Introduction: The accuracy of Emergency Department (ED) in making a provisional diagnosis is crucial as it has direct impact on the patient treatment, safety, length of stay and cost of treatment. The study of the accuracy of the provisional diagnosis made by ED to compare with the discharge diagnosis is scarce in its availability and most results vary with different continents. This study was conducted to evaluate the accuracy of the diagnosis made by ED in Hospital Universiti Sains Malaysia (HUSM) and the factors contributed to the discrepancy.
Methods: This was a retrospective cross-sectional study in which medical records of patient admitted to HUSM within Mei 2016 until December 2017 were selected using simple random sampling methods. The folders were then reviewed and the association within the categorized diagnosis accuracy was analysed using the ICD-10 classification. The sample size was 180 cases and the accuracy of the diagnosis was divided into two main categories. The factors associated with the unmatched diagnosis from both, patients and provider were then measured using multiple logistic regressions.
Results: HUSM Emergency department had 84.4 percent of matched diagnosis with 15.56 percent of unmatched diagnosis. As the age of patient was younger by a year, we noted the probability of making unmatched diagnosis increased by two percent. No provider factors were noted to be associated with increase of the incident of unmatched diagnosis.
Conclusions: HUSM Emergency department had a low diagnostic discrepancy as compared to the discharge diagnosis.
admission, discharge, discrepancy, emergency, medicine, HUSM, malaysia, USM
2. Lim, G., et al., Study on the discrepancies between the admitting diagnoses from the emergency department and the discharge diagnoses. Hong Kong J Emerg Med, 2002. 9: p. 5.
3. Amiri, H., et al., Comparison of Presumptive Diagnoses in the Emergency Department and the Final Diagnoses in the Wards. Turk J Emerg Med, 2010. 10: p. 5.
4. Goh, S.H. and B.Y. Low, Accident & emergency department diagnosis--how accurate are we? Singapore Med J, 1996. 37(1): p. 24-30.
5. El-Mahalli, A.A. and S.A. Mokhtar, Miss and missed diagnosed cases at the emergency department of king fahd hospital of the university in khobar, king saudi arabia. The Journal of the Egyptian Public Health Association, 2008. 84(5-6): p. 501-516.
6. Wogan, J.M., ED follow-up: A comparison of admission and discharge diagnoses. The American Journal of Emergency Medicine, 2001. 19(3): p. 249-251.
7. Chattopadhyay, A., et al., Gap Analysis between Provisional Diagnosis on Admission and Final Diagnosis during Discharge-A Comparative Study.
8. Wu, C.-L., et al., Unplanned Emergency Department Revisits within 24 Hours in a Referral Hospital. 中華民國急救加護醫學會雜誌, 2008. 19(4): p. 146-154.
9. Goh, S.H., et al., Unplanned returns to the accident and emergency department--why do they come back? Ann Acad Med Singapore, 1996. 25(4): p. 541-6.
10. Lo, S.M., et al., Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments. International Emergency Nursing, 2014. 22(2): p. 116-120.
11. O'Connor, P.M., et al., Unnecessary delays in accident and emergency departments: do medical and surgical senior house officers need to vet admissions? J Accid Emerg Med, 1995. 12(4): p. 251-4.
12. Chiu, H., et al., A comparison of emergency department admission diagnoses and discharge diagnoses: retrospective study. Hong Kong J Emerg Med, 2003. 10(2): p. 70-5.
13. Ayanian, J.Z. and J.S. Weissman, Teaching hospitals and quality of care: a review of the literature. The Milbank Quarterly, 2002. 80(3): p. 569-593.
14. McPhee, S.J., M.A. Papadakis, and M.W. Rabow, Current medical diagnosis & treatment 2010. 2010: McGraw-Hill Medical New York:.
15. Wong JD, Bajear JM, Wong GG, Alibhai SM, Huh J-H, Cesta A, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Annals of Pharmacotherapy. 2008;42(10):1373-9.
16. Wogan JM. Emergency department follow-up of hospitalized patients. The American Journal of Emergency Medicine. 2000;18(4):510-1.
17. Willis BH, Sur SD. How good are emergency department senior house officers at interpreting X-rays following radiographers' triage? European Journal of Emergency Medicine. 2007;14(1):6-13.
18. Weatherburn G, Bryan S, Nicholas A, Cocks R. The effect of a Picture Archiving and Communications System (PACS) on diagnostic performance in the accident and emergency department. Journal of Accident and Emergency Medicine. 2000;17(3):180-4.
19. Urrutia A, Bechini J, Tor J, Olazábal A, Rey-Joly C. Evaluation of chest X-ray readings by emergency room physicians of a universitary hospital. Medicina Clinica. 2001;117(9):332-3.
20. Tudor GR, Finlay D, Taub N. An assessment of inter-observer agreement and accuracy when reporting plain radiographs. Brain and Language. 1997;52(3):235-8.
21. Ting HH, Lee TH, Soukup JR, Cook EF, Angelos Tosteson AN, Brand DA, et al. Impact of physician experience on triage of emergency room patients with acute chest pain at three teaching hospitals. The American Journal of Medicine. 1991;91(4):401-8.
22. Snaith B, Hardy M. Emergency department image interpretation accuracy: The influence of immediate reporting by radiology. International Emergency Nursing. 2014;22(2):63-8.
23. Rizoli SB, Boulanger BR, McLellan BA, Sharkey PW. Injuries missed during initial assessment of blunt trauma patients. Accident Analysis and Prevention. 1994;26(5):681-6.
24. Rickett AB, Finlay DBL, Jagger C. The importance of clinical details when reporting accident and emergency radiographs. Injury. 1992;23(7):458-60.
25. Regel G, Bayeff-Filloff M. Emergency room management of the multiply-injured patient with limb injuries: A systematic review of the literature. Unfallchirurg. 2004;107(10):919-26.
26. Quirke M, Boland F, Fahey T, O'Sullivan R, Hill A, Stiell I, et al. Prevalence and predictors of initial oral antibiotic treatment failure in adult emergency department patients with cellulitis: A pilot study. BMJ Open. 2015;5(6).
27. Pickrell L, Duggan C, Dhillon S. From hospital admission to discharge: an exploratory study to evaluate seamless care. Pharmaceutical Journal. 2001.
28. Petinaux B, Bhat R, Boniface K, Aristizabal J. Accuracy of radiographic readings in the emergency department. American Journal of Emergency Medicine. 2011;29(1):18-25.
29. O'Connor PM, Dowey KE, Bell PM, Irwin ST, Dearden CH. Unnecessary delays in accident and emergency departments: do medical and surgical senior house officers need to vet admissions? Journal of accident & emergency medicine. 1995;12(4):251-4.
30. O'Connor P, Dowey K, Bell P, Irwin S, Dearden C. Unnecessary delays in accident and emergency departments: do medical and surgical senior house officers need to vet admissions? Emergency Medicine Journal. 1995;12(4):251-4.
31. Morton RJ. Fracture clinic referrals: the need for self audit. Injury. 1988;19(2):77-8.
32. McLauchlan CAJ, Jones K, Guly HR. Interpretation of trauma radiographs by junior doctors in accident and emergency departments: A cause for concern? Emergency Medicine Journal. 1997;14(5):295-8.
33. McDonald KM, Matesic B, Contopoulos-Ioannidis DG, Lonhart J, Schmidt E, Pineda N, et al. Patient safety strategies targeted at diagnostic errors: A systematic review. Annals of Internal Medicine. 2013;158(5 PART 2):381-9.
34. Lu TC, Tsai CL, Lee CC, Ko PCI, Yen ZS, Yuan A, et al. Preventable deaths in patients admitted from emergency department. Emergency Medicine Journal : EMJ. 2006;23(6):452-5.
35. Lo SM, Choi KTY, Wong EML, Lee LLY, Yeung RSD, Chan JTS, et al. Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments. International Emergency Nursing. 2014;22(2):116-20.
36. Letts M, Davidson D, Lapner P. Multiple trauma in children: Predicting outcome and long-term results. Canadian Journal of Surgery. 2002;45(2):126-31.
37. Lee C, Bleetman A. Commonly missed injuries in the accident and emergency department. Trauma. 2004;6(1):41-51.
38. Lawrence S, Spencer LM, Sinnott M, Eley R. It takes two to tango: Improving patient referrals from the emergency department to inpatient clinicians. Ochsner Journal. 2015;15(2):149-53.
39. Lane DC, Monefeldt C, Rosenhead JV. Looking in the Wrong Place for Healthcare Improvements: A System Dynamics Study of an Accident and Emergency Department. The Journal of the Operational Research Society. 2000;51(5):518-31.
40. Krüger W, Ludman AJ. Core knowledge in critical care medicine2014. 1-422 p.
41. Kremli MK. Missed musculoskeletal injuries in a University Hospital in Riyadh: Types of missed injuries and responsible factors. Injury. 1996;27(7):503-6.
42. Katz DA, Aufderheide TP, Bogner M, Rahko PS, Hillis SL, Selker HP. Do Emergency Department Patients With Possible Acute Coronary Syndrome Have Better Outcomes When Admitted to Cardiology Versus Other Services? Annals of Emergency Medicine. 2008;51(5):561-70.e1.
43. Kansagara D, Ramsay RS, Labby D, Saha S. Post-discharge intervention in vulnerable, chronically ill patients. Journal of Hospital Medicine. 2012;7(2):124-30.
44. Hulbert DC, Riddle WL, Longstaff PM, Belstead JS, Beckett MW. An audit of litigation costs in four accident and emergency departments. Emergency Medicine Journal. 1996;13(6):400-1.
45. Hardy M, Snaith B, Scally A. The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: A randomised controlled trial. British Journal of Radiology. 2013;86(1021).
46. Gwynne A, Barber P, Tavener F. A review of 105 negligence claims against accident and emergency departments. Emergency Medicine Journal. 1997;14(4):243-5.
47. Guly HR. Diagnostic errors in an accident and emergency department. Emergency Medicine Journal. 2001;18(4):263-9.
48. Guly HR. A scale for measuring the severity of diagnostic errors in accident and emergency departments. Emergency Medicine Journal. 1997;14(5):290-2.
49. Furnival RA, Woodward GA, Schunk JE. Delayed diagnosis of injury in pediatric trauma. Pediatrics. 1996;98(1):56-62.
50. Frost SA, Alexandrou E, Bogdanovski T, Salamonson Y, Parr MJ, Hillman KM. Unplanned admission to intensive care after emergency hospitalisation: Risk factors and development of a nomogram for individualising risk. Resuscitation. 2009;80(2):224-30.
51. Friedman SM, Merman E, Chopra A. Clinical impact of diagnostic imaging discrepancy by radiology trainees in an urban teaching hospital emergency department. International Journal of Emergency Medicine. 2013;6(1).
52. Evans R. Trauma misdiagnosis in the emergency unit. Clinical Risk. 2003;9(5):175-8.
53. Cohen RI, Eichorn A, Motschwiller C, Laktikova V, La Torre G, Ginsberg N, et al. Medical intensive care unit consults occurring within 48 hours of admission: A prospective study. Journal of Critical Care. 2015;30(2):363-8.
54. Chiu H, Chan K, Chung C, Ma K, Au K. A comparison of emergency department admission diagnoses and discharge diagnoses: retrospective study. Hong Kong J Emerg Med. 2003;10(2):70-5.