Who Consults Us and Why? An Evaluation of Medicine Consult/Comanagement Services at Academic Medical Centers
Although general medicine consultation is an integral component of inpatient medical care and a requirement of internal medicine training, little is known about current consultative practice. We used a cross-sectional, prospective survey design to examine current practices at 11 academic medical centers over four 2-week periods from July 2014 through July 2015. Out of 11 consult services, 4 had comanagement agreements with surgical services, primarily with orthopedic surgery. We collected data regarding 1,264 consultation requests. Most requests (82.2%) originated from surgical services, with most requests originating from either orthopedic surgery (44.4%) or neurosurgery (11.6%). The most common reason for consultation at sites with a consult and comanagement service was medical management/comanagement (23.3%) and at sites with a consult-only service was preoperative evaluation (16.4%). On average, consultants addressed more than 2 reasons per encounter. Many of these reasons were unidentified by the consulting service. Learners on these services should perform comprehensive evaluations to identify potentially unidentified issues.
© 2018 Society of Hospital Medicine
Medicine Consult/Comanagement Consortium Members
The Medicine Consult/Comanagement Consortium consists of: Mary Anderson Wallace, MD, Brian Wolfe, MD (University of Colorado), Meridale Baggett, MD, Douglas Wright, MD, PhD (Harvard University), Joyeeta G. Dastidar MD, Maureen Kelly, MD (Columbia University), Leonard S. Feldman, MD (Johns Hopkins University), Cecily J. Gallup, MD, MPH (University of California, San Francisco), Paul J. Grant, MD (University of Michigan), Craig R. Keenan, MD (University of California, Davis), Fletcher Penney, MD (Medical University of South Carolina).
Acknowledgments
The authors thank the clinicians at each site who were involved in data collection for this study, including Barbara Statland, MD. The authors also thank Timothy Niessen, MD for data and physician coordination and Musarrat Nahid, MSc. for statistical analysis.
Disclosures
Paul J. Grant receives royalties from the medical textbook Perioperative Medicine: Medical Consultation and Comanagement, Wiley Publishing 2012. Craig R. Keenan receives medicolegal consultation fees from Weiss-Salinas Law Group and American Psychiatric Association Publishers for book royalties. All other authors declare that they do not have any conflicts of interest.
Funding Information
The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration. Investigator salary support is provided through the South Texas Veterans Health Care System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or our institutions.
