Approach to quality assurance in an emergency department: a one-year review.

The Joint Commission on Accreditation of Hospitals requires that an organized quality assurance program be in place for all emergency departments under its review. The authors' institution has had a quality assurance program since 1978. The program is structured to assess medical records against pre-established standards of medical care; to review all radiologic, electrocardiographic and bacteriologic culture reports to avoid discrepancies following initial clinical intervention; and to analyze all emergency department deaths. A review of this program was undertaken for the year 1982 to assess outcome and benefit. Of 74,760 charts reviewed, 744 did not meet the pre-established standards. Seventy-seven patients were asked to return to the emergency department at once. Three hundred fourteen radiographs were initially misread by clinicians and 63 patients were called back for immediate reexamination. Seventy-four electrocardiograms were initially misinterpreted, and 21 patients required urgent call-back. One hundred eighteen patients with positive urine cultures and 35 patients with positive throat cultures were not treated or were incorrectly treated during their initial visit. These patients were notified of the need for additional therapy. There were 158 emergency department deaths, and 11 were thought to have been possibly preventable.