Gap Analysis between Provisional Diagnosis on Admission and Final Diagnosis during Discharge-A Comparative Study

Background: Achieving a high degree of diagnostic accuracy is important in practice of medicine. High degree of accuracy of provisional diagnosis may lead to use of lesser number of investigations with lesser cost burden to the health sector. Therefore, this gap analysis study aims to find out that how accurately provisional diagnosis matches final diagnosis. Methodology: This was a retrospective record based comparative study done in the Medicine Ward of R.G.Kar Medical College, Kolkata over a period of one month. Every patient having planned discharged on a particular day from male/female ward were selected and his/her treatment file was viewed and relevant informations were collected. The major outcome variable of the study was the matching/unmatching of final diagnosis with provisional diagnosis of the case. Results: Out of 420 patients, 182(43.3%) had their final diagnosis same as that of their provisional diagnosis. Association was found to be significant in case of period of hospital stay, referrals, type of investigations and number of investigations. Clinical examination had 55.4% sensitivity and while diagnostic investigations had sensitivity of 44.51% . Conclusion: Matching of provisional diagnosis with discharge diagnosis with greater accuracy and lesser number of investigations can lead to greater patient satisfaction along with lesser burden on health resources of the state. Technological developments for diagnosis are important but will never supplant the role of careful history taking for symptoms and clinical examination for signs. Keywords - gap analysis, provisional diagnosis, final diagnosis