Quality of care for joint dislocation in 47 US EDs.
BACKGROUND
Little is known about emergency department (ED) quality of care for joint dislocation. We sought to determine concordance of ED management of dislocation with guideline recommendations and to assess whether higher concordance was associated with better patient outcomes.


METHODS
We conducted a retrospective chart review study of joint dislocation as part of the National ED Safety Study (www.emnet-usa.org). We identified all charts with a primary ED or hospital discharge diagnosis of joint dislocation in 47 EDs across 19 US states between 2003 and 2005. Concordance with guideline recommendations was evaluated using 5 individual quality measures and composite guideline concordance scores. Concordance scores were calculated as the percentage of eligible patients receiving guidelines-recommended care. These percentage scores were rescaled from 0 to 100, with 100 indicating perfect concordance.


RESULTS
The cohort consisted of 1980 ED patients; the patients' median age was 38 years, and 63% were men. Care for dislocation was excellent, with a concordance score of more than 85 across all quality measures. The median ED composite guideline concordance score was 93 (interquartile range, 90-95). In multivariable analyses, receiving treatment in EDs with the highest (fourth quartile) composite guideline concordance scores was independently associated with a significantly higher likelihood of successful joint reduction (adjusted odds ratio, 3.28; 95% confidence interval, 1.38-7.81), as compared with treatment in EDs with the lowest (first quartile) scores.


CONCLUSIONS
Concordance of ED management of joint dislocation with guideline recommendations was high. Greater concordance with guideline-recommended care may increase the likelihood of successful joint reduction.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Chu-Lin
CL
Tsai
Ashley F
AF
Sullivan
James A
JA
Gordon
Rainu
R
Kaushal
David J
DJ
Magid
David
D
Blumenthal
Carlos A
CA
Camargo
D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059408:Pain Management / Q000592:standards; D010147:Pain Measurement / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States