Background: Febrile cases represent a major diagnostic and management challenge in tertiary healthcare facilities. Early diagnostic screening has been advised for therapeutic and admission decisions but its practical effect on clinical pathway, and patient outcome is under investigated. This study will assess the impact of early diagnostic screening on clinical care, patterns of hospitalization, and patient-reported outcomes of adults presenting with fever in tertiary care hospitals in Dhaka, Bangladesh. Methods: A hospital-based cross-sectional study was done over a period from January to December 2024 in two tertiary care hospitals, Dhaka. One hundred and twenty successive adult febrile patients (antipyretic cut-off value: ≥38°C) were taken. A structured questionnaire and medical record review were used to gather information on screening, clinical management, hospitalization outcomes, and patient satisfaction. Predictors of hospital admission were determined by multivariable logistic regression. Results: 70.8% of the patients received early diagnostic screening with CBC (82.4%) and rapid antigen tests (58.8%) being performed most frequently. Patients screened were significantly more often admitted (56.5% vs 20.0%, p<0.001) and spent less time in hospital (mean days: 2.8 vs 3.5, p=0,023). Screening results guided treatment in 82.4% of cases. Early testing was an independent positive predictor of admission with aOR=4.85 (95% CI 1.92 — 12.25) in adjusted analysis. Patient satisfaction was much higher in patients screened (88.3% vs 28.6% satisfied, p<0.001). Conclusion: Unstructured, early diagnostic screening results in more targeted therapy and higher rates of admission, yet shorter hospital stays and patient satisfaction. It should be incorporated into febrile illness algorithms with preference in using this pan-malaria primer technology for better patient care, and effectiveness of health system in tertiary hospitals.