Fischer und Konitzer’s comments relating to the epidemiological contextualization of quality indicators while considering the low prevalence and high prevalence of potential pathologies represent a further partial aspect in assessing the diagnostic quality of a medical emergency department. They also reflect the core problem of accuracy in making or excluding a diagnosis and the dependence on the prevalence of pathology.
The increasing use of medical services in emergency departments has been confirmed by several German federal states, is based on different underlying motivations, and is also a consequence of the professionalization process of interdisciplinary emergency departments in Germany.
The quality indicators we presented in our study described the diagnostic agreement (DA) of admission and main hospital diagnosis and their relation to the length of stay in the emergency department (DE). We looked merely at the diagnoses that justified admission on the one hand and that were confirmed or negated by further inpatient treatment on the other hand. Epidemiological contextualization is not required for such a study of inpatient diagnoses. Rather, quality indicators provide an opportunity to identify diagnostic groups from low-prevalence conditions (for example, aortic dissection, porphyria) that are underrepresented compared with other diagnostic groups—for example, from high-prevalence conditions (atrial fibrillation, acute coronary syndromes)—and are therefore diagnosed too late or not at all. In this context, individual measures to optimize processes in the diagnostic approach in a medical emergency setting may then be evaluated on the basis of the changed indicators (DE, DA).
Something that would be of interest in this context is the question of whether for outpatient treatment in an emergency department, the need for stepwise diagnostic evaluation is confirmed as a consequence of the Bayesian theorem, in analogy to approaches in primary care medicine (for example, watchful waiting). To our knowledge, quality indicators for outpatient treatment of cases in an emergency department do not currently exist.
PD Dr. med. Harald Dormann
Klinikum Fürth, Zentrale Notaufnahme
Jakob-Henle-Str. 1, 90766 Fürth, Germany
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Dormann H, Diesch K, Ganslandt T, Hahn EG: Numerical |
parameters and quality indicators in a medical emergency
department. Dtsch Arztebl Int 2010; 107(15): 261–7. VOLLTEXT