Discrepancies between admission and discharge diagnoses in a university hospital

Admission screening and certification systems for utilization review are based on acceptance of attending physicians' admitting diagnosis. This study was conducted to: 1) determine the consistency of admission diagnosis as compared to discharge diagnosis: i) identify the characteristics of patients and diagnoses subject to higher rates of diagnostic discrepancy; and 3) analyze the apparent reasons for such discrepancies. The following methods were used: direct comparison of admission and discharge diagnosis on a sample (n = 955) of university hospital patients using a rating scale to measure the degree of change in specificity and category of diagnosis; analysis of diagnostic change by hospital service, demographic characteristics of patients, length of stay, and source of payment; review of charts with the greatest diagnostic discrepancy. Diagnostic changes were found in 26.8 per cent of all admissions (n = 230) and were most frequent in neurological, medical and pediatric patients. The rate of change varied with patient age and length of stay and was lowest in Medicaid patients. Changes were usually from general to more specific diagnosis in related categories, with 4.3 per cent being discharged undiagnosed and 2.9 per cent with unrelated diagnosis. Major causes for discrepancies were related to clinical and laboratory findings. No evidence was found for deliberate diagnostic manipulation to gain admission or to improve financial coverage.