Study on the Discrepancies between the Admitting Diagnoses from the Emergency Department and the Discharge Diagnoses

Abstract

Objective To study the extent of diagnostic discrepancies at admission (diagnoses made by doctors in the Emergency Department) and discharge (final diagnoses at the ward) in our Emergency Department (ED) where the doctors have direct admitting rights; and how such discrepant diagnoses affected inter-departmental transfer of patients after their admission. Method A non-concurrent cohort study was performed on admissions through our ED between 24th to 30th April 1997. The admitting and discharge diagnoses and units were recorded. The reasons for the unmatched diagnoses and inter-departmental transfers were studied. The significance of transfers amongst patients who had matched and unmatched diagnoses was compared using the Chi-test at 95% confidence interval. Results Three hundred and sixty-one admissions were recorded during the study period. There were 314 (86.7%) and 47 (13.3%) admissions with matched and unmatched diagnoses respectively. Nine of the 47 admissions with unmatched diagnoses and 16 of the 314 admissions with matched diagnoses were transferred (p=0.001). Conclusion The ED doctors achieved a high level of diagnostic accuracy. The most common reason for unmatched diagnosis was because of the difficulty of diagnosing the patient's complex medical problem in the short contact time in the ED. The level of accuracy should increase with the advent of more diagnostic modalities and increased contact time with the patients in the ED.