Summary
Diagnostic agreement between a comprehensive, fast-track community hospital emergency department and the corresponding referral hospital
Mellado Vergel FJ, Díaz Ricomá N, Mena Parra D, Rosell Ortiz F, Contreras Rodríguez AM, León Ruiz L
Affiliation of the authors
Hospital de Alta Resolución El Toyo. Empresa Pública Hospital de Poniente de Almería. Consejería de Salud de la Junta de Andalucía. Almería, Spain. Empresa Pública Emergencias Sanitarias. Almería, Spain. Complejo Hospitalario Torrecárdenas. Almería, Spain
DOI
Quote
Mellado Vergel FJ, Díaz Ricomá N, Mena Parra D, Rosell Ortiz F, Contreras Rodríguez AM, León Ruiz L. Diagnostic agreement between a comprehensive, fast-track community hospital emergency department and the corresponding referral hospital. Emergencias. 2010;22:282-5
Summary
Objectives: To assess between-hospital agreement on diagnoses for patients transferred
from a ‘high resolution’ (comprehensive, fast-track) community hospital to the
corresponding referral hospital, analyzing the rate of diagnostic error, epidemiologic
factors related to error, reasons for error, and influence on in-hospital mortality.
Methods: Diagnoses for patients transferred in 2009 were studied. Agreement was
analyzed in 2 categories: 1) diagnosis within the correct syndrome grouping, whether
strictly coincident or not, and 2) incorrect diagnosis. Variables compared were age, sex,
the hospital department ordering the transfer, and diagnosis. The main reason for error
was investigated.
Results: A total of 1494 patients were transferred to the referral hospital. The mean (SD)
age of transferred patients was 41.6 (30) years; 56% were men. Ninety-one percent
were sent from the emergency department. The most frequent diagnostic groups were
trauma (27%), internal medicine (25.8%), surgery (20.2%), and pediatrics (9.7%). There
was diagnostic agreement in 91.8% of the cases. The most common reasons for error
were insufficient clinical evaluation (69.7%), and misinterpretation of radiographs
(21.3%). Age was associated with lack of diagnostic agreement (P=.003). No deaths
occurred as a result of lack of agreement.
Conclusions: In general, there was diagnostic agreement; the error rate was 8.2%. Sex,
origin of the transfer order, and diagnostic group were unrelated to error; younger
patient age was related to lack of agreement. The main reason for error was inadequate
clinical evaluation. There were no deaths among patients for whom there was diagnostic
disagreement.