Improving Diagnostic Safety in Emergency Departments in Viet Nam: High-Risk Presentations, Reassessment and Safe Disposition

Improving Diagnostic Safety in Emergency Departments in Viet Nam: High-Risk Presentations, Reassessment and Safe Disposition

A patient arrives at an emergency department with symptoms that could have several explanations. The initial assessment identifies no immediate need for resuscitation, and the patient is assigned a priority level based on the information available. While waiting for further evaluation, however, the patient's condition changes.

Another patient completes the initial examination and investigations. The results appear reassuring, but the cause of the symptoms remains uncertain. The clinical team must decide whether further observation or assessment is necessary, whether admission or transfer is appropriate, or whether the patient can reasonably be discharged.

Both situations illustrate a central challenge in emergency diagnostic safety. Decisions often need to be made before an illness is fully understood, while the information available to healthcare professionals continues to evolve.

Emergency clinicians regularly encounter nonspecific symptoms, incomplete histories, time-sensitive conditions, and competing demands. They must recognize patients who require urgent intervention while making appropriate decisions for those whose conditions initially appear less serious.

The challenge is not simply to establish a diagnosis as quickly as possible. It is to recognize clinically important risks, respond when a patient's condition changes, and determine the most appropriate next step when uncertainty remains.

For healthcare organizations in Viet Nam, improving diagnostic safety in emergency departments requires attention to the reliability of initial assessment, opportunities for reassessment, access to investigations and professional expertise, and the decisions made when patients are discharged, admitted, or transferred.

The goal is not to eliminate every diagnostic uncertainty before a patient leaves the emergency department. It is to support clinical decisions that reflect the available evidence, the potential consequences of unresolved concerns, and the patient's changing condition.

Why Emergency Departments Present Distinct Diagnostic Safety Challenges

Emergency departments assess people with acute illnesses and injuries, many of whom arrive without an established diagnosis.

Unlike services where patients may be referred with a relatively specific clinical question, emergency teams often begin with symptoms that could have many explanations.

Chest discomfort, abdominal pain, headache, dizziness, breathlessness, weakness, fever, and altered mental status are familiar presentations. Their underlying causes, however, can range from relatively minor conditions to illnesses requiring urgent intervention.

The information available during the first assessment may be limited. Previous medical records may not be accessible, the clinical history may be incomplete, and investigations may take time. Some conditions become more recognizable only as additional symptoms or findings develop.

Clinicians must make decisions despite these uncertainties. They need to determine who requires immediate attention, who may benefit from further observation or specialist consultation, and what level of care is appropriate after the emergency assessment.

In December 2022, the U.S. Agency for Healthcare Research and Quality published Diagnostic Errors in the Emergency Department: A Systematic Review, with an updated addendum issued in August 2023.

The review identified diagnostic errors as an important patient safety concern and highlighted several potentially serious conditions, including stroke, myocardial infarction, aortic aneurysm or dissection, spinal cord injury, and thromboembolic disease.

However, the review's estimates of overall diagnostic error frequency have been subject to methodological criticism, particularly concerning extrapolation from selected studies and the representativeness of the underlying evidence.

These estimates should not be interpreted as established diagnostic error rates for emergency departments in Viet Nam. The evidence is more appropriately used to understand potential risks, recognize limitations in current knowledge, and identify areas that may warrant further attention.

The World Health Organization's World Patient Safety Day 2024 reinforced the importance of addressing both cognitive and system-related factors in diagnostic safety. In emergency care, these influences interact in an environment where clinical conditions, available information, and priorities may change rapidly.

This combination makes emergency diagnostic safety a distinct area for organizational improvement, even though it shares fundamental principles with diagnostic excellence in other healthcare settings.

Triage Determines Priority, Not the Final Diagnosis

Triage is one of the first important safety functions in emergency care. Its purpose is to assess the urgency of a patient's condition and establish the priority for further evaluation or intervention.

Acuity-based triage helps identify people who require immediate attention and those who may be able to wait for further assessment.

The WHO Interagency Integrated Triage Tool, developed in collaboration with the International Committee of the Red Cross and Médecins Sans Frontières, provides an international approach to prioritizing patients according to acuity.

However, a triage category should not be confused with a definitive diagnosis.

A patient initially considered stable may have an important underlying condition that is not yet apparent. Conversely, a patient requiring immediate stabilization may not have a confirmed diagnosis when urgent intervention begins.

Triage reflects the information available at a particular point in time. It should remain responsive to subsequent changes rather than become a permanent judgment about the patient's condition.

This distinction is especially important when patients spend extended periods waiting for clinical assessment or investigations.

Someone who initially appears stable may develop new symptoms, abnormal physiological findings, or other changes that warrant additional attention. The original priority category may no longer adequately represent the patient's needs.

The organizational question is therefore not only whether initial triage is performed appropriately. It is also whether the emergency department can recognize clinically important changes while patients remain in its care.

Observation responsibilities, communication between staff, access to reassessment, and arrangements for escalating concerns all influence this capability.

The appropriate approach depends on clinical risk, staffing, available resources, and applicable professional requirements. A single reassessment interval should not be assumed suitable for every patient or emergency department.

The essential distinction is that triage begins the process of prioritizing care. It does not replace subsequent clinical judgment or ongoing assessment.

Recognizing High-Risk Presentations Without Encouraging Unnecessary Testing

One of the most difficult aspects of emergency diagnosis is recognizing serious disease when the initial presentation is nonspecific or atypical.

Some time-sensitive conditions produce characteristic findings. Others may begin with symptoms that are common and difficult to distinguish from less serious illnesses.

This creates a balance between two potential risks.

Failure to recognize an important condition may expose the patient to preventable harm. At the same time, investigating every possible diagnosis in every patient may lead to unnecessary testing, incidental findings, additional costs, and delays.

Improving diagnostic safety requires proportionate attention to the likelihood and potential consequences of serious conditions.

The AHRQ emergency department review identified several diseases associated with substantial harm when diagnostic opportunities are missed. Its findings support attention to presentations in which an uncommon but serious explanation may deserve consideration.

They do not establish that every patient presenting with a particular symptom requires identical investigations.

Dizziness provides one example. Its diagnostic significance depends on the broader presentation, examination findings, relevant risk factors, and other available information. The symptom alone cannot determine which investigations are appropriate.

The same principle applies to other common presentations, including chest discomfort, headache, weakness, and abdominal pain.

Healthcare organizations can support clinicians by providing access to appropriate professional guidance, relevant diagnostic capabilities, specialist consultation, and suitable escalation arrangements.

Education and clinical decision-support resources may also help professionals recognize selected high-risk presentations and understand important limitations of diagnostic investigations.

However, these tools must be used within their intended purpose and applicable professional requirements. A checklist, risk score, or decision rule should not be treated as a substitute for clinical assessment.

Nor should the absence of an abnormal finding from one investigation automatically be interpreted as excluding every serious condition that could explain the presentation.

The objective is to improve the reliability of recognizing clinically important risks without assuming that more investigations necessarily produce safer care.

Reassessment When the Clinical Picture Changes

An initial assessment cannot capture every development in an evolving illness.

A patient may arrive with relatively mild symptoms and deteriorate later. Another may initially appear severely unwell but improve following appropriate treatment.

New information may become available through laboratory investigations, imaging, repeated observations, or additional clinical history. These developments can change the likelihood of different diagnoses and the urgency of further action.

Reassessment is therefore an important component of safe emergency care.

It involves more than repeating a previous examination. A meaningful reassessment considers what has changed, whether the working diagnosis remains reasonable, and whether the patient's clinical needs or risks have altered.

For example, a patient may remain under observation while awaiting investigations. If the clinical condition changes, an earlier reassuring finding may no longer provide sufficient information for the current decision.

Clinical improvement can also be informative, but it does not automatically exclude every serious underlying condition.

Emergency departments need workable arrangements for recognizing and responding to these developments.

This is particularly relevant for patients waiting outside closely monitored treatment areas. Responsibility for observation and reassessment should remain clear even when patients move between waiting spaces, treatment areas, or professional teams.

A patient should not depend solely on findings recorded during initial triage when the clinical situation has subsequently changed.

At the same time, repeated assessments should be clinically meaningful. A procedure that generates documentation without improving recognition of changes may increase workload without providing the intended benefit.

For healthcare organizations in Viet Nam, an improvement initiative may begin by examining where changes in patient condition are most likely to be overlooked and whether staff have clear arrangements for communication and escalation.

The purpose is to ensure that new clinical information can influence decisions when it matters.

Diagnostic Investigations Must Be Interpreted in Context

Laboratory tests, imaging, electrocardiography, and other investigations provide essential information in emergency care.

Their value depends on how they are selected, performed, interpreted, and incorporated into clinical decisions.

A normal result does not necessarily exclude every important disease. An abnormal finding does not automatically establish a serious condition requiring immediate intervention.

Interpretation depends on the clinical question, test performance, timing, patient characteristics, and the available evidence.

The timing of an investigation may be particularly relevant when symptoms or physiological changes are still evolving. A result obtained early in an illness may have different implications from one obtained later.

Healthcare professionals therefore need to consider whether the available investigations adequately address the clinical concern rather than treating an isolated result as definitive.

This also has organizational implications.

Investigations may be delayed, some results may remain pending, and preliminary interpretations may subsequently change. Clinically important information may become available after a decision about admission, transfer, or discharge has already been made.

The healthcare organization should have appropriate arrangements for professional review and any necessary action.

The specific responsibilities depend on clinical circumstances and how services are organized.

The objective is not to require every investigation to be completed before every emergency care decision. It is to prevent clinically important information from being overlooked because it became available at a different stage of care.

Safe Disposition Is a Clinical Decision

One of the most consequential decisions in emergency care concerns what should happen after the initial assessment and any necessary investigations or treatment.

A patient may require hospital admission, further observation, transfer to another facility, or discharge with an appropriate plan.

This decision is commonly described as disposition.

Disposition is not simply an administrative action that closes an emergency encounter. It is a clinical judgment informed by the patient's condition, available evidence, unresolved uncertainty, and the care that can be provided safely afterward.

A safe disposition decision does not necessarily require a definitive diagnosis.

Some patients can appropriately leave the emergency department with a provisional explanation or without a fully established cause for every symptom.

In other situations, uncertainty may be significant enough to justify further evaluation, observation, specialist consultation, admission, or transfer.

The challenge is determining whether the remaining uncertainty is acceptable in the circumstances.

A patient may have reassuring investigation results but continue to experience symptoms that are not adequately explained. Another may improve clinically while still having findings that deserve further consideration.

The absence of a confirmed diagnosis is not automatically a reason for admission. Equally, the absence of an abnormal test result is not, by itself, sufficient justification for discharge.

The decision should reflect the overall clinical assessment and the options available for appropriate subsequent care.

Operational pressures may complicate these decisions. Emergency departments often face demands to reduce waiting times, improve patient flow, and make treatment spaces available for incoming patients.

These objectives matter, but they should not displace clinically appropriate decision-making.

A reasonable disposition decision considers the clinical risk that remains and whether the chosen next step is appropriate to the patient's condition and circumstances.

This does not guarantee that an unexpected outcome cannot occur. It provides a sound basis for assessing the quality of the decision using the information reasonably available at the time.

Discharge Safety When Diagnostic Uncertainty Remains

Discharge from an emergency department may be appropriate even when a diagnosis remains provisional.

However, discharge should account for what is known, what remains uncertain, and whether the patient can reasonably obtain additional assessment when necessary.

Communication accompanying discharge should not imply greater diagnostic certainty than the evidence supports.

If the cause of symptoms has not been fully established, the patient may need to understand that further evaluation could become necessary and how appropriate care can be accessed if the clinical situation changes.

This approach is often described as safety-netting.

Safety-netting does not replace necessary emergency evaluation. It provides an additional safeguard when discharge is clinically appropriate despite some remaining uncertainty.

Information should be relevant to the patient's circumstances, understandable, and practical.

A lengthy standard discharge document does not, by itself, establish that the person has received useful guidance.

Healthcare professionals may need to consider whether communication difficulties, transportation barriers, or other circumstances could affect the patient's ability to obtain the recommended care.

Some patients may require assistance from an authorized representative or caregiver, subject to applicable professional, consent, and confidentiality requirements.

Discharge arrangements should also account for clinically significant investigations that remain pending.

In some circumstances, a patient may appropriately leave before every ordered result is finalized. However, the healthcare organization should have a reliable arrangement for recognizing and acting on important results that become available later.

Responsibility may involve emergency clinicians, laboratories, imaging services, outpatient teams, or other professionals, depending on how care is organized.

The essential concern is whether responsibility for reviewing and responding to relevant information is clear.

The same attention is needed when a patient chooses to leave before the recommended evaluation is complete. Such circumstances should be handled according to applicable legal and professional requirements, with appropriate consideration of the patient's ability to make the decision, information provided, and clinical risks involved.

They should not automatically be treated as equivalent to routine discharge following a completed clinical assessment.

The aim is not to keep every patient in the emergency department until all possible findings are available. It is to prevent important information or unresolved concerns from becoming disconnected from clinical responsibility when the encounter ends.

Admission and Transfer Must Preserve Important Diagnostic Information

Admission and transfer create different diagnostic safety concerns from discharge home.

When responsibility moves from one team or facility to another, the receiving professionals need sufficient information to understand the patient's condition and the reasoning behind the decisions already made.

This includes the current assessment, important findings, pending investigations, and significant uncertainty that may influence further care.

A provisional diagnosis should not automatically be treated as confirmed simply because it appears in an admission or transfer document.

Likewise, important concerns should not disappear during handover.

The WHO Emergency Care Toolkit includes an Acute Transfer Checklist, Acute Referral Form, and Counter-Referral Form to support communication and coordination between healthcare facilities.

These resources illustrate the importance of transferring relevant clinical information when responsibility changes.

However, using an international form does not automatically establish compliance with Vietnamese transfer requirements or guarantee effective communication.

Healthcare organizations should examine whether their processes support timely professional communication, suitable documentation, and clear responsibility.

Internal transfers within hospitals deserve similar attention. A patient admitted from the emergency department may continue to require diagnostic evaluation after leaving the emergency area.

An unexpected transfer to intensive care may warrant review, but it does not inherently mean that emergency clinicians made an earlier diagnostic error.

The transfer may reflect expected disease progression, appropriate escalation, or circumstances that were not reasonably apparent during the initial assessment.

The same distinction applies when a diagnosis established during hospitalization differs from the initial emergency assessment.

A prospective observational study published in the Journal of Clinical Medicine in September 2026 examined differences between initial emergency department diagnoses and subsequent internal medicine discharge diagnoses at a Swiss hospital.

Among 515 patients admitted from the emergency department to internal medicine, the researchers identified diagnostic discrepancies in 52 patients, representing 10.1% of the study population.

These discrepancies were associated with a greater likelihood of subsequent transfer within the hospital. The researchers also examined hospital length of stay and other outcomes, although the findings should not be interpreted as demonstrating that diagnostic discrepancies directly caused those outcomes.

The study involved a single hospital and a selected group of admitted patients. Its results should not be generalized to all emergency department encounters or interpreted as evidence that every diagnostic discrepancy represented an avoidable error.

A diagnosis may change because new information becomes available during hospitalization. Understanding whether a missed opportunity occurred requires examination of the original clinical circumstances, available evidence, and decisions made at the relevant time.

The purpose of safe handover is to allow diagnostic assessment to continue appropriately, without losing important findings or creating a misleading impression of certainty.

Operational Pressure and Patients Requiring Additional Assessment Support

Emergency departments may face high patient volumes, limited treatment spaces, staffing constraints, and delays in accessing inpatient beds or specialist services.

These conditions can influence clinical work.

Healthcare professionals may need to manage several patients, communicate urgent findings, interpret investigations, and make decisions while coordinating care with other departments.

When workload becomes difficult to manage, attention, communication, and opportunities for reassessment may be affected.

However, crowding should not automatically be identified as the cause of a particular diagnostic error. The relationship between operational conditions and diagnostic outcomes is complex, and individual cases require appropriate assessment.

In February 2026, the European Observatory on Health Systems and Policies published Dealing With the Challenges in Urgent and Emergency Care: What Are the Policy Options?

WHO/Europe highlighted the report in March 2026, emphasizing that improving urgent and emergency care requires coordination across the wider healthcare system.

Although the report focuses on the WHO European Region, its broader message is relevant: emergency department performance depends partly on workforce capacity, inpatient services, referral arrangements, and the organization of care beyond the emergency department itself.

For Viet Nam, improvement may require cooperation between emergency teams, diagnostic services, inpatient departments, hospital leadership, and other healthcare facilities.

Faster movement through an emergency department does not necessarily mean safer diagnosis. A shorter stay may reflect efficient care, but it may also raise concerns if necessary evaluation has been abbreviated.

Conversely, a longer stay does not automatically establish poor-quality care.

The important question is whether organizational arrangements support timely and clinically appropriate decisions.

Some patients may also require additional assessment support because their presentations or communication needs are more complex.

Older people may have multiple health conditions or take several medications. Children require age-appropriate assessment. Pregnancy and the postpartum period can change the context in which symptoms are interpreted.

People with disabilities, altered mental status, or communication difficulties may need additional support to obtain an appropriate clinical history or examination.

These considerations should not become assumptions that every person in a particular group has the same diagnostic needs.

The relevant concern is whether clinicians have the resources, information, and professional support needed to assess each patient according to their circumstances.

Learning From Unexpected Emergency Department Returns

An unexpected return to an emergency department may raise questions about the original diagnostic assessment or disposition decision.

Some patients return because symptoms have worsened or an illness has evolved. Others return because a previously uncertain diagnosis has become clearer.

Certain returns may reveal a missed opportunity for diagnosis, while others reflect an appropriate clinical course despite reasonable earlier decisions.

A return visit should therefore be treated as a potential signal for review rather than proof of diagnostic error.

Healthcare organizations sometimes examine unscheduled returns within defined periods, such as 48 or 72 hours.

These windows may help identify records for review, but no single interval captures every important diagnostic event.

A later return may be clinically significant, while an early return may be unrelated to a diagnostic problem.

A meaningful review considers the original presentation, clinical information available at the time, investigations, disposition decision, and subsequent developments.

Knowing the eventual diagnosis can make earlier findings appear more obvious than they reasonably were.

Reviewers should therefore remain alert to hindsight bias and avoid judging an earlier decision solely through information that became available later.

The purpose is to understand whether an opportunity for safer or more reliable care existed, not to attribute an unexpected outcome automatically to individual professional failure.

What Electronic Triggers Can and Cannot Establish

Research has increasingly examined the use of electronic health record information to identify emergency encounters that may warrant diagnostic safety review.

These methods are commonly called electronic triggers or e-triggers.

They apply predefined criteria to select records with characteristics potentially associated with missed opportunities for diagnosis.

In a study published online in December 2024 and appearing in the February 2025 issue of JAMA Internal Medicine, Vaghani and colleagues evaluated six electronic triggers using data from the United States Veterans Affairs healthcare system.

The triggers addressed selected high-risk presentations, unexpected returns, concerning symptom-disease combinations, and abnormal test results without documented follow-up under the study's definitions.

Their positive predictive values ranged from 11.0% to 52.4%, depending on the trigger.

These findings suggest that electronic triggers can help identify potentially relevant records for retrospective review. However, they also demonstrate that many selected encounters do not meet the study's criteria for a missed diagnostic opportunity after professional assessment.

An electronic trigger is therefore a screening method, not an independent determination of diagnostic error.

A more recent study by Marks and colleagues, published in JAMA Network Open on June 29, 2026, examined the use of large language models to screen for missed diagnostic opportunities within two emergency care electronic trigger cohorts.

The researchers evaluated 288 encounters after exclusions.

The cohorts included patients returning with hospital admission within 72 hours after emergency discharge and patients requiring escalation to intensive care within 24 hours after admission from the emergency department.

Physician review identified 39 encounters with missed opportunities for diagnosis under the study's adjudication framework.

This proportion reflects deliberately selected encounters and must not be interpreted as the prevalence of missed diagnosis across all emergency department visits.

The models demonstrated different combinations of sensitivity and specificity, with varying levels of agreement with physician reviewers.

The findings suggest potential value in supporting record screening, but they do not establish that automated systems can reliably determine negligence, replace clinical review, or prevent patient harm in routine practice.

Both studies were conducted in particular United States healthcare environments. Their performance estimates cannot automatically be generalized to Vietnamese emergency departments.

For DxEx.vn, the main significance of this research is the distinction between identifying cases that may deserve review and determining whether a missed diagnostic opportunity actually occurred.

Detailed governance of AI-assisted review systems, including validation, information security, monitoring, and implementation, requires separate specialist consideration.

Measuring Emergency Diagnostic Safety Without Misleading Conclusions

Healthcare organizations need information to understand whether their diagnostic safety improvement efforts are working.

However, diagnostic safety cannot be assessed adequately through a single operational indicator.

Emergency department length of stay, testing volume, admission rates, and unscheduled returns may provide useful information about service activity and selected risks.

None is a complete measure of diagnostic accuracy.

A shorter stay does not necessarily mean safer diagnosis. A higher admission rate does not automatically demonstrate better recognition of serious disease. An unscheduled return is not equivalent to a confirmed error.

Measures should therefore be selected according to the specific improvement concern.

If the objective is to improve recognition of deterioration, an organization may examine whether clinically important changes are identified, communicated, and acted upon appropriately.

If the concern involves disposition decisions, selected reviews of relevant returns or unexpected outcomes may provide useful information.

If the concern involves admission or transfer, the organization may examine whether the receiving team obtains important clinical information and understands unresolved diagnostic questions.

Such assessments require clear definitions, appropriate denominators, reliable data, and careful professional interpretation.

In January 2026, WHO published its Data Set for Emergency Care, containing 47 core and 31 extended data elements.

The dataset provides a standardized approach to recording selected aspects of emergency care, including triage and relevant prehospital information.

It may support monitoring, evaluation, and quality improvement, particularly where organizations are developing more consistent emergency care information systems.

However, the dataset is not itself a validated instrument for identifying diagnostic errors, nor is its full implementation a mandatory requirement for every healthcare facility in Viet Nam.

Organizations should distinguish routine service monitoring from structured professional review of potential diagnostic concerns.

Balancing measures are equally important.

An intervention intended to improve recognition of serious disease may increase unnecessary investigations or admissions. A change designed to improve patient flow may unintentionally reduce opportunities for clinically necessary reassessment.

The objective is to determine whether a specific aspect of emergency diagnostic care has become more reliable while identifying any new risks created by the intervention.

Practical Improvement Opportunities in Viet Nam

Emergency care in Viet Nam is provided across healthcare organizations with different resources, staffing arrangements, and diagnostic capabilities.

Large hospitals may have access to extensive investigations and specialist expertise but also experience substantial patient volumes and operational pressures.

Smaller hospitals and other facilities receiving emergency patients may have more limited access to particular investigations or specialties.

These differences mean that improvement priorities should reflect local circumstances.

A large emergency department may identify difficulties related to prolonged waiting, communication between teams, or patients remaining in emergency treatment spaces while awaiting inpatient beds.

A smaller facility may identify concerns involving recognition of time-sensitive conditions, access to diagnostic services, or arranging transfer when the patient's needs exceed local capabilities.

The intervention should follow from the problem identified.

For example, if patients waiting for assessment are not consistently reassessed when their conditions change, the organization may need to clarify observation responsibilities or improve communication between staff.

If important pending investigations are sometimes overlooked after discharge, the priority may be to establish clearer arrangements for reviewing and acting on relevant results.

If transfers are delayed because information or consultation arrangements are insufficient, improvement should address those particular barriers.

International resources may help inform the design of changes.

The WHO Emergency Care Toolkit provides materials concerning initial assessment, triage, documentation, referral, transfer, and selected clinical processes.

The WHO/International Committee of the Red Cross Basic Emergency Care program, developed in collaboration with the International Federation for Emergency Medicine, offers a systematic educational approach for first-contact healthcare professionals managing acute illness and injury.

These resources can support essential emergency care capacity development, but they should be used within their intended scope and adapted to applicable Vietnamese professional requirements.

Introducing a tool or providing training does not automatically establish that diagnostic safety has improved.

A practical initiative should begin with a clearly defined concern, involve relevant healthcare professionals, and remain feasible within the organization's resources.

Changes may be tested on a manageable scale before wider implementation, with subsequent evaluation of intended benefits and possible unintended consequences.

The aim is to strengthen emergency diagnostic decisions without creating unnecessary administrative burden.

Legal, Ethical, and Professional Considerations in Viet Nam

Improving diagnostic safety in emergency departments must operate within Viet Nam's legal and professional framework for medical examination and treatment.

The Law on Medical Examination and Treatment No. 15/2023/QH15 provides an important foundation concerning emergency care, professional responsibilities, healthcare facility operations, patient rights, and medical incident prevention.

The Law should be considered together with applicable amendments, including those reflected in Consolidated Document No. 26/VBHN-VPQH issued by the Office of the National Assembly on February 26, 2026.

Article 61 specifically addresses emergency care, including care provided at healthcare facilities and prehospital emergency care.

Clause 2 requires emergency care to be based on assessment, classification, and the application of professional and technical measures appropriate to the patient's condition.

This provision is directly relevant to the relationship between triage, clinical assessment, and appropriate emergency intervention.

Article 61 also addresses circumstances in which additional professional or technical support is required.

Depending on the situation, the healthcare facility may need to arrange professional consultation, request assistance from another facility, obtain appropriate remote professional support, or transfer the emergency patient to a suitable healthcare facility.

The Article further establishes responsibilities concerning the prioritization of personnel, medical equipment, and medicines for emergency care and the appropriate transfer of emergency patients.

These requirements provide a legal context for examining whether emergency care arrangements are appropriate to a facility's responsibilities and capabilities.

However, Article 61 should not be interpreted as prescribing a particular international triage system, a universal reassessment interval, or one standardized disposition checklist for every emergency department in Viet Nam.

Article 62 addresses medical examination, the indication of treatment methods, and medication prescribing. It requires compliance with applicable professional and technical regulations and establishes responsibilities for timely and accurate professional decisions.

Article 71 addresses medical incident prevention through identification, reporting, analysis of causes, and preventive measures intended to reduce recurrence.

These provisions are relevant to quality improvement and patient safety activities, including the review of potential diagnostic concerns.

Decree No. 96/2023/ND-CP and applicable Ministry of Health regulations provide further requirements concerning healthcare practice, facility operations, and professional activities, subject to relevant amendments.

Healthcare organizations should ensure that their emergency care arrangements remain consistent with their authorized scope, applicable technical requirements, and institutional responsibilities.

International guidance from WHO, AHRQ, and professional emergency medicine organizations can support evidence-informed improvement. It does not automatically become mandatory Vietnamese clinical practice requirements.

Professional Accountability and Diagnostic Review

Unexpected deterioration, an emergency department return, hospital admission, or a subsequent change in diagnosis does not automatically establish negligence or a legally recognized professional or technical error.

Similarly, selection through an electronic trigger is not confirmation of diagnostic failure.

Professional review requires consideration of the information available at the relevant time, the patient's condition, applicable professional requirements, and the circumstances under which decisions were made.

Organizations should distinguish internal learning activities from formal processes for determining professional or legal responsibility.

An internal quality improvement review cannot replace mandatory medical incident reporting, complaint resolution, or other legally required procedures where those obligations apply.

At the same time, healthcare professionals should be able to identify and examine legitimate safety concerns without assuming that every unexpected outcome demonstrates individual misconduct.

The purpose is to strengthen clinical reliability while maintaining lawful professional accountability.

Confidentiality and Personal Data Protection

Emergency diagnostic safety reviews may involve medical records, sensitive health information, clinical outcomes, and details concerning professional decisions.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/ND-CP, both effective January 1, 2026, form part of the applicable legal framework governing personal data processing, including health-related information.

Healthcare organizations using patient-level data for quality improvement, case review, research, or technology-assisted screening should assess the applicable legal basis, purposes of processing, authorized access, security safeguards, retention requirements, and other relevant obligations.

Particular care is required when records are shared between healthcare facilities, processed through external systems, or used for research or publication.

Appropriate aggregation or de-identification may reduce privacy risks, but it does not automatically eliminate legal obligations where individuals remain identifiable or re-identification is reasonably possible.

Automated screening or AI-assisted tools may introduce additional data governance, security, and professional oversight considerations.

International evidence should inform lawful and responsible improvement, not justify unrestricted access to identifiable clinical information.

Making Emergency Diagnosis Safer Through Better Decisions

Diagnostic safety in emergency departments cannot be reduced to the accuracy of one assessment or investigation.

It depends on decisions made as new information becomes available and a patient's condition evolves.

Triage establishes the urgency of initial attention but does not determine the final diagnosis. Clinical assessment identifies likely explanations and important risks, while reassessment allows new findings to influence care.

Disposition determines the next stage of care and requires consideration of the patient's condition, unresolved concerns, and available options for appropriate further management.

These activities are connected, but each presents a distinct opportunity to improve reliability and safety.

International evidence highlights the importance of recognizing serious conditions, responding to changes in clinical status, supporting professional communication, and learning from selected encounters where a missed diagnostic opportunity may have occurred.

At the same time, no single checklist, electronic trigger, risk score, or technology can guarantee diagnostic safety.

For healthcare organizations in Viet Nam, progress may begin with identifying where emergency diagnostic decisions are vulnerable and whether staff have sufficient support for assessment, reassessment, consultation, and disposition.

The most appropriate improvements will depend on local clinical needs, available resources, organizational conditions, and the causes of identified problems.

Improving diagnostic safety in emergency departments means supporting clinically appropriate decisions as a patient's condition evolves, recognizing important uncertainty, and ensuring that the next step in care reflects the risks and information available.

A safer emergency department is not necessarily one in which every patient receives more investigations or every diagnosis is established before the encounter ends.

It is one in which important risks are recognized, decisions remain responsive to changing information, and practical safeguards support appropriate professional judgment.

Strengthening these capabilities is an important part of advancing diagnostic quality, safety, and reliability in Viet Nam.

Evidence and Policy Context

This article draws on international evidence and professional guidance, including the Agency for Healthcare Research and Quality's Diagnostic Errors in the Emergency Department: A Systematic Review (2022, updated 2023); the World Health Organization's World Patient Safety Day 2024 materials on improving diagnosis for patient safety; and the WHO Emergency Care Toolkit.

The discussion also considers the WHO Interagency Integrated Triage Tool; the WHO/International Committee of the Red Cross Basic Emergency Care program, developed in collaboration with the International Federation for Emergency Medicine; and WHO resources concerning emergency care documentation, referral, and transfer.

Recent developments include the WHO Data Set for Emergency Care (2026), which provides 47 core and 31 extended data elements to support standardized emergency care information collection.

Research concerning missed diagnostic opportunities includes Vaghani and colleagues' Implementation of Electronic Triggers to Identify Diagnostic Errors in Emergency Departments, published online in December 2024 and in the February 2025 issue of JAMA Internal Medicine.

The article also considers Marks and colleagues' Screening for Missed Opportunities for Diagnosis in the ED Using eTriggers and Large Language Models, published in JAMA Network Open on June 29, 2026.

These studies provide evidence concerning methods for selecting emergency encounters that may warrant diagnostic safety review. Their findings should not be treated as established diagnostic error rates for Vietnamese emergency departments or as evidence that automated tools can independently determine professional negligence.

Additional evidence includes Ackfeld and colleagues' Diagnostic Discrepancies Between Emergency Department Assessment and Internal Medicine Discharge Diagnosis: A Prospective Observational Study in a Swiss Tertiary Hospital, published in the Journal of Clinical Medicine in September 2026.

This study illustrates the importance of interpreting diagnostic discrepancies in their clinical context rather than automatically treating differences between initial and subsequent diagnoses as confirmed errors.

The discussion also draws on AHRQ's Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action (2023) and the European Observatory on Health Systems and Policies' February 2026 policy brief Dealing With the Challenges in Urgent and Emergency Care: What Are the Policy Options?, highlighted by WHO/Europe in March 2026.

The Vietnamese legal context includes the Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH (2026); Decree No. 96/2023/ND-CP, as applicable; relevant Ministry of Health professional and technical regulations; the Law on Personal Data Protection No. 91/2025/QH15; and Decree No. 356/2025/ND-CP.

International emergency care resources and diagnostic safety frameworks are presented as sources of evidence-informed professional education and organizational improvement. They should not be interpreted as mandatory Vietnamese clinical protocols, substitutes for professional judgment, or instruments for determining individual legal liability.

Professional Scope and Disclaimer

This article is published by Diagnostic Excellence Vietnam (DxEx.vn) for professional education, knowledge-sharing, and general information. It examines emergency department diagnostic safety from the perspectives of healthcare quality, patient safety, risk management, reassessment, disposition decisions, and systems-based improvement.

The content does not constitute individualized medical advice, clinical diagnosis, emergency treatment instructions, patient-specific discharge or transfer recommendations, legal advice, an assessment of an individual healthcare professional's competence, or a legally binding interpretation of Vietnamese regulations. Diagnostic Excellence Vietnam (DxEx.vn) is not a healthcare provider, regulatory authority, or accreditation or certification body.

Emergency assessment, triage, clinical decision-making, professional consultation, admission, transfer, discharge, medical incident reporting, quality improvement activities, personal data processing, and organizational implementation remain subject to applicable Vietnamese laws, professional standards, institutional responsibilities, and the judgment of appropriately qualified healthcare professionals and authorized healthcare organizations.