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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency and General Internal Medicine, Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake Aichi, 470-1192, Japan. iwatam@quartz.ocn.ne.jp.
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Iwata
authors.forename: Katsuo
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Kitagawa