Bernhard M, Raatz C, Zahn P, Merker A, Gries A
Zentrale Notaufnahme/Notaufnahmestation, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
Anaesthesist. 2013 Aug;62(8):617-23. doi: 10.1007/s00101-013-2207-5. Epub 2013 Aug 7.
Primary care physicians and specialists often refer patients to the emergency department with a specific diagnosis and request for admission. Such an external diagnosis frequently influences the initial evaluation in the emergency department. The present study aimed to evaluate the accuracy of such external diagnoses and to assess the consequences of incorrect diagnoses on length of stay and number of specialty consultations in the emergency department.
This was a prospective observational study over the course of 3 months in the emergency department of a tertiary care center. External admission diagnoses made by primary care physicians and specialists were categorized as "accurate", "partially accurate" and "inaccurate". A special analysis of the external admission diagnosed was performed for patients admitted directly to an intermediary care unit and intensive care unit or patients who were transferred directly from the emergency department to the operating room.
Data for 784 patients were analyzed. Patients were on average 63.1 ± 19.5 years old (minimum-maximum 18-97 years, median 68 years) and 54 % were male. After emergency department evaluation and treatment 57.8 % of external diagnoses were categorized as accurate, 23.6 % as partially accurate and 18.6 % as inaccurate. Patients with partially accurate and inaccurate diagnoses had a 3 and 6.5 times higher rate of specialty consultations in the emergency department, respectively, when compared with patients with an accurate diagnosis (number of specialty consultations n = 0: 77.3 % vs. 54.1 % vs. 92.9 %, p < 0.05; n = 1: 20.0 % vs. 40.4 % vs. 6.2 %, p < 0.05; n = 2: 2.7 % vs. 5.5 % vs. 0.9 %, p < 0.05, respectively. Patients with an accurate diagnosis had a shorter total length of stay than patients with a partially accurate or inaccurate diagnosis [mean ± SD (min-max; median): 192 ± 108 min (10-707 min; 181 min) vs. 246 ± 126 min (27-1,026 min; 214 min) vs. 258 ± 138 min (22-700 min; 232 min), p < 0.001], respectively. Out of 85 patients admitted directly to an intermediary care unit, intensive care unit and patients who were transferred directly from the emergency department to the operating room the diagnosis was accurate, partially accurate and inaccurate in 56.5 %, 24.7 % and 18.8 %, respectively.
Admission diagnoses made by primary care physicians and specialists who subsequently refer patients to the emergency department are subject to certain inaccuracies. Inaccurate admission diagnoses are associated with an increased length of stay and a considerably higher rate of specialty consultation in the emergency department. Standardized operating procedures, treatment algorithms and triage systems are important to identify such incorrect diagnoses so that these patients can undergo appropriate diagnostic investigation and treatment.
基层医疗医生和专科医生常常带着特定诊断结果并提出住院请求，将患者转诊至急诊科。这种外部诊断常常会影响急诊科的初步评估。本研究旨在评估此类外部诊断的准确性，并评估错误诊断对急诊科住院时间和专科会诊次数的影响。
这是一项在三级医疗中心急诊科进行的为期3个月的前瞻性观察研究。基层医疗医生和专科医生做出的外部住院诊断被分类为“准确”、“部分准确”和“不准确”。对直接入住中间护理单元和重症监护病房的患者，或从急诊科直接转入手术室的患者的外部住院诊断进行了专项分析。
分析了784例患者的数据。患者平均年龄为63.1±19.5岁（最小-最大年龄18-97岁，中位数68岁），54%为男性。经过急诊科评估和治疗后，57.8%的外部诊断被分类为准确，23.6%为部分准确，18.6%为不准确。与诊断准确的患者相比，诊断部分准确和不准确的患者在急诊科的专科会诊率分别高出3倍和6.5倍（专科会诊次数n = 0：77.3%对54.1%对92.9%，p < 0.05；n = 1：20.0%对40.4%对6.2%，p < 0.05；n = 2：2.7%对5.5%对0.9%，p < 0.05）。诊断准确的患者总住院时间比诊断部分准确或不准确的患者短[平均值±标准差（最小-最大；中位数）：192±108分钟（10-707分钟；181分钟）对246±126分钟（27-1026分钟；214分钟）对258±138分钟（22-700分钟；232分钟），p < 0.001]。在85例直接入住中间护理单元、重症监护病房以及从急诊科直接转入手术室的患者中，诊断准确、部分准确和不准确的分别占56.5%、24.7%和18.8%。
基层医疗医生和专科医生随后将患者转诊至急诊科时做出的住院诊断存在一定的不准确情况。不准确的住院诊断与住院时间延长以及急诊科专科会诊率大幅提高有关。标准化的操作程序、治疗算法和分诊系统对于识别此类错误诊断很重要，以便这些患者能够接受适当的诊断检查和治疗。
