National study on the quality of emergency department care in the treatment of acute myocardial infarction and pneumonia.
OBJECTIVE
To measure the quality of emergency department (ED) care for patients with acute myocardial infarction (AMI) and pneumonia (PNA) and to estimate the number of preventable deaths in these patients.


METHODS
The authors performed a cross sectional study of ED visits with the diagnosis of AMI or PNA from 1998 to 2004. Data from the National Hospital Ambulatory Medical Care Survey were used. The study involved 544 EDs across the United States. The authors measured the proportion of patients receiving recommended therapies for AMI (aspirin and beta-blockers [BBs]) and PNA (appropriate antibiotics and pulse oximetry). The excess deaths associated with current care were estimated.


RESULTS
Aspirin was administered to 40% and BBs to 17% of patients with AMI. Recommended antibiotics were administered to 69% and pulse oximetry was measured in 46% of patients with PNA. During the study period, the percentage receiving BBs and recommended antibiotics increased. There were more than 2.7 million opportunities to improve care and 22,000 excess deaths per year associated with current treatment of AMI and PNA.


CONCLUSIONS
Quality of care in the ED management of AMI and PNA is below national goals. This deficiency accounts for significant preventable deaths.
Pham
Julius Cuong
JC
Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. jpham3@jhmi.edu
Kelen
Gabor D
GD
Pronovost
Peter J
PJ
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010092:Oximetry / Q000706:statistics & numerical data; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents; D001241:Aspirin