertheless expected within the framework of its multi-year contract of objectives and means”. Finally, the chamber calls on the CHU to “strengthen the collection and monitoring of this information, in order to shed light on areas for improving the care offered to patients”.

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