Consultation patterns and clinical correlates of consultation in a tertiary care setting.

Michaela R Jordan · Joslyn Conley · William Amin Ghali

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Healthcare Systems and Technology Hospital Admissions and Outcomes Chronic Disease Management Strategies

Abstract

BACKGROUND: Consultation in hospital is an essential tool for acquiring subspecialty support when managing patients. There is limited knowledge on the utilization of subspecialty consultation from hospital based general internists. Consultation patterns to medical subspecialists and the patient factors that may influence consultation are reported for general medical services. METHODS AND FINDINGS: Hospital discharge data were obtained for patients from medical services over a 2-year period. Consultations requested to medicine subspecialties were identified, and then reported by type and frequency. Information on demographic factors, clinical diagnoses, length of stay (LOS), time in critical care units, and disposition were compared for patients with and without consultation.3979 patients were hospitalized during the study and 2885 consultations occurred. Almost half of the patients received at least one consultation (48.3%). Gastroenterology (26.3%), infectious diseases (14.6%) and respirology (13.6%) were the most frequently consulted services. Patients with consultation had a greater number of total diagnoses (7.3 vs. 5.5, P < 0.001), a greater mean LOS (15.9 vs. 6.8 days), were more likely to spend time in the ICU (11.5% vs. 3.5%) and CCU (4.3% vs. 1.2%), and to expire in hospital (10.7% vs. 4.9%). CONCLUSION: Consultation occurs frequently and its presence is an indicator of patient complexity and high use of health system resources. Analysis of consultation patterns for specific patient populations could assist in optimizing efficiency in health care delivery. Targeting quality improvement strategies toward optimizing consultation processes, engaging heavily utilized subspecialties in educational roles and assisting with resource planning are areas for future consideration.

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1983Impact of inter-physician communication on the effectiveness of medical consultations 2007Principles of Effective Consultation 1999Reasons for outpatient referrals from generalists to specialists 1997Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance.1999HMO physicians' use of referrals 1987Outpatient consultation 1992Referral and consultation in primary care: do we understand what we're doing?2006Exploring the Generalist-Subspecialist Interface in Internal Medicine

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2013Elements of a High-Quality Inpatient Consultation in the Intensive Care Unit. A Qualitative Study 2011Requesting physicians' experiences regarding infectious disease consultations

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