[The emergency department: a new concept for a reform]

Emergency care are now restructuring in France. The role of emergency departments is defined by new regulations. They include the closure of small emergency rooms and definition of three levels for the others. The most advanced units, i.e. level 1 or S.A.U., will be equipped and staffed to respond to any kinds of medical problems. However, such a restructuration requires high investments from the hospitals and changes in patient's habits. This document describes the organization of a level 1 emergency department in a large teaching hospital in Paris. Principles and tools used to design this model have been drawn from a previous analysis of different emergency care in North America and Europe. The role of triage nurse, observation units, information system, continuous quality improvement approaches are described. Team work training has been used to put these new concepts in. Academics and research activities from this department are also reported.