The Value of the Correct Initial Diagnoses of Patients Treated in the Emergency Department by Internists to their Final Outcome

Introduction: The initial diagnosis of patients coming to the Emergency Department (ED) is one of the qualitative indicators of the ED. The correct initial diagnosis in ED is related to the final outcome of the patients and the possible complications during their hospitalization. Aim: The aim of this study was to investigate the degree of agreement between initial diagnosis and final diagnosis of patients and the impact of disagreement on diagnosis with mortality and morbidity of patients. Material and Methods: This was a retrospective research study, which was conducted at the ED of a large public hospital of Attica prefecture from March 2017 to September 2017. The collection of data was done through the hospital's IT system and included gender, age, day (holiday vs. daily), ICD-10 entry diagnosis, ICD-10 discharge diagnosis, outcome (death vs. survival), transfer to another clinic (yes vs no) and the total duration of hospitalization. As initial diagnosis was defined the diagnosis placed in the emergency department and was the diagnosis that patient was admitted to the clinic. As final diagnosis was defined the diagnosis recorded on the discharged notes. Diagnosis disagreement was considered when there was difference in any of the three digits of the ICD-10 code. The statistical analysis of the data was done through the SPSS v.21 statistical package. Results: The study included 500 patients, 248 (49.6%) of whom were males and 252 (50.4%) women. Overall, 49 (9.8%) patients died and 21 (4.2%) patients were transferred to another department. We found 125 admission ICD-10 codes and 242 discharged ICD codes. Diagnosis agreement was present in 352 (70.4%) patients and disagreement in 148 (29.6%) patients. Patients whose initial diagnosis disagreed with the final diagnosis were significantly more likely to be hospitalized in another department (8.1% vs 2.6%, p<0.05). Similarly, the diagnosis disagreement was associated with a significantly longer duration of hospitalization (6.1±8.7 versus 4.2±4.1 days, p<0.05) and significantly lower discharge rate (80.4% vs 88.4%, p<0.05). Conclusions: The rate of disagreement diagnosis in the study is higher than that of international studies, mainly due to the range of possible diagnoses. Targeted interventions are needed to reduce it, such as implementing an organized triage system in ED, training doctors in emergency situations, and staffing ED with specialized personnel.