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The provision of diagnosis at emergency department discharge: a pilot study
  1. Leana S Wen1,
  2. Joshua M Kosowsky2,
  3. Edith R Gurrola3,
  4. Carlos A Camargo Jr4
  1. 1Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Brigham & Women's/Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Emergency Medicine, Brigham & Women's Hospital, Massachusetts, USA
  3. 3Department of Emergency Medicine, University of Arizona, Phoenix, Arizona, USA
  4. 4Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
  1. Correspondence to Dr Leana S Wen, Department of Emergency Medicine, Massachusetts General Hospital, Neville House, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; wen.leana{at}gmail.com

Abstract

Objectives Understanding the cause of patients’ symptoms usually involves identification of a pathological diagnosis. Anecdotal reports suggest that emergency department (ED) providers do not prioritise giving pathological diagnoses, and often reiterate the patient's symptom as the discharge ‘diagnosis’. 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 in the USA, with an 88 000 annual visit volume. All charts of patients presenting with the three most common ED chief complaints (chest pain, abdominal pain and headache) were reviewed by two reviewers. Charts were coded as either symptomatic or pathological diagnosis based on the discharge diagnosis provided by the attending physician. Those with discrepant coding by the two reviewers were subject to review by a third adjudicator.

Results 797 charts met the inclusion criteria. Five charts (0.6%) were coded differently by the two reviewers; a discussion with the third reviewer resulted in consensus in all cases. For patients presenting with chest pain, abdominal pain and headache, the proportion that received a pathological ED discharge diagnosis were 17%, 43% and 41%, respectively.

Conclusions According to our pilot study, 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 clinical outcomes and patient satisfaction.

  • emergency departments
  • clinical care
  • communications
  • diagnosis
  • emergency care systems, emergency departments

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