Patient Issues
ER Patients Are Both Dead and Alive in Federal Database
Oct 26, 2012 - 10:06:57 AM

( - WASHINGTON - According to the National Hospital Ambulatory Medical Care Survey (NHAMCS) - a report produced by the Centers for Disease Control and Prevention - one-quarter of intubated emergency patients are either discharged from the hospital or admitted to a non-critical care unit, which is medically impossible. An analysis of 10 years of NHAMCS reports, published yesterday online in Annals of Emergency Medicine, raises serious questions about the accuracy and reliability of NHAMCS data on intubated patients ("Congruence of Disposition After Emergency Department Intubation in the National Hospital Ambulatory Medical Care Survey")

"Eleven patients were recorded as having both died in the ER and been admitted to the ICU," said study author Steven Green, MD, of Loma Linda University Medical Center in Loma Linda, Calif. "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."

Dr. Green analyzed 875 emergency department visits in which a patient was intubated. Intubated patients either die or are admitted to a critical care unit. However, the NHAMCS recorded that 9 percent of those patients were discharged from the hospital and 17 percent were admitted to a non-critical care unit. In 37 of the visits, disposition was recorded multiple ways, as in the 11 patients recorded as both dead and alive. Another example is one patient being recorded as having been taken to surgery and also transferred to another hospital.

"In view of how much the medical community has come to depend upon and trust the NHAMCS database, these findings are troubling," said Dr. Green. "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."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit

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