Organisational determinants and consequences of diagnostic discrepancy in two large patient groups in the emergency departments: a national study of consecutive episodes between 2008 and 2016

Table 4 Organisational determinants of diagnostic discrepancy for consecutive ED patients between 2008 and 2016

Organisational determinants	Hip fracture (n = 69,928)		Erysipelas (n = 37,558)
Organisational determinants	Definition 1^a OR (95% CI)	Definition 2^b OR (95% CI)	Definition 1^a OR (95% CI)	Definition 2^b OR (95% CI)
Senior physicians employed at the ED	2.75 (2.15–3.50)	3.59 (2.72–4.74)	3.29 (2.65–4.08)	3.59 (2.86–4.50)
Senior physicians 24-h a day	0.68 (0.53–0.88)	0.64 (0.47–0.84)	1.09 (0.86–1.37)	1.23 (0.96–1.56)
External senior physicians	0.50 (0.39–0.65)	0.50 (0.38–0.66)	0.44 (0.36–0.54)	0.41 (0.33–0.50)
Flow coordinator	0.97 (0.75–1.23)	0.97 (0.75–1.28)	0.69 (0.55–0.84)	0.61 (0.49–0.75)
Multidisciplinary team	1.50 (1.19–1.88)	1.42 (1.10–1.82)	1.40 (1.15–1.70)	1.52 (1.24–1.85)
Decision authority	1.83 (1.47–2.27)	1.94 (1.52–2.47)	1.80 (1.49–2.18)	1.77 (1.45–2.15)
Facilities in one building	0.65 (0.52–0.81)	0.52 (0.41–0.67)	1.39 (1.13–1.73)	1.39 (1.11–1.75)

OR odds ratio, CI confidence interval
^aHierarchically and diagnostically different diagnoses were defined as diagnostic discrepancy; hip fracture n = 2308, erysipelas n = 3206
^bDiagnostically different diagnoses were defined as diagnostic discrepancy; hip fracture n = 1998, erysipelas n = 2977
Results are coefficients from mixed effects models expressing the association between diagnostic discrepancy and the emergency department organisational characteristics. All estimates are adjusted for all covariates shown in Table 2 (episode-level age, gender and comorbidity and department-level teaching status, episode volume, and average 30-day readmission, 30-day mortality and episode costs)

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