Accuracy of admitting diagnosis in acute surgical patients by non consultant hospital doctors.

The incidence of accurate diagnosis made by non-consultant hospital doctors (NCHDs) is unknown in acute surgical admissions. There is a common assumption that reliance is made on excessive and inappropriate investigations. The aim of study was to assess the accuracy of admitting diagnosis by the NCHDs and the appropriateness of radiological investigations ordered. Data were collected on 100 consecutive acute surgical admissions. A final diagnosis was made in all the patients. 79 patients had accurate initial diagnosis (NCHDs). 23 scans were performed which confirmed the initial diagnosis. Out of 21 initial inaccurate diagnoses, final diagnosis was made on repeated clinical examination in 10, on imaging alone in 5 and by endoscopy or surgery in the remaining 6 patients. 11 patients had scans and 7 were appropriate. We conclude that 79% of diagnoses made by NCHDs are the accurate final diagnoses. The utilization of diagnostic modalities especially radiological imaging is highly appropriate. Our study suggests that the physical presence of a consultant on site may not lead to significant improvement to the delivery of health care to the Irish population.