Pham Julius Cuong, Kelen Gabor D, Pronovost Peter J
Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Acad Emerg Med. 2007 Oct;14(10):856-63. doi: 10.1197/j.aem.2007.06.035.
To measure the quality of emergency department (ED) care for patients with acute myocardial infarction (AMI) and pneumonia (PNA) and to estimate the number of preventable deaths in these patients.
The authors performed a cross sectional study of ED visits with the diagnosis of AMI or PNA from 1998 to 2004. Data from the National Hospital Ambulatory Medical Care Survey were used. The study involved 544 EDs across the United States. The authors measured the proportion of patients receiving recommended therapies for AMI (aspirin and beta-blockers [BBs]) and PNA (appropriate antibiotics and pulse oximetry). The excess deaths associated with current care were estimated.
Aspirin was administered to 40% and BBs to 17% of patients with AMI. Recommended antibiotics were administered to 69% and pulse oximetry was measured in 46% of patients with PNA. During the study period, the percentage receiving BBs and recommended antibiotics increased. There were more than 2.7 million opportunities to improve care and 22,000 excess deaths per year associated with current treatment of AMI and PNA.
Quality of care in the ED management of AMI and PNA is below national goals. This deficiency accounts for significant preventable deaths.
评估急诊科对急性心肌梗死（AMI）和肺炎（PNA）患者的护理质量，并估算这些患者中可预防死亡的人数。
作者对1998年至2004年诊断为AMI或PNA的急诊科就诊病例进行了横断面研究。使用了来自国家医院门诊医疗调查的数据。该研究涉及美国各地的544家急诊科。作者测量了接受AMI推荐治疗（阿司匹林和β受体阻滞剂[BBs]）和PNA推荐治疗（适当的抗生素和脉搏血氧饱和度测定）的患者比例。估算了与当前治疗相关的额外死亡人数。
40%的AMI患者接受了阿司匹林治疗，17%的患者接受了BBs治疗。69%的PNA患者接受了推荐的抗生素治疗，46%的患者进行了脉搏血氧饱和度测定。在研究期间，接受BBs和推荐抗生素治疗的比例有所增加。每年有超过270万个改善护理的机会，与当前AMI和PNA治疗相关的额外死亡人数为22000人。
急诊科对AMI和PNA的管理护理质量低于国家目标。这种不足导致了大量可预防的死亡。
