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Health 2008, May 2   Creating “medical branches”     Nearby hospitals throughout the region are joining forces with the Poitiers CHU in order to improve patient management while pooling together their respective spheres of competence and material means. The glaring lack of specialized doctors in France is compelling public hospitals to coordinate their efforts to ameliorate their welcome of patients. The regional sanitary organization schema (Sros) has given rise to a concept of cooperation in some activities between local hospital establishments and those considered as “recourses”, which are to be found in the four departmental capitals (Poitiers, Niort, Angoulême, La Rochelle) as well as Saintes in the southern area of Charente-Maritime. Thanks to this new structuring of medical care, a patient requiring chemotherapy in his cancer treatment will follow the same protocol throughout the territory. In other words, someone hospitalized in a rural area will undergo the same cure as would a fellow patient in the Poitiers CHU. One advantage the affirmation you just read is that it breaks with some preconceived ideas. More precisely, certain local establishments have already chosen to contractually stipulate partnership with their reference hospital in the form of inter-hospital medical federations. This is the case with the Montmorillon hospital center, which presently welcomes staff members from Poitiers several times a month, as is explained by its director, Jean Martin: “Since January, a visceral surgery specialist from the Poitiers CHU comes once a week and, every fifteen days, Dr. Cartier performs advanced consultations in carcinological surgery (relative to cancer). They provide reinforcement for our surgeon. Moreover, we have created our own biology facilities. The results of analyses performed by our laboratory are subsequently transferred for interpretation to a secure computerized CHU-based network.”. « We organize medical branches, indicates in his turn Thierry Lefèvre, associate general director of the Poitiers CHU. It is in our interest to integrate patients from southern Vienne who might be enticed by other public or private hospitals. We perform 50% of the surgical interventions in Poitou-Charentes, and this must be made to last.” It should be added the doctors remain administratively attached to the Poitiers CHU, thereby facilitating recruitment. A dearth of radiologists The new public health policy is based on a clearly documented fact, which is that hospitals are not able to bring about each and every intervention. In other words, they need to hand off the football. Above and beyond questions of financial wherewithal, a ward that fails to effectuate a minimum number of operations per year is now deemed incompetent. In each discipline, threshold numbers have been set. As a result, one of the new prerogatives of local hospitals consists in their welcoming long-term patients in need, for example, of reeducation. Each establishment likewise retains its emergency service, and must consequently cope with a dearth of radiologists – yet another reason for cooperation. And just like Montmorillon, the Confolens hospital center recently signed a convention with the CHU so as to develop “computer-based expertise”. Everything remains to be done, including the purchase of digitization material for radiographs, which will be financed by the regional council. Coordination of investments is another salient feature of the regional and interregional cooperation presently coming into being. 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