[The role of medical management in the involvement of the emergency department in the hospital].

The functional and structural reordering of the accident and emergency services is a priority for hospital management staffs. A true reordering must be based on the following questions: 1.Demand for accident and emergency care is predictable. 2.The way the hospital deals with this can be improved. 3.Hospitals have the responsibility of setting up patient control mechanisms as an alternative to conventional admission. The role of the centre's admissions unit in managing patients is basic in defining the functional regulations and procedures for managing admissions; in setting up a daily planning and decision making meeting with the active participation of the management, the admissions unit and the accident and emergency unit, as well as drawing up a daily map of hospitalisation needs. Other policies will facilitate a more efficient patient circuit from admission to discharge: -Setting up a 24 hour accident and emergency preadmission unit. -Implementing an effective system of bed assignment based on priorities. -Adapting urgent admissions and scheduled ones (for diagnostic tests, surgery) by implementing fast ambulatory diagnostic pathways and by implementing conventional hospital alternatives such as short stay units, home hospitalisation, preadmission units, convalescence units. -Implementing hospital policy on internal patient circulation. (internal movements, priorities in patients' location, discharges.).