Background Highlights
Abstract
Communication between consulting and consultant services is essential to provide high-value care. We implemented a collaborative project between hospital medicine (HM), emergency medicine (EM), and departmental leadership of the major consulting services to provide feedback regarding consultant communication, promptness, and follow-up planning. We conducted pre- and postintervention surveys of HM and EM clinicians and measured the mean turnaround time (TAT) from consult order to consultant note completion. Perceptions of consultant promptness and follow-up communication improved postintervention. Mean TAT was significantly reduced postintervention (1098 vs. 1011 min, p = .002, confidence interval [CI]: 30.7-143.3). A collaborative approach using interdepartmental feedback improved perceptions of the quality of interactions with consulting services.
Table 1: Consultant Guidelines
Responsiveness and Communication:
Primary services will place a consult order in Epic and directly contact the consulting service
Consults called before 12pm should have initial recommendations in epic by 5pm. Consults after 12pm (unless urgent/emergent) should have recommendations by 10am the following morning in Epic
Post consult Feedback
A dialog between teams should determine who places the specific orders
Follow up:
Consult services shall address “readiness for discharge” and include specialty specific recommendations and follow up when signing off.
Background: Decreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.
Objective: To quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.
Methodology: We conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.
Results: During the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.
Conclusion: This report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.