Describing Variability of Inpatient Consultation Practices: Physician, Patient, and Admission Factors
Appropriate use of consultation can improve patient outcomes, but inappropriate use may cause harm. Factors affecting the variability of inpatient consultation are poorly understood. We aimed to describe physician-, patient-, and admission-level factors influencing the variability of inpatient consultations on general medicine services. We conducted a retrospective study of patients hospitalized from 2011 to 2016 and enrolled in the University of Chicago Hospitalist Project, which included 6,153 admissions of 4,772 patients under 69 attendings. Consultation use varied widely; a 5.7-fold difference existed between the lowest (mean, 0.613) and highest (mean, 3.47) quartiles of use (P <.01). In mixed-effect Poisson regression, consultations decreased over time, with 45% fewer consultations for admissions in 2015 than in 2011 (P <.01). Patients on nonteaching hospitalist teams received 9% more consultations than did those on teaching services (P =.02). Significant variability exists in inpatient consultation use. Further understanding may help to identify groups at high-risk for underuse/overuse and aid in the development of interventions to improve high-value care.
© 2020 Society of Hospital Medicine
CONCLUSION
We found that the use of consultation on general medicine services varies widely between admissions, with large differences between the highest and lowest frequencies of use. This variation can be partially explained by several physician-, patient-, and admission-level characteristics. Our work may help identify patient and attending groups at high risk for under- or overuse of consultation and guide the subsequent development of interventions to improve value in consultation. One additional consultation over the average LOS of 4.6 days adds $420 per admission or $4.8 billion to the 11.5 million annual Medicare admissions.15 Increasing research, guidelines, and education on the judicious use of inpatient consultation will be key in maximizing high-value care and improving patient outcomes.
Acknowledgments
The authors would like to acknowledge the invaluable support and assistance of the University of Chicago Hospitalist Project, the Pritzker School of Medicine Summer Research Program, the University of Chicago Center for Quality, and the University of Chicago Center for Health and the Social Sciences (CHeSS). The authors would additionally like to thank John Cursio, PhD, for his support and guidance in statistical analysis for this project.
Disclaimer
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; or the decision to approve publication of the finished manuscript. Preliminary results of this analysis were presented at the 2018 Society of Hospital Medicine Annual Meeting in Orlando, Florida. All coauthors have seen and agree with the contents of the manuscript. The submission is not under review by any other publication.
