Sortie du patient handicapé : de la fragmentation à la coopération

The standards of production in a hospital unit (based on homogeneous groups of patients) stands on triple criteria: rationalization of care process, evidence based medicine, and resource utilization groups. This all defines the sanitary model at hospital admission. The real discharge is social and medical. It faces the complexity of various cases based on biological, psychological and social criteria. The assessment of professional practices dedicated to the improvement of the discharge process of heavily disabled patients tested the “Intermed”score. We studied how to stratify the needs inside and outside the hospital. The aim was double: improve the quality of care and decrease the vulnerablility of the hospital to the lack of solution. Over 13 patients who did need hopitalisation after four months: 11 where under 60 years old, 11 had a three points score at the Glasgow score, all of them had at least a 25 points score at the “Intermed” test at admission, one who had a two points GOS had a 23 points Intermed score. We suggest to pursue the study of the use of Intermed score for SSR short stays on the base of the graduated answers it allows as multidisciplinary teams or social and health networks.