title: Lower rates of appropriate initial diagnosis in older emergency department patients associated with hospital length of stay.
abstract: OBJECTIVE
  Emergency department (ED) doctors are under time pressure to expedite decision-making. This task would seem more difficult in older patients who present atypically, have multiple comorbidities and require more diagnostic tests. This study aimed to investigate the rate of appropriate initial diagnosis of older ED patients admitted under medical units, and whether time was a factor.
  
  
  METHODS
  Retrospective review of all patients admitted under medical units from ED over a one-month period was conducted.
  
  
  RESULTS
  Four hundred ninety-three records were reviewed. Mean time to ED review was 87 minutes, and to medical registrar review, 409 minutes. Overall rate of appropriate initial diagnosis made by ED was 85.8%, with significantly lower rate detected in older patients. Overall rate for medical registrar was 94.5%.
  
  
  CONCLUSIONS
  Admitted older ED patients received lower rates of appropriate initial diagnosis. Time may be a contributing factor to this lower rate. Length of stay was prolonged if initial diagnosis was inappropriate.
authors.affiliation: Aged Care, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Tee Juan
authors.initials: TJ
authors.lastname: Ong
authors.affiliation: Aged Care, Northern Hospital, Epping, Victoria, Australia.
authors.forename: Yohanes
authors.initials: Y
authors.lastname: Ariathianto
authors.affiliation: Aged Care, Northern Hospital, Epping, Victoria, Australia.
authors.forename: Rabindra
authors.initials: R
authors.lastname: Sinnappu
authors.affiliation: Aged Care, Northern Hospital, Epping, Victoria, Australia.
authors.forename: Wen Kwang
authors.initials: WK
authors.lastname: Lim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002983:Clinical Competence; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D005260:Female; D005853:Geriatrics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: accuracy; diagnosis; emergency department; time