Misdiagnosis Common at Readmission

Article excerpt

TUCSON, ARIZ. -- Psychiatric patients who were readmitted to the same hospital within 30 days frequently received different diagnoses and often diagnoses that were incompatible with one another, a new study shows.

Less than half of patients with bipolar disorder received the same diagnosis upon readmission, and 90% of patients with schizoaffective disorder were later diagnosed with bipolar disorder, major depression, or schizophrenia.

The findings were surprising because presumably little would have changed in that short a period of time, and the four diagnoses are unlikely to coexist in the same patient, Dr. Richard Van Rhoads said at a psychopharmacology conference sponsored by the University of Arizona.

The variance in diagnoses was likely caused by unavailability of prior records, patients providing incomplete histories, time constraints that often limited patient evaluation to just 30 minutes, and a lack of rigor in applying DSM-IV criteria, he said.

Dr. Van Rhoads reviewed billing data for the top three diagnoses in 2005 among patients who were readmitted within a month of discharge, and identified 930 admissions among 376 patients readmitted to University Physicians Healthcare, a large Tucson hospital used for involuntary commitment.

A total of 255 patients had two admissions, 82 had three admissions, 27 had four admissions, and 12 patients had more than four admissions.

The same diagnosis was found at different admissions in only 50 of the 255 patients with two admissions, 7 of the 82 patients with three admissions, and 2 of the 27 patients with four admissions. None of the 12 patients with more than four admissions had the same diagnosis at every admission.

An analysis by diagnosis alone revealed that schizoaffective disorder was the most likely to be diagnosed as something else, he said. Only 9 of the 86 patients (10%) diagnosed with schizoaffective disorder kept the diagnosis each time they were readmitted. …