Assessing the quality of care by house staff in a mucicipal hospital emergency department

The hypothesis that the results of process measures of the quality of care would be improved in a busy municipal hospital emergency department by using a medical record audit and reviewing findings with house staff and those responsible for their training was tested over a one year period and, tentatively, rejected. Out of 21 audit items, 14 showed no significant change. Of the remaining seven, only three items showed significant improvement. Other mediating factors are related to quality of care in this setting such as patient/staff ratios, supervision, the focus of training programs, the physical plant, staff attitudes, behavior and questions of control.