The level of agreement regarding patient disposition between emergency physicians and consultants in the emergency department

Mitsunaga Iwata, Katsuo Yamanaka, Yoshimi Kitagawa

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Consultation is a common and important aspect of emergency medicine practice. We examined the frequency of consultations, the level of agreement and factors of disagreement with regard to the disposition of patients who visited two emergency departments (EDs) of tertiary care hospitals in Japan. Findings: We analyzed 3,503 consecutive patients who visited two EDs in Japan during a 3-month period. The initial diagnosis in the ED, the presence of consultation, and the patient disposition following the ED visit were recorded. At least one consultation was requested in 34.7% of the patients (1,215/3,503), and 88% of these patients were admitted to the hospital (1,063/1,215). Consultants and emergency physicians (EPs) agreed on patient disposition 95% of the time (1,153/1,215), with κ = 0.76 (95% CI 0.70-0.82). Opinions about disposition were discordant in 5% of the patients consulted upon. In 63% of those cases, patients were not diagnosed in the ED. Conclusion: Consultants and EPs agreed on patient disposition in most cases. In more than half of the cases in which disagreements arose between EPs and consultants, the EPs were not able to reach an initial diagnosis. Further studies are needed to examine the association between disagreements in disposition and adverse outcomes.

Original languageEnglish
Article number22
JournalInternational Journal of Emergency Medicine
Volume6
Issue number1
DOIs
Publication statusPublished - 20-08-2013

Fingerprint

Consultants
Hospital Emergency Service
Emergencies
Physicians
Referral and Consultation
Japan
Emergency Medicine
Tertiary Healthcare
Tertiary Care Centers

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

@article{ac4c1cef19284113b2168d52bd731275,
title = "The level of agreement regarding patient disposition between emergency physicians and consultants in the emergency department",
abstract = "Background: Consultation is a common and important aspect of emergency medicine practice. We examined the frequency of consultations, the level of agreement and factors of disagreement with regard to the disposition of patients who visited two emergency departments (EDs) of tertiary care hospitals in Japan. Findings: We analyzed 3,503 consecutive patients who visited two EDs in Japan during a 3-month period. The initial diagnosis in the ED, the presence of consultation, and the patient disposition following the ED visit were recorded. At least one consultation was requested in 34.7{\%} of the patients (1,215/3,503), and 88{\%} of these patients were admitted to the hospital (1,063/1,215). Consultants and emergency physicians (EPs) agreed on patient disposition 95{\%} of the time (1,153/1,215), with κ = 0.76 (95{\%} CI 0.70-0.82). Opinions about disposition were discordant in 5{\%} of the patients consulted upon. In 63{\%} of those cases, patients were not diagnosed in the ED. Conclusion: Consultants and EPs agreed on patient disposition in most cases. In more than half of the cases in which disagreements arose between EPs and consultants, the EPs were not able to reach an initial diagnosis. Further studies are needed to examine the association between disagreements in disposition and adverse outcomes.",
author = "Mitsunaga Iwata and Katsuo Yamanaka and Yoshimi Kitagawa",
year = "2013",
month = "8",
day = "20",
doi = "10.1186/1865-1380-6-22",
language = "English",
volume = "6",
journal = "International Journal of Emergency Medicine",
issn = "1865-1372",
publisher = "Springer London",
number = "1",

}

The level of agreement regarding patient disposition between emergency physicians and consultants in the emergency department. / Iwata, Mitsunaga; Yamanaka, Katsuo; Kitagawa, Yoshimi.

In: International Journal of Emergency Medicine, Vol. 6, No. 1, 22, 20.08.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The level of agreement regarding patient disposition between emergency physicians and consultants in the emergency department

AU - Iwata, Mitsunaga

AU - Yamanaka, Katsuo

AU - Kitagawa, Yoshimi

PY - 2013/8/20

Y1 - 2013/8/20

N2 - Background: Consultation is a common and important aspect of emergency medicine practice. We examined the frequency of consultations, the level of agreement and factors of disagreement with regard to the disposition of patients who visited two emergency departments (EDs) of tertiary care hospitals in Japan. Findings: We analyzed 3,503 consecutive patients who visited two EDs in Japan during a 3-month period. The initial diagnosis in the ED, the presence of consultation, and the patient disposition following the ED visit were recorded. At least one consultation was requested in 34.7% of the patients (1,215/3,503), and 88% of these patients were admitted to the hospital (1,063/1,215). Consultants and emergency physicians (EPs) agreed on patient disposition 95% of the time (1,153/1,215), with κ = 0.76 (95% CI 0.70-0.82). Opinions about disposition were discordant in 5% of the patients consulted upon. In 63% of those cases, patients were not diagnosed in the ED. Conclusion: Consultants and EPs agreed on patient disposition in most cases. In more than half of the cases in which disagreements arose between EPs and consultants, the EPs were not able to reach an initial diagnosis. Further studies are needed to examine the association between disagreements in disposition and adverse outcomes.

AB - Background: Consultation is a common and important aspect of emergency medicine practice. We examined the frequency of consultations, the level of agreement and factors of disagreement with regard to the disposition of patients who visited two emergency departments (EDs) of tertiary care hospitals in Japan. Findings: We analyzed 3,503 consecutive patients who visited two EDs in Japan during a 3-month period. The initial diagnosis in the ED, the presence of consultation, and the patient disposition following the ED visit were recorded. At least one consultation was requested in 34.7% of the patients (1,215/3,503), and 88% of these patients were admitted to the hospital (1,063/1,215). Consultants and emergency physicians (EPs) agreed on patient disposition 95% of the time (1,153/1,215), with κ = 0.76 (95% CI 0.70-0.82). Opinions about disposition were discordant in 5% of the patients consulted upon. In 63% of those cases, patients were not diagnosed in the ED. Conclusion: Consultants and EPs agreed on patient disposition in most cases. In more than half of the cases in which disagreements arose between EPs and consultants, the EPs were not able to reach an initial diagnosis. Further studies are needed to examine the association between disagreements in disposition and adverse outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84881520455&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881520455&partnerID=8YFLogxK

U2 - 10.1186/1865-1380-6-22

DO - 10.1186/1865-1380-6-22

M3 - Article

C2 - 23835292

AN - SCOPUS:84881520455

VL - 6

JO - International Journal of Emergency Medicine

JF - International Journal of Emergency Medicine

SN - 1865-1372

IS - 1

M1 - 22

ER -