Department of Medicine, Section of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
PLoS One. 2021 Jun 15;16(6):e0253316. doi: 10.1371/journal.pone.0253316. eCollection 2021.
The discrepancy between admission and discharge diagnosis can lead to possible adverse patient outcomes. There are gaps in integrated studies, and less is understood about its characteristics and effects. Therefore, this study was conducted to determine the frequency, characteristics, and outcomes of diagnostic discrepancies at admission and discharge.
This retrospective study reviewed the admitting and discharge diagnoses of adult patients admitted at Aga Khan University Hospital (AKUH), Internal Medicine Department between October 2018 and February 2019. The frequency and outcomes of discrepancies in patient diagnoses were noted among Emergency Department (ED) physician versus admitting physician, admitting physician versus discharge physician, and ED physician versus discharge physician for the full match, partial match, and mismatch diagnoses. The studied outcomes included interdepartmental transfer, Intensive Care Unit (ICU) transfer, in-hospital mortality, readmission within 30 days, and the length of stay. For simplicity, we only analyzed the factors for the discrepancy among ED physicians and discharge physicians.
Out of 537 admissions, there were 25.3-27.2% admissions with full match diagnoses while 18.6-19.4% and 45.3-47.9% had mismatch and partial match diagnoses respectively. The discrepancy resulted in an increased number of interdepartmental transfers (5-5.8%), ICU transfers (5.6-8.7%), in-hospital mortality (8-11%), and readmissions within 30 days in ED (14.4%-16.7%). A statistically significant difference was observed for the ward's length of stay with the most prolonged stay in partially matched diagnoses (6.3 ± 5.4 days). Among all the factors that were evaluated for the diagnostic discrepancy, older age, multi-morbidities, level of trainee clerking the patient, review by ED faculty, incomplete history, and delay in investigations at ED were associated with significant discrepant diagnoses.
Diagnostic discrepancies are a relevant and significant healthcare problem. Fixed patient or physician characteristics do not readily predict diagnostic discrepancies. To reduce the diagnostic discrepancy, emphasis should be given to good history taking and thorough physical examination. Patients with older age and multi-morbidity should receive significant consideration.
入院诊断与出院诊断之间的差异可能导致患者出现不良结局。虽然已有综合研究，但对其特征和影响的了解仍较少。因此，本研究旨在确定入院和出院时诊断差异的频率、特征和结果。
本回顾性研究分析了 2018 年 10 月至 2019 年 2 月阿克巴汗大学医院（AKUH）内科收治的成年患者的入院和出院诊断。记录了急诊科（ED）医生与入院医生、入院医生与出院医生之间的患者诊断差异的频率和结果，包括完全匹配、部分匹配和不匹配诊断。研究结果包括跨科室转科、转入重症监护病房（ICU）、院内死亡、30 天内再入院和住院时间。为简单起见，我们仅分析了 ED 医生和出院医生之间差异的影响因素。
在 537 例入院患者中，完全匹配诊断的入院率为 25.3%-27.2%，不匹配和部分匹配诊断的入院率分别为 18.6%-19.4%和 45.3%-47.9%。诊断差异导致跨科室转科（5-5.8%）、转入 ICU（5.6-8.7%）、院内死亡（8-11%）和 ED 30 天内再入院（14.4%-16.7%）增加。部分匹配诊断的住院时间差异具有统计学意义，住院时间最长（6.3 ± 5.4 天）。在评估诊断差异的所有因素中，年龄较大、多种合并症、接受住院医培训的医生级别、ED 教员审查、病史不完整和 ED 检查延迟与显著的诊断差异相关。
诊断差异是一个相关且重要的医疗保健问题。固定的患者或医生特征并不能轻易预测诊断差异。为了减少诊断差异，应重视良好的病史采集和全面的体格检查。年龄较大和合并多种疾病的患者应引起高度重视。
