James Eames1, Arie Eisenman2, Richard J Schuster3. 1. 1Augusta University/University of Georgia Medical Partnership, 108 Spear Road Athens, GA 30606, USA. 2. 3The Emergency Department, Galilee Medical Center, Nahariya and The Bar Ilan University Faculty of Medicine in Galilee, Zafed, Israel. 3. 2Center for Global Health University of Georgia, Athens, GA, USA.
Abstract
BACKGROUND: Previous studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes. METHODS: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality. RESULTS: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001). CONCLUSION: These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.
BACKGROUND: Previous studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes. METHODS: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality. RESULTS: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001). CONCLUSION: These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.
Authors: S Fatima Faqar-Uz-Zaman; Natalie Filmann; Dora Mahkovic; Michael von Wagner; Charlotte Detemble; Ulf Kippke; Ursula Marschall; Luxia Anantharajah; Philipp Baumartz; Paula Sobotta; Wolf O Bechstein; Andreas A Schnitzbauer Journal: BMJ Open Date: 2021-01-08 Impact factor: 2.692
Authors: Wolf E Hautz; Moritz M Kündig; Roger Tschanz; Tanja Birrenbach; Alexander Schuster; Thomas Bürkle; Stefanie C Hautz; Thomas C Sauter; Gert Krummrey Journal: Diagnosis (Berl) Date: 2021-10-21