Auditing the quality of care in emergency departments

A methodology for evaluating the quality of emergency department care in the form of a retrospective process audit for emergent and urgent cases was developed and tested in the Philadelphia General Hospital Emergency Department. A physician panel develped criteria against which the management of six "chief complaints," as indicated on the medical record, was measured. Then nonphysician auditors examined records retrospectively for a three-week period, covering every day and shift for a total sample of 389 cases. The physician panel made an implicit review of those records that varied from the criteria. The results of the review in four diagnostic areas showed that for chest pain 51% (36) did not meet the provisional standards; for abdominal pain 35% (35) did not; for wounds 51% (51) did not, and for sore throats 43% (22) did not. These results were presented to the ED staff and charts were re-audited after one month. The results of this second audit are being tabulated though preliminary findings indicate an improvement in the percentage of cases meeting the criteria.