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Researcher: ER Patients Dead and Alive in Federal Database

October 26, 2012
by Gabriel Perna
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According to a report produced by a Loma Linda University Medical Center researcher, and posted on the Annals of Emergency Medicine website, a number of intubated emergency patients within a federal database were listed as both dead and alive. The report calls into the data quality of the National Hospital Ambulatory Medical Care Survey (NHAMCS), which is produced by the Centers for Disease Control and Prevention.

"Eleven patients were recorded as having both died in the ER and been admitted to the ICU," study author Steven Green, M.D., of Loma Linda University Medical Center in Loma Linda, Calif, said in a statement. "In addition, while it is theoretically possible that a patient could be intubated, extubated and discharged, it would be a highly unusual circumstance. It is impossible to believe that more than one-fourth of these patients were placed anywhere other than the ICU or the morgue, and yet that is what 10 years of federal reports indicate. Something doesn't add up."

For the study, Green looked 875 emergency department visits where a patient was intubated, meaning they either die or are admitted to a critical care unit. He found, NHAMCS recorded that nine percent of those patients were discharged from the hospital and 17 percent were admitted to a non-critical care unit, something that he says is medically impossible. Furthermore, he found in 37 of the visits, there was conflicting information in the disposition, including the 11 patients recorded as both dead and alive. He also found one patient being recorded as having been taken to surgery and being transferred another hospital.

"In view of how much the medical community has come to depend upon and trust the NHAMCS database, these findings are troubling,” Green added. "NHAMCS is overall a fabulous program with a talented, dedicated staff. However, it is clear that some important data elements are not being accurately abstracted, and that greater attention to the reliability of the chart review process is necessary."


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