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American Academy of Emergency Medicine

Quality of Care Study

Impact of an Emergency Medicine Residency Program on the Quality of Care in an Urban Community Hospital Emergency Department

Robert M. McNamara, M.D., John J. Kelly, D.O.

Ann Emerg Med. 1992;5:65-70.

The impact of the introduction of an Emergency Medicine residency program with primarily Emergency Medicine residency-trained faculty was assessed to determine the quality of care in an urban community hospital Emergency Department with approximately 27,000 patient visits a year. The authors examined this issue by virtue of a natural experiment where such a program assumed responsibility for physician coverage of an urban community hospital Emergency Department from a group of nonresidency-trained emergency physicians in July 1989. A retrospective chart review was conducted of a consecutive sample of patients who presented to the Emergency Department with one of five complaints and subsequently were discharged home during January through March 1989 and January through March 1990. The quality of care provided was assessed by the frequency of physician documentation on the Emergency Department record of specific items related to the evaluation of these complaints.

The study demonstrated a higher quality of care after the introduction of the Emergency Medicine residency for each of the conditions examined. These conditions included adults with chest pain, women with abdominal pain, patients with head injury, headache or an extremity laceration.

The results of this study support the concept that the development of Emergency Medicine as a specialty has had a positive impact on the quality of care in the Emergency Department. Currently, residency-trained emergency physicians are highly concentrated in states where Emergency Medicine residencies are located. Efforts to increase the number and geographic distribution of training programs in this field should be encouraged as this will allow placement of well-trained emergency physicians in more US hospitals.