Tribune. “We must completely get out of the dogma of reducing beds in architectural hospital projects”, declared Olivier Véran on November 18, during the national seminar of hospital workers. These remarks are consistent with the abolition of the interministerial committee for performance and modernization of the hospital care offer (Copermo), announced during the Ségur de la santé. However, in the field, the hospital projects imposed by the Copermo of the “world before” are continuing in Caen, Rennes, Nantes, Reunion, Nancy, Paris …
Thus, the Grand Paris Nord hospital campus project, which provides for the merger of two very large hospital structures, the university hospital centers of Bichat (18e arrondissement) and Beaujon to Clichy (Hauts-de-Seine), is still in progress with minimal modification. A new hospital, adjoining the university and research part, is to be built in Saint-Ouen (Seine-Saint-Denis), and the project still provides for the closure of more than 300 full hospital beds in medicine, surgery and in obstetrics, which represents a drop of almost 30% in hospital capacity.
Shortened average length of stay
The logic behind the elimination of this very large number of beds is clearly described in the various medical projects. It stems from two accounting objectives imposed by Copermo.
First objective: a shortening of the average length of stay (DMS) is requested for Bichat-Beaujon, which would result in a length of hospitalization 30% less than that of other French hospitals. Thus, for a given pathology, if the duration of hospitalization is, on average, six days in French hospitals, it should be four days in the new hospital.
This objective is not justified by any medical or scientific study. On the contrary, the development of ambulatory care, a desirable objective, is only possible for the less severe patients. Full hospitalization will therefore be reserved for the heaviest patients with longer MSDs, as shown by the projections of the Department of Research, Studies, Evaluation and Statistics (Drees).
Second objective: achieve a bed occupancy rate of over 95%. However, an occupancy rate above 85% does not make it possible to accommodate unscheduled patients, that is to say emergencies referred by city doctors as well as people who arrive at the emergency room and who require hospitalization. For example, a twenty-bed cardiology department with an occupancy rate of 95% would therefore only have one bed free at all times. It seems difficult in these conditions to be able to receive patients urgently.
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