When a patient is transferred the diagnoses given on admission to the receiving hospital may differ from those at the sending hospital.
Diagnostic discordance:
(1) removal of a diagnosis at the receiving hospital (loss)
(2) addition of a diagnosis at the receiving hospital (gain)
Exclusions:
(1) change in status (typically deterioration) during transfer
(2) change related to use of synonyms
Risk factors for diagnostic discordance:
(1) physician: nonspecialist at sending hospital
(2) patient factors: infant or other vulnerable patient; deteriorating
(3) diagnosis: multi-trauma with or without head trauma; toxicology; metabolic; renal; gastrointestinal
(4) failure to use health information exchange (telemedicine, etc) between the sites