Discharge summaries get diagnosis wrong

SCORES of patients are leaving hospital with the wrong diagnosis in their medical records, causing massive discrepancies in hospital funding amounting to hundreds of thousands of dollars.

An audit of 150 patients' discharge summaries at Maroondah Hospital in Melbourne between November 2011 and January last year found half were missing significant clinical information and one in 10 had the wrong diagnosis.

The findings suggest hospitals are putting patients at risk, giving GPs the wrong information to continue caring for patients after a hospital stay and incorrectly coding their work for government funding.

Dr Nicholas Chin and three colleagues looked at 150 discharge summaries and compared them with more detailed medical records to determine how accurate diagnoses were, whether other illnesses or factors were missed, and how the patients' care was recorded for the purpose of funding.

The most common patients in the audit were those with respiratory conditions, heart failure, kidney infections and urinary tract infections.

They found that nearly half, or 72 patients' discharge summaries, needed to be assigned to different ''diagnostic related groups'', which dictate funding. In most cases, this was due to improved documentation of an additional diagnosis, the presence of another disorder or complications treated during the person's stay.

In 18 of these 72 cases, the review resulted in a new principal diagnosis that had previously not been acknowledged.

In the remaining 78 patient cases, only 38 were managed correctly, with 40 needing to be amended for funding purposes even though the diagnoses were correct.

The errors meant the hospital was not being paid enough for 65 of the 150 cases and would effectively be overpaid for seven of them.

The most commonly missed problems in the patients' medical records were acute renal (kidney) failure, anaemia, liver problems, infections and electrolyte disturbances - an imbalance of certain salts in the blood that can cause serious illness.

A report on the audit published in the online edition of the Internal Medicine Journal said staff at Maroondah Hospital had since changed their practice to include more regular reviews. However, the authors said, during 2011-12 more than 900 queries had resulted in ''reallocations'' of more than $1 million.

Given the uniformity of clinical practice across Australia, the researchers said it was ''more than likely'' incomplete medical documentation was a ''nationwide phenomenon'' that should be improved.

They said discharge summaries, which are often written by junior doctors, should be overseen by senior staff and were ''critical in improving patient safety and quality of care especially in the post hospital phase of the patient's clinical management''.

Maroondah hospital, managed by Eastern Health, cares for about 5500 patients a year.

In response to questions from The Age, Eastern Health's director of medical services and research, Dr Colin Feekery, said regular audits were now being done to ensure ''medical documentation becomes a true reflection of the actual care delivered''.

The story Discharge summaries get diagnosis wrong first appeared on The Sydney Morning Herald.

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