242 The Provision of Diagnosis at Emergency Department Discharge: A Pilot Study

Abstract

Study Objectives: Understanding the cause of patients' symptoms usually involves identification of a pathological diagnosis, without which effective treatment often cannot be initiated. Anecdotal reports suggest that emergency department (ED) providers do not prioritize giving pathological diagnoses to patients at time of discharge, and often reiterate the patient's symptom as the discharge “diagnosis.” No study has examined the proportion of patients who receive a pathological diagnosis at ED discharge that explains the likely cause of their symptoms. Our pilot study sought to identify the proportion of patients at a large teaching hospital who receive a symptomatic versus pathological diagnosis at ED discharge.Methods: We performed a chart review of all adult patients who were discharged from an urban ED with an emergency medicine residency and an annual visit volume of 88,000. All charts of patients presenting with the 3 most common ED chief complaints (chest pain, abdominal pain, and headache) were reviewed by a 4th-year medical student and a third-year emergency medicine resident. Charts were coded as either symptomatic or pathological diagnosis based on the discharge diagnosis provided by the attending physician. Those with both symptomatic and pathological discharge diagnosis (eg “chest pain” and “muscular chest pain”) were coded as pathological diagnosis. Those that received different coding by the 2 reviewers were subject to an analysis by a third adjudicator, an emergency medicine attending.Results: 797 charts met the inclusion criteria. Five charts (0.6%) were coded differently by the 2 reviewers; a discussion with the third reviewer resulted in consensus in all cases. The table below shows the number and percentage of symptomatic versus pathological discharge diagnosis for patients presenting with one of these 3 chief complaints:Tabled 1Conclusion: According to our pilot study at a large teaching hospital, it appears that most patients are discharged from the ED without a pathological diagnosis that explains the likely cause of their symptoms. Future studies will investigate whether this finding is consistent across institutions, and whether provision of a pathological diagnosis affects ED clinical outcomes, including patient satisfaction. Study Objectives: Understanding the cause of patients' symptoms usually involves identification of a pathological diagnosis, without which effective treatment often cannot be initiated. Anecdotal reports suggest that emergency department (ED) providers do not prioritize giving pathological diagnoses to patients at time of discharge, and often reiterate the patient's symptom as the discharge “diagnosis.” No study has examined the proportion of patients who receive a pathological diagnosis at ED discharge that explains the likely cause of their symptoms. Our pilot study sought to identify the proportion of patients at a large teaching hospital who receive a symptomatic versus pathological diagnosis at ED discharge. Methods: We performed a chart review of all adult patients who were discharged from an urban ED with an emergency medicine residency and an annual visit volume of 88,000. All charts of patients presenting with the 3 most common ED chief complaints (chest pain, abdominal pain, and headache) were reviewed by a 4th-year medical student and a third-year emergency medicine resident. Charts were coded as either symptomatic or pathological diagnosis based on the discharge diagnosis provided by the attending physician. Those with both symptomatic and pathological discharge diagnosis (eg “chest pain” and “muscular chest pain”) were coded as pathological diagnosis. Those that received different coding by the 2 reviewers were subject to an analysis by a third adjudicator, an emergency medicine attending. Results: 797 charts met the inclusion criteria. Five charts (0.6%) were coded differently by the 2 reviewers; a discussion with the third reviewer resulted in consensus in all cases. The table below shows the number and percentage of symptomatic versus pathological discharge diagnosis for patients presenting with one of these 3 chief complaints: Conclusion: According to our pilot study at a large teaching hospital, it appears that most patients are discharged from the ED without a pathological diagnosis that explains the likely cause of their symptoms. Future studies will investigate whether this finding is consistent across institutions, and whether provision of a pathological diagnosis affects ED clinical outcomes, including patient satisfaction.