Impact of an emergency medicine residency program on the quality of care in an urban community hospital emergency department

Study objectives: To assess the impact of the introduction of an emergency medicine residency program on the quality of care in an urban community hospital emergency department. Design: A retrospective chart review of all ED encounters for a three-month period beginning six months before and six months after the introduction of an emergency medicine residency. Setting: A 27,000-visit-per-year urban community hospital ED. Type of participants: All patients who presented to the ED with one of five complaints and subsequently were discharged home. The five presenting categories examined were nontraumatic chest pain when age 30 years or more, lower abdominal pain in women aged 15 to 40 years, recent head trauma, headache of nontraumatic origin, and extremity laceration. Interventions: None. Measurements and main results: The frequency of physician documentation on the ED record of explicit criteria related to the five presenting complaints was used as a measure of the quality of care. Items sought for documentation included elements of. the history and physical examination and diagnostic evaluations. The explicit criteria lists were drawn from the literature, including clinical policy guidelines. For each of the presenting complaints evaluated, documentation of the majority of items reflecting the quality of care was higher during the residency period. In no instance did the level of documentation decrease. Conclusion: As measured by a process evaluation, documentation of the medical record, the introduction of an emergency medicine residency significantly improved the quality of care in this urban community hospital ED.