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World Journal of Emergency Medicine ›› 2019, Vol. 10 ›› Issue (2): 94-100.doi: 10.5847/wjem.j.1920-8642.2019.02.005

Special Issue: Survey on Emergency Medicine

• Original Articles • Previous Articles     Next Articles

Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

Mark Rose1, Carina Newton1, Benchaa Boualam3, Nancy Bogne3, Adam Ketchum3, Umang Shah3, Jordan Mitchell3, Safura Tanveer3, Tucker Lurie4, Walesia Robinson1, Rebecca Duncan2, Stephen Thom1, Quincy Khoi Tran1,2()   

  1. 1 Department of Emergency Medicine, University of Maryland, School of Medicine, Baltimore, USA
    2 Program of Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, Baltimore, USA
    3 University of Maryland at College Park, College Park, USA
    4 University of Maryland, School of Medicine, Baltimore, USA
  • Received:2018-06-15 Accepted:2018-11-30 Online:2019-06-15 Published:2019-06-15
  • Contact: Quincy Khoi Tran E-mail:qtran@umm.edu

Abstract:

BACKGROUND: Acute aortic dissection (AoD) is a hypertensive emergency often requiring the transfer of patients to higher care hospitals; thus, clinical care documentation and compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) is crucial. The study assessed emergency providers (EP) documentation of clinical care and EMTALA compliance among interhospital transferred AoD patients.
METHODS: This retrospective study examined adult patients transferred directly from a referring emergency department (ED) to a quaternary academic center between January 1, 2011 and September 30, 2015. The primary outcome was the percentage of records with adequate documentation of clinical care (ADoCC). The secondary outcome was the percentage of records with adequate documentation of EMTALA compliance (ADoEMTALA).
RESULTS: There were 563 electronically identified patients with 287 included in the final analysis. One hundred and five (36.6%) patients had ADoCC while 166 (57.8%) patients had ADoEMTALA. Patients with inadequate documentation of EMTALA (IDoEMTALA) were associated with a higher likelihood of not meeting the American Heart Association (AHA) ED Departure SBP guideline (OR 1.8, 95% CI 1.03-3.2, P=0.04). Male gender, handwritten type of documentation, and transport by air were associated with an increased risk of inadequate documentation of clinical care (IDoCC), while receiving continuous infusion was associated with higher risk of IDoEMTALA.
CONCLUSION: Documentation of clinical care and EMTALA compliance by Emergency Providers is poor. Inadequate EMTALA documentation was associated with a higher likelihood of patients not meeting the AHA ED Departure SBP guideline. Therefore, Emergency Providers should thoroughly document clinical care and EMTALA compliance among this critically ill group before transfer.

Key words: Acute aortic dissection, EMTALA, Interhospital transfer, Documentation, Compliance