Emergency departments across the nation are failing to meet
national goals in treating many
heart attack and pneumonia patients, according to a study by
Johns Hopkins researchers published in
the October issue of Academic Emergency Medicine.
In a survey that also found care levels dependent on race,
geography and type of health
insurance, the investigators studied records of 1,492 heart
attack patients and 3,955 pneumonia
patients seen at 544 emergency departments between 1998 and 2004.
Results showed only 40 percent emergency department
compliance with recommended aspirin
therapy and 17 percent with recommended beta blocker treatment of
heart attack patients. Only 69
percent of patients with pneumonia got recommended antibiotics,
and fewer than half (46 percent)
had blood oxygen levels assessed as recommended by the American
The Joint Commission regulating hospitals and the Centers
for Medicare and Medicaid Services
say that all eligible heart attack and pneumonia patients
presenting to emergency departments should
receive aspirin/beta blocker therapy, or antibiotic and oxygen
"If these numbers are applied nationwide, we estimate that
as many as 22,000 deaths a year
could be prevented in the U.S. if ED caregivers followed practice
standards," said Julius Pham,
principal investigator for the study and assistant professor of
in the Johns Hopkins
Emergency Medicine and
Anesthesiology and Critical Care Medicine. "More resources
should be directed at studying why this is happening and [at]
developing strategies to ensure that 100
percent of patients get the recommended treatments."
Also troubling, the Johns Hopkins researchers say, are
racial, geographic and financial
differences in access to recommended care.
Whites were 40 percent more likely to receive aspirin
therapy than nonwhites, while people
going to emergency departments in the Northeast were 40 percent
more likely to receive aspirin than
similar patients in the West. Patients with private insurance
were consistently more likely to receive
appropriate treatment, while patients seen in government
hospitals, either state or county, were
consistently less likely to get the optimum care.
"These data suggest that the burden of inappropriate care is
borne more by minorities and the
poor than by others," Pham said. "They also suggest that we still
have much work to do to ensure that
everyone receives equitable care.
"Our findings lend support to the need for meaningful
measures of ED performance, such as
length of stay and return to ED within 72 hours, and for
monitoring to assure improvement," he said.
Other members of the research team were Gabor Kelen,
director of the Johns Hopkins
Department of Emergency Medicine; and Peter Pronovost, assistant
professor of anesthesiology and
critical care medicine and medical director of Johns Hopkins'
Center for Innovation in Quality Patient