Elements of a High-Quality Inpatient Consultation in the Intensive Care Unit. A Qualitative Study

Stevens, Jennifer P.; Johansson, Anna; Schonberg, Mara A.; Howell, Michael D.

doi:10.1513/annalsats.201212-120oc

Cited by 24 publications

(36 citation statements)

References 26 publications

(18 reference statements)

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“…2,9,22 In particular, Chen et al identified variability in the use of medical consultants following specific surgical procedures, 22 whereas we studied inpatient consultation more generally across the full spectrum of inpatient conditions seen in the Medicare population. While our study confirms earlier findings that sicker and more complex patients receive more consultations, we also demonstrate that patient comorbidities and prior hospitalizations contribute little to explaining the use of consultation use during acute hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…Large numbers of consultations may be accompanied both by increased resource utilization and multiple and potentially conflicting recommendations of several consulting services. 2 Given the evidence of variation in consultation practices, further investigation should assess the clinical consequences of these practices and the circumstances under which consultation is beneficial, wasteful, or harmful.…”

Section: Discussionmentioning

confidence: 99%

“…The vast majority of consultations are likely beneficial to patient care. 1,2 The involvement of additional medical perspectives, however, may also carry risks to the patient. For example, each new physician could recommend additional diagnostic and therapeutic interventions, contribute to a longer length of stay, offer conflicting recommendations, or lead to excessive specialist involvement after discharge.…”

Section: Introductionmentioning

confidence: 99%

“…For example, each new physician could recommend additional diagnostic and therapeutic interventions, contribute to a longer length of stay, offer conflicting recommendations, or lead to excessive specialist involvement after discharge. 2 As a result, it is possible that some consultations could actually worsen care, leading to both inferior patient outcomes and higher costs.…”

Section: Introductionmentioning

confidence: 99%

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Variation in Inpatient Consultation Among Older Adults in the United States

et al. 2015

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BACKGROUND: Differences among hospitals in the use of inpatient consultation may contribute to variation in outcomes and costs for hospitalized patients, but basic epidemiologic data on consultations nationally are lacking. OBJECTIVE: The purpose of the study was to identify physician, hospital, and geographic factors that explain variation in rates of inpatient consultation. The primary outcome measured was number of consultations conducted during the hospitalization, summarized at the hospital level as the number of consultations per 1,000 Medicare admissions, or Bconsultation density.K EY RESULTS: Consultations occurred 2.6 times per admission on average. Among non-critical access hospitals, use of consultation varied 3.6-fold across quintiles of hospitals (933 versus 3,390 consultations per 1,000 admissions, lowest versus highest quintiles, p<0.001). Sicker patients received greater intensity of consultation (rate ratio [RR] 1.18, 95 % CI 1.17-1.18 for patients admitted to ICU; and RR 1.19, 95 % CI 1.18-1.20 for patients who died). However, even after controlling for patient-level factors, hospital characteristics also predicted differences in rates of consultation. For example, hospital size (large versus small, RR 1.31, 95 % CI 1.25-1.37), rural location (rural versus urban, RR 0.78, CI 95 % 0.76-0.80), ownership status (public versus not-for-profit, RR 0.94, 95 % CI 0.91-0.97), and geographic quadrant (Northeast versus West, RR 1.17, 95 % CI 1.12-1.21) all influenced the intensity of consultation use. CONCLUSIONS: Hospitals exhibit marked variation in the number of consultations per admission in ways not fully explained by patient characteristics. Hospital Bconsultation density^may constitute an important focus for monitoring resource use for hospitals or health systems.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variation in Inpatient Consultation Among Older Adults in the United States

et al. 2015

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“…However, several reports in the literature detail the difficulties inpatient physicians have with consulting services 16,22 and perhaps explain some factors underlying this association. Physicians identify difficulties with consulting providers having lower investment in the case, demonstrating unprofessional behaviors, and providing conflicting information to the patient.…”

Section: Discussionmentioning

confidence: 99%

The number of inpatient consultations is negatively correlated with patient satisfaction in patients with prolonged hospital stays

Schmocker

Holden

Vang

et al. 2016

The American Journal of Surgery

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Background Patient satisfaction is often measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Our aim was to examine the structural and clinical determinants of satisfaction among inpatients with prolonged lengths of stays (LOS). Methods Adult patients who were admitted between 2009 and 2012, had a LOS ≥ 21 days, and completed the HCAHPS survey were included. Univariate analyses assessed the relationship between satisfaction and patient/system variables. Recursive partitioning was used to examine the relative importance of the identified variables. Results 101 patients met inclusion criteria. The average LOS was 35 days and 58% were admitted to a surgical service. Satisfaction with physician communication was significantly associated with fewer consultations (p<0.01), non-operative admission (p<.001), no ICU stay (p<.01), non-surgical service (p<.01), and non-ER admissions (p=.03). Among these, having fewer consultations had the highest relative importance. Conclusions In long stay patients, having fewer inpatient consultations was the strongest predictor of patient satisfaction with physician communication. This suggests that examination of patient-level data in clinically relevant subgroups may be a useful way to identify targets for quality improvement.

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Patient and Clinician Perceptions of Factors Relevant to Ideal Specialty Consultations

et al. 2022

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Key Points Question How do stakeholders envision the ideal inpatient consultation and in what ways do consultations commonly fall short of this ideal? Findings In this qualitative study of 17 specialists, 13 hospitalists, 4 patients, and 4 family members, participants identified 11 key information exchanges that occur during an ideal consultation, as well as 6 common defects and 5 contextual factors that influence how these information exchanges transpire. Meaning These findings suggest that successful inpatient consultation requires a complicated, sequenced series of time-sensitive information exchanges guided primarily by unwritten norms and highly vulnerable to failure.

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Elements of a High-Quality Inpatient Consultation in the Intensive Care Unit. A Qualitative Study

Abstract: Several key factors are necessary for a consult to be judged high quality. An opportunity exists to develop an instrument to assess and to improve specialty consultations in the ICU based on these findings.

Cited by 24 publications

References 26 publications

Variation in Inpatient Consultation Among Older Adults in the United States

Variation in Inpatient Consultation Among Older Adults in the United States

The number of inpatient consultations is negatively correlated with patient satisfaction in patients with prolonged hospital stays

Patient and Clinician Perceptions of Factors Relevant to Ideal Specialty Consultations

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