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Background In France, the progressive use of emergency departments (EDs) by primary care providers (PCPs) as a point of access to hospitalization for nonurgent patients is one of the many causes of their overcrowding. To increase the proportion of direct hospital admissions, it is necessary to improve coordination between PCPs and hospital specialists. The objective of our work was to describe the design and implementation of an electronic referral system aimed at facilitating direct hospital admissions. Methods This initiative was conducted in a French area (Hauts-de-Seine Sud) through a partnership between the Antoine-Béclère University Hospital, the Paris-Saclay University Department of General Medicine and the local health care network. The implementation was carried out in 3 stages, namely, conducting a survey of PCPs in the territory about their communication methods with the hospital, designing and implementing a web-based application called “SIPILINK” (Système d'Information de la Plateforme d’Intermédiation Link) and an innovative organization for hospital management of the requests, and analysing through descriptive statistics the platform use 9 months after launch. Results The e-referral platform was launched in November 2019. First, a PCP filled out an electronic form describing the reason for his or her request. Then, a hospital specialist worked to respond within 72 h. Nine months after the launch, 132 PCPs had registered for the SIPILINK platform, which represented 36.6% of PCPs in this area. Of the 124 requests made, 46.8% corresponded to a hospitalization request (conventional or day hospitalization). The most requested specialty was internal medicine (48.4% of requests). The median time to first response was 43 min, and 43.5% of these requests resulted in direct admission (conventional or day hospitalization). Conclusions This type of system responds to a need for coordination in the primary-secondary care direction, which is less often addressed than in the secondary-primary care direction. The first results show the potential of the system to facilitate direct admissions within a short time frame. To make the system sustainable, the next step is to extend its use to other hospitals in the territory.

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BackgroundHospital discharge is a critical transition point for many inpatients, particularly elderly patient who are especially vulnerable. One of the main related cause is lack of coordination between the hospital and community healthcare professionals and caregivers. In our local territory (500 000 inhabitants, 14 cities), we have decided to improve coordination by focusing on communication.PurposeThe aim was to design, evaluate and compare a new discharge communication tool (NCT), according to the needs of the community caregiver and hospital professionals, with the classic institutional discharge form.Material and methodsGroup meetings, interviews and brainstorming sessions were organised to elaborate this NCT. Qualitative and quantitative methods were used to compare the two tools over 4 weeks, in the acute geriatric unit (AGU). Short answers and tick boxes were chosen to quickly screen patient information at discharge through 6 professional domains. Finally, we evaluated global satisfaction of NCT among community and hospital professionals by anonymous questionnaire or phone interviews.Results78 elderly patients were discharged from AGU. The main significant difference between the two communication tools was the transmission rate of these documents at discharge (70% for NCT vs 0%). The final reception rate by the final home based caregiver was 64% for the NCT. The NCT was significantly more completed, although it was sometimes partially completed. Nurses and nurses’ aides were the most implicated; physiotherapists had the best total level. However, geriatricians were not committed to this new process. Concerning professional satisfaction: community professionals were satisfied to very satisfied by the information transmitted which was considered clear and easy to read. On the hospital side, they considered the NCT easier and quicker to fill, clearer than the old version, and declared that it was significantly less time consuming than previously (5% vs 70%).ConclusionThis first collaborative and pilot study allowed us to pool energies from community and hospital professionals to develop a practical and useful communication tool to improve elderly patient discharge. This contributes to the elimination of existing silos all along the care process of the elderly patient and acknowledges the equal importance of each caregiver. More developments are warranted to further improve the availability rate of NCT to the final caregiver.No conflict of interest.