Abstract
A quality-assurance program for hospital care has been well accepted in Japan, but clinical indicators for evaluating the quality of care in tertiary emergency medical centers have not been identified. The Committee of Clinical Indicators for Quality Assurance of the Japanese Association for Acute Medicine therefore developed ten such indicators, including two indicators for head injuries, three for abdominal injuries, two for cardiopulmonary resuscitation, two for acute myocardial infarctions, and one for asthmatic attacks. Assessments were prospectively made using a questionnaire over a 3-month period, from April 1 to June 30, 1999, during which 4, 860 cases were collected from 80 out of 159 Japanese emergency and critical care centers. Suitable clinical indicators appeared to include the time from admission until computed tomography examination for isolated head traumas, time from admission until laparotomy in hemodynamically unstable abdominal traumas, blood gas analysis in the emergency room (ER) for endogenic cardiopulomonary arrest on arrival (CPAOA), return of spontaneous circulation in endogenic CPAOA, time from admission until thrombolytic therapy in acute myocardial infarction, and the mortality rate for acute myocardial infarction. A cross-analysis on the characteristics of hospitals showed an association between a larger number of treated patients and better procedures and outcomes. In conclusion, certain clinical indicators were determined to be useful for evaluating the quality of care in tertiary emergency medical centers. The development of new clinical indicators and the consolidation of disease-specific registry systems are the next anticipated tasks of the committee.
