Published online Nov 27, 2014. doi: 10.4240/wjgs.v6.i11.229
Revised: September 16, 2014
Accepted: October 14, 2014
Published online: November 27, 2014
Processing time: 133 Days and 16.6 Hours
AIM: To evaluate the diagnostic accuracy (DA) in acute surgical patients admitted to a District General Hospital.
METHODS: The case notes of all acute surgical patients admitted under the surgical team for a period of two weeks were reviewed for the data pertaining to the admission diagnoses, relevant investigations and final diagnoses confirmed by either surgery or various other diagnostic modalities. The diagnostic pathway was recorded from the source of referral [general practitioner (GP), A and E, in-patient] to the correct final diagnosis by the surgical team.
RESULTS: Forty-one patients (23 males) with acute surgical admissions during two weeks of study period were evaluated. The mean age of study group was 61.05 ± 23.24 years. There were 111 patient-doctor encounters. Final correct diagnosis was achieved in 85.4% patients. The DA was 46%, 44%, 50%, 33%, 61%, 61%, and 75% by GP, A and E, in-patient referral, surgical foundation year-1, surgical senior house officer (SHO), surgical registrar, and surgical consultant respectively. The percentage of clinical consensus diagnosis was 12%. Surgery was performed in 48.8% of patients. Sixty-seven percent of GP-referred patients, 31% of A and E-referred, and 25% of the in-patient referrals underwent surgery. Surgical SHO made the most contributions to the primary diagnostic pathway.
CONCLUSION: Approximately 85% of acute surgical patients can be diagnosed accurately along the diagnostic pathway. Patients referred by a GP are more likely to require surgery as compared to other referral sources. Surgical consultant was more likely to make correct surgical diagnosis, however it is the surgical SHO that contributes the most correct diagnoses along the diagnostic pathway.
Core tip: Approximately 85% of acute surgical patients can be diagnosed accurately along the diagnostic pathway. One of the strategies to reduce diagnostic error is to develop pathways for feedback. It is particularly important to develop feedback pathways for the junior doctors, as it has been shown that less experienced doctors tend to most over-estimate their diagnostic accuracy. With anonymity removed, the basic design of this study seems well suited to enable feedback to each physician involved in the care of an acute surgical patient.