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ED Presenting Complaint vs Discharge Diagnosis

Article: Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying "Nonemergency" Emergency Department Visits. JAMA. 2013;309(11):1145-1153.

Summary

ED diagnosis and appropriate use - they may not match.

Abstract

Importance Reduction in emergency department (ED) use is frequently viewed as a potential source for cost savings. One consideration has been to deny payment if the patient's diagnosis upon ED discharge appears to reflect a "nonemergency" condition. This approach does not incorporate other clinical factors such as chief complaint that may inform necessity for ED care.

Objective To determine whether ED presenting complaint and ED discharge diagnosis correspond sufficiently to support use of discharge diagnosis as the basis for policies discouraging ED use.

Design, Setting, and Participants The New York University emergency department algorithm has been commonly used to identify nonemergency ED visits. We applied the algorithm to publicly available ED visit data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS) for the purpose of identifying all "primary care–treatable" visits. The 2009 NHAMCS data set contains 34 942 records, each representing a unique ED visit. For each visit with a discharge diagnosis classified as primary care treatable, we identified the chief complaint. To determine whether these chief complaints correspond to nonemergency ED visits, we then examined all ED visits with this same group of chief complaints to ascertain the ED course, final disposition, and discharge diagnoses.

Main Outcomes and Measures Patient demographics, clinical characteristics, and disposition associated with chief complaints related to nonemergency ED visits.

Results Although only 6.3% (95% CI, 5.8%‑6.7%) of visits were determined to have primary care–treatable diagnoses based on discharge diagnosis and our modification of the algorithm, the chief complaints reported for these ED visits with primary care–treatable ED discharge diagnoses were the same chief complaints reported for 88.7% (95% CI, 88.1%‑89.4%) of all ED visits. Of these visits, 11.1% (95% CI, 9.3%‑13.0%) were identified at ED triage as needing immediate or emergency care; 12.5% (95% CI, 11.8%‑14.3%) required hospital admission; and 3.4% (95% CI, 2.5%‑4.3%) of admitted patients went directly from the ED to the operating room.

Conclusions and Relevance Among ED visits with the same presenting complaint as those ultimately given a primary care–treatable diagnosis based on ED discharge diagnosis, a substantial proportion required immediate emergency care or hospital admission. The limited concordance between presenting complaints and ED discharge diagnoses suggests that these discharge diagnoses are unable to accurately identify nonemergency ED visits.

Interview with Maria C. Raven, MD, MPH, MSc, author of Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying "Nonemergency" Emergency Department Visits.

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Dolencia expuesta frente a diagnóstico tras el alta en el servicio de urgencias

Artículo: Comparación entre dolencia expuesta y diagnóstico tras el alta para identificar visitas «no urgentes» al servicio de urgencias. JAMA. 2013;309(11):1145-1153.

Summary

Diagnóstico del paciente y utilización correcta del servicio de urgencias: no siempre coinciden.

Entrevista con Maria C. Raven, MD, MPH, MSc, autor de Comparación entre dolencia expuesta y diagnóstico tras el alta para identificar visitas «no urgentes» al servicio de urgencias.

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Étude comparative du motif de consultation aux urgences et du diagnostic de sortie

Article: Comparaison du motif de consultation et du diagnostic de sortie pour identifier les consultations « non urgentes » dans les services d'urgence. JAMA. 2013;309(11):1145-1153.

Summary

Diagnostic posé dans les services d'urgence et recours adapté aux urgences : quelle correspondance ?

Entretien avec Maria C. Raven, MD, MPH, MSc, auteur de Comparaison du motif de consultation et du diagnostic de sortie pour identifier les consultations « non urgentes » dans les services d'urgence.

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Sintomo all'arrivo in pronto soccorso e diagnosi di dimissione

Articolo: Confronto tra sintomi alla presentazione e diagnosi di dimissione per identificare le visite al pronto soccorso non di emergenza. JAMA. 2013;309(11):1145-1153.

Summary

Diagnosi e uso adeguato del pronto soccorso: potrebbero non corrispondere.

Intervista a Maria C. Raven, MD, MPH, MSc, autore di Confronto tra sintomi alla presentazione e diagnosi di dimissione per identificare le visite al pronto soccorso non di emergenza.

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急诊就诊主诉与出院诊断

文章: 通过比较入院主诉与出院诊断确定“非急诊”的急诊病例。 JAMA. 2013;309(11):1145-1153.

Summary

急诊室的诊断与患者是否为急诊病例 - 两者并不一致。

专访 Maria C. Raven, MD, MPH, MSc, 作者 通过比较入院主诉与出院诊断确定“非急诊”的急诊病例。

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ED Presenting Complaint vs Discharge Diagnosis

статья: Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying "Nonemergency" Emergency Department Visits. JAMA. 2013;309(11):1145-1153.

Summary

Перевод отсутствует.

Интервью с Maria C. Raven, MD, MPH, MSc автор “Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying 'Nonemergency' Emergency Department Visits".

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ED Presenting Complaint vs Discharge Diagnosis

Artigo: Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying "Nonemergency" Emergency Department Visits. JAMA. 2013;309(11):1145-1153.

Summary

Não há tradução disponível.

Entrevista com o Maria C. Raven, MD, MPH, MSc autor de “Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying 'Nonemergency' Emergency Department Visits".

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Zusammenhang zwischen Vorstellungsgrund in der Notfallabteilung und Entlassungsdiagnose

Artikel: Vergleich zwischen Vorstellungsgrund und Entlassungsdiagnose zur Identifizierung von "Nichtnotfall"-Besuchen in der Notfallabteilung. JAMA. 2013;309(11):1145-1153.

Summary

Diagnosen und angemessene Inanspruchnahme von Notfallabteilungen - vielleicht keine Übereinstimmung.

Interview mit Maria C. Raven, MD, MPH, MSc, autor Vergleich zwischen Vorstellungsgrund und Entlassungsdiagnose zur Identifizierung von "Nichtnotfall"-Besuchen in der Notfallabteilung.

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