Quality of Diagnostic Examinations in a University Hospital Outpatient Clinic

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Abstract
The quality of outpatient diagnostic medicine at the Peter Bent Brigham Hospital was assessed in a two-phase study. In phase 1 the records of 249 randomly selected outpatients were graded and assigned scores for completeness of patient evaluation by means of a standardized work sheet with 55 categories of history, physical examination, and laboratory tests. Records that received higher scores belonged to patients seen more frequently in the medical clinic or in at least one consultation clinic. Many diagnostic categories not commonly evaluated fell into discrete historical, anatomical, or laboratory clusters. In phase 2, 25 patients with high record scores and 25 age- and sex-matched patients with low record scores were reevaluated. In all 50 patients many critical new or different findings were uncovered, but their yield in apparently overlooked areas was ten times greater in the low-scoring group. We conclude that both record review and patient reevaluation are necessary to assess the quality of ambulatory diagnostic examinations.

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