Medical education and quality of care in the pediatric emergency department setting: a combined model.

ABSTRACT

OBJECTIVES: To describe a combined program for ongoing medical education and quality assurance in the pediatric emergency department. METHODS: Between January and June 2003, all residents and students working in the emergency department of a major tertiary pediatric center were required to participate in a structured 1-h morning session every weekday conducted by the attending physician. The charts of all children who had presented to the emergency department within the last 24 h were systematically reviewed for measures of management and pertinent clinical, academic, or administrative aspects. Radiology reports were reviewed for discrepancies between readings and culture results for appropriateness of treatment. All educational comments, X-ray discrepancies, culture findings that warranted a change in therapy, and unscheduled return visits to the emergency department within 24 h were recorded and statistically analyzed (BMDP software). RESULTS: The charts of 18,663 children aged 3 days to 18 years were reviewed. Educational comments numbered 1527 (8.2% of cases). Significant discrepancies were found in 216 X-ray films (6.1%) and nonsignificant discrepancies in 357 (10.2%). A change in therapy was indicated in 19 of 4005 blood cultures (0.5%), 59 of 1270 urine cultures (4.65%), and 227 other cultures (1.2%). One hundred eighty-three children (1.3%) returned for an unscheduled visit. Over time, there was an increase in nonsignificant X-ray discrepancies and a decrease in educational comments and significant X-rays discrepancies. CONCLUSIONS: A combined program of medical education/quality assurance-improvement in the emergency department is feasible and seems to contribute to improved medical services and patient care.