182 Chapter 8 Supporting information Table of contents Supplementary material 1. Diagnostic handbook Supplementary material 2. Calculations of the reduction of working hours for medical specialists set against the hours of students and residents Supplementary material 3. Reasons for disagreement between students Supplementary material 4. Members of the OPTIMACT Study Group Supplementary Table S1. Inter-observer agreement between students for specific diagnostic labels in 240 cases Supplementary Table S2. Classification by the expert panel in 60 validation cases Supplementary Table S3. Inter-observer agreement between members of the expert panel for specific diagnostic labels in 60 validation cases Supplementary material 1. Diagnostic handbook Guidelines 1. Start the assessment of each patient by following the flowchart (next page). 2. More than one diagnosis can be applicable per patient. Please go through the entire handbook for each patient, irrespective of already assigned diagnostic labels. 3. Refer a case to the Adjudication Committee when two or more labels “…of unknown origin” are assigned (i.e. “Thoracic pain of unknown origin”, “Dyspnea of unknown origin”, or “Fever of unknown origin”). 4. If a patient has new complaints after ED discharge but within 28 days of follow-up, please review critically if these complaints correspond to a diagnosis that was already present during ED presentation. If not, do not label this diagnosis. To clarify: the diagnostic labels are a reflection of the diagnoses at ED presentation and not meant for new problems that emerge during hospitalization or after hospital discharge. 5. If you are confronted with a very complex case (for example a patient with many concurrent problems, complex comorbidities or unclear documentation), you are encouraged to refer this case to the Adjudication Committee even if the guidelines in the handbook do not state so. 6. Use your common sense. Using this handbook allows you to diagnose patients into several predefined categories. However, sometimes this is not straightforward. If the guidelines lead you to a diagnostic label that you do not support, either choose the label that you find most suitable or refer the case to the Adjudication Committee. 7. If follow-up data is missing (i.e. a patient has been transferred to another hospital but the transfer correspondence has not been uploaded yet), please indicate so on the assessment form.
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