Quality Of Emergency Medical Care Research Articles

The New Japanese Postgraduate Medical Education and Quality of Emergency Medical Care

BackgroundThe new postgraduate medical education (PGME) was recently introduced to improve quality of emergency care in Japan. ObjectivesTo compare the quality of care and confidence in provision of emergency medicine between physicians who completed the old and new PGME programs. MethodsA cross-sectional survey was sent to 279 physicians of postgraduate years 4–9, and 208 responses (75%) were received. Quality of care in emergency medicine was measured using 26 questions on treatment choices for various clinical conditions. Each question had six responses, including a single correct choice. Effect size was obtained by dividing the total difference in score by the standard deviation of the score distribution. Confidence in emergency medicine was rated using four self-reported items on the level of confidence in treating acute illnesses in various emergency medicine settings. ResultsThe mean score for quality of care was significantly higher in the new PGME group (15.3) compared to the old PGME group (12.8). The difference in scores was 2.5 (p < 0.01) and the effect size (0.47) indicated a moderate difference. Linear regression of total scores adjusted for physician covariates produced similar results of an adjusted score difference of 2.5 (p < 0.01) and an adjusted effect size of 0.47. The new PGME group also had significantly greater confidence in provision of emergency medicine based on significant differences between the groups for all four self-reported items (all p < 0.05). ConclusionsJapanese physicians who complete the new PGME program are likely to provide higher quality of care and have greater confidence in emergency medicine compared to those who completed the old PGME program.

The Quality of Emergency Medical Care in Baden-Württemberg (Germany)

In 2004, the German federal state of Baden-Württemberg implemented a quality management system for pre-hospital emergency care. Since then, there has been a semi-annual assessment of the frequency of different types of emergency medical interventions and the quality of care. The frequencies of different types of intervention were determined and reported both in absolute numbers and as incidence figures, i.e., interventions per 1000 inhabitants per year. The quality of care was rated with the Mainz Emergency Evaluation Score (MEES), and analyses of resuscitation outcomes and guideline implementation were performed. From 2004 to 2008, there were a total of 524,833 pre-hospital emergency medical interventions in Baden-Württemberg. The annual incidence of emergency interventions rose by 22% over this period (from 16.2 to 19.9 interventions per 1000 inhabitants per year), and the percentage of patients who were severely ill or severely injured rose as well, from 47.3% to 51.1%. The percentage of patients over age 75 rose from 29.1% to 31.3%. 11,858 patients with myocardial infarction (MI) were treated in 2008; the incidence of treatment for MI rose by 60% from 2004 to 2008, from 0.907 to 1.448 interventions per 1000 inhabitants per year. A major improvement in the diagnostic evaluation of MI came about through the purchase of more 12-channel ECG machines. In 2008, the emergency medical teams succeeded in improving the patient's condition in 69.07% of all cases (77.9% for MI, 63.2% for stroke, 74.4% for multiple trauma). 21 patients per 100,000 inhabitants per year arrived in the hospital alive after out-of-hospital cardiac arrest and pre-hospital resuscitation. Even in the face of increasing utilization, the quality of emergency medical care in Baden-Württemberg has remained high. Since a quality management system was introduced in 2004, the physicians in charge of emergency medical teams have had access to the data that they need in order to evaluate and further develop the services that they provide.

Quality assurance and clinical indicators in emergency medicine

Quality assurance and clinical indicators in emergency medicine

Assessment of injury severity: the triage index.

Injury severity scales of proven reliability and validity are essential for the appropriate allocation of therapeutic resources, for prediction of outcome, and for evaluation of the quantity and quality of emergency medical care in differing facilities and over time. Quantitation of injury severity in the field is particularly necessary. Existing scales are too imprecise to permit comparisons of management or systems of care. In this paper, the authors present the Triage Index, a measure of injury severity based on five simple variables observed in a design data set of 1084 patients. The Triage Index has been developed with state-of-the-art multivariate statistical techniques, meets the requirements of an interval ranking scale, and has been both validated and assessed for interuser reliability. The Triage Index is proposed as a validated system of early, rapid, noninvasive, accurate patient assessment permitting appropriate matching of trauma victims with available therapeutic resources as a means of reducing mortality and morbidity.

Trauma Care Study

To the Editor .—Early in their careers, physicians are taught the responsibility of accuracy and validity. Abuse of a scientific forum is a serious matter, with wide-ranging implications for individual patient care and medicolegal issues. Drs West, Trunkey, and Lim in theArchives(114:455-460, 1979) described a method and offered conclusions relating to comparisons of the quality of emergency medical care between two geographical areas. The report almost totally avoids the qualifications necessary for a valid scientific presentation. The Society of Neurologic Surgeons of Orange County, Calif, has determined that none of the authors of this report is either a neurosurgeon or a neuropathologist, or has ever consulted with members of either specialty. The authors are thus unqualified to assess care of patients with injuries to the CNS. Furthermore, a committee of the Society of Neurological Surgeons of Orange County has reviewed the available CNS-injury material of their report and

Toward a system of emergency medical care.

A previous column1 traced the impetus for a program to improve the quality of emergency medical care in Massachusetts. Co-ordinated by the Department's Office of Emergency Medical Services, the program's objectives are to upgrade resources of personnel and equipment in the pre-hospital and hospital sectors and to establish co-ordinated systems of care that meet local needs but are consistent with statewide minimum standards. Some of the progress to date merits consideration: the acquisition of modern equipment; the training of personnel who deliver care at the scene of an emergency, en route to the hospital, and in the emergency ward; and . . .