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Unfortunately, many people with an acute illness use the emergency department as their gateway to the healthcare system.  Aside from the high cost of care, there are questions about the quality of care that can be provided for patients who enter into the medical system using the emergency department as opposed to a primary care physician.  The actual cost implications were not known until recently.  In research we published, we uncovered a significant quality problem with incorrect admission diagnoses made in the emergency department that led to higher costs of care and lower quality of care.

The time spent in the hospital and cost of care for a patient’s treatment is driven by the initial diagnosis assigned to the patient at the time of admission.   Often the initial contact occurs in the emergency department where there is limited access to complete records, and no primary physician who knows the patient well.   In addition, there are no established benchmarks for how long it should take to correctly diagnose a patient’s condition or how much testing will be required before the accurate diagnosis can be made.  As such, there is remarkable variability between patients who present with similar symptoms or who ultimately have the same final diagnosis.  What is clear is that only a rare few patients have a complete and accurate diagnosis at the point of admission from the emergency department.

In this study, we reviewed the records of 2,390 adults who were admitted to a major urban university teaching hospital through the emergency department.  Strikingly, we found 68% of patients who were admitted to the hospital through the emergency department had an admission diagnosis that differed from their final discharge diagnosis.  As a result, these patients with discrepant diagnoses had longer hospital length of stay, higher cost of care, and were 55% more likely to be re-admitted within 30 days of hospital discharge.

Given tightening economic pressures on hospitals, it is critical to understand why there is such a high rate of diagnosis discrepancies in patients admitted through the emergency department.  Although more work is needed to determine causes of these discrepancies, our study demonstrates the potential adverse consequences on hospital length of stay, costs, and readmission.

Cost and Quality Implications of Discrepancies Between Admitting and Discharge Diagnoses.

McNutt R, Johnson T, Kane J, Ackerman M, Odwazny R, Bardhan J.

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