ABSTRACT
@#Introduction: Accurate provisional diagnosis in the Emergency Department (ED) is important as it has a significant impact on safety. It also affects the patients’ treatment, length of stay and cost of treatment. The data on the accuracy of making diagnosis made by ED doctors is scarce and most results vary with different countries. This study was conducted to evaluate the accuracy of the diagnosis made by the ED doctors in Hospital Universiti Sains Malaysia (USM) and the factors contributed to the discrepancy. Method: This was a retrospective cross-sectional study conducted in Hospital USM from May 2016 to December 2017. Medical records of the patients who were admitted to the hospital were selected using simple random sampling methods. The folders were reviewed and the association within the categorised diagnosis accuracy was analysed using the ICD-10 classification. The sample size was 180 cases, and cases were divided into two main categories. The factors associated with the unmatched diagnosis from both patients and provider were then measured using multiple logistic regressions. Results: Hospital USM Emergency Department had 15.6 per cent of unmatched diagnosis and 84.4 per cent of matched diagnosis. No difference between age and gender in making accurate diagnosis. The odds of having unmatched diagnosis in patients from the green zone are 4.2 times higher compared to the red zone. Conclusion: ED Hospital USM has a high diagnostic accuracy, especially involving the patients in red zone and yellow zone.
ABSTRACT
Background: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. Objectives: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. Methods: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Results: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients’ choice of transportation. Conclusion: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultura and logistic factors may need to beaddressed.