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Evaluating Misalignment Between Emergency Department and Discharge Diagnoses.

Wanting Cui1, Xingyue Huo1, Joseph Finkelstein1

  • 1Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, Utah.

Studies in Health Technology and Informatics
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Summary

Diagnostic discrepancies between emergency department (ED) and inpatient care are common, affecting patient outcomes. High mismatch rates highlight the need for improved diagnostic consistency across care settings.

Keywords:
Data MiningDiagnostic DiscrepancyElectronic Health Records

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Area of Science:

  • Health Informatics
  • Clinical Research
  • Data Science

Background:

  • Diagnostic discrepancies between emergency department (ED) and inpatient settings can impact patient care and outcomes.
  • Accurate and consistent diagnosis is crucial for effective treatment and hospital resource management.

Purpose of the Study:

  • To quantify diagnostic discrepancies between emergency department (ED) and inpatient care.
  • To compare these discrepancies across different healthcare datasets and diagnostic classification levels.

Main Methods:

  • Utilized three datasets: All of Us Research Program, a synthetic VA dataset, and TriNetX.
  • Compared diagnoses at the category (530+) and body system (22) levels for patients admitted through the ED.
  • Employed many-to-many and one-to-one comparison methods based on dataset characteristics.

Main Results:

  • Consistently high rates of diagnostic mismatch were observed across all datasets.
  • No matches at the category level ranged from 19.10% (All of Us) to 58.30% (VA dataset).
  • No matches at the body system level ranged from 7.70% (TriNetX) to 30.30% (VA dataset).
  • Partial matches were more frequent in patients with high comorbidities.
  • Inaccurate diagnoses correlated with longer hospital stays.

Conclusions:

  • Significant diagnostic discrepancies exist between emergency department (ED) and inpatient care.
  • These mismatches, particularly in patients with comorbidities, may lead to prolonged hospitalizations.
  • Improved diagnostic concordance is needed to enhance patient care continuity and efficiency.