Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services

Abstract

The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.

Waiting it out: consultation delays prolong in-patient length of stay

“…Studies have found perceived differences between hospitalists and subspecialists in whether the purpose of consult is clearly stated 25. Pushback from subspecialty fellows has also been found to be common, with comparatively less resistance or reluctance from subspecialist attendings responding to hospitalist consult requests 26. More open discussions and joint efforts in improving direct communication can potentially increase understanding between teams.…”

Enhancing the Inpatient Consultation Learning Environment to Optimize Teaching and Learning

“…Similarly, medicine hospitalists cited workload as a critical factor in their ability to learn from consultants. 2 In addition, when the fellow is finishing rounds later in the day, the ability to relay the recommendations in person to the primary team, which is a key factor to effective teaching, may be impaired.…”

“…An analysis of Medicare data suggests that an average Medicare patient receives 2.6 consults per admission, and a recent study of medicine hospitalists suggested that more than half request multiple consultations daily. 1,2 Several studies, including unpublished data from our center, suggest that the number of inpatient consultations has been steadily increasing over time. 3,4 In addition to providing clinical care, studies have shown that an optimal consult interaction includes both effective communication with, and teaching directed to, the team requesting consultation.…”

“…5,6 Research from our group suggests that both housestaff and hospitalist primary teams have a strong desire to learn and that fellows have a strong desire to teach in the setting of inpatient consultation. 2,7,8 Furthermore, fellow teaching has been identified as part of the core competencies by the Accreditation Council for Graduate Medical Education (ACGME). 9 An effective teaching interaction during consultation has many potential benefits.…”

Reply to “Increasing Inpatient Consultation: Hospitalist Perceptions and Objective Findings. In Reference to: ‘Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services‘”

“…1 In contrast, our study found that more than a third of hospitalists reported an increase in consultation requests. 2 There may be several explanations for this discrepancy. First, as Kachman et al suggest, there may be differences between hospitalist perception and actual consultation use.…”