Missed diagnoses among elderly patients discharged from an accident and emergency department

Objective-To investigate how often elderly patients are discharged from an accident and emergency (A&E) department with unrecognised but remediable problems. Methods-Over a period of six months, 174 elderly patients fulfilling inclusion criteria for the study were discharged from A&E, and of these 97 (56%) agreed to be reviewed in the day hospital. They were assessed by a doctor, nurse, physiotherapist, occupational therapist, speech therapist, and social worker. A full blood count, urea and electrolytes, liver and thyroid function tests, a chest radiograph, and an electrocardiogram were performed. A Barthel activity of daily living index was performed on the first visit and before discharge. Results-28% had missed diagnoses which benefited from day hospital attendance and a further 13 patients had been admitted before they could attend day hospital. Those patients presenting with falls and living alone constituted a high risk group. Conclusions-Elderly patients attending A&E merit special consideration to detect underlying medical or social problems.