Background: Communication with consultant teams is critical to the hospitalist workflow, especially in hospitals with multiple levels of hierarchy due to varying training backgrounds and experiences. We aimed to increase knowledge of the communication dynamic between hospitalists and consultant attendings in medical and surgical specialties.

Methods: We surveyed Emory Division of Hospital Medicine physicians and Advanced Practice Providers to assess interactions with consultant attendings. Surveys were administered online using REDCap. The survey questions were divided into demographic/characteristics of respondents, communication with medical subspecialists and communication with surgical specialists. Survey data was analyzed, and observational results are presented below.

Results: 87 completed surveys were analyzed. For medical subspecialties, cardiology, hematology/oncology, and neurology were services with the most pushback to hospitalist consults and 50% of providers felt that pushback negatively affected patient care. For surgical subspecialties, urology and neurosurgery were services with the most pushback. There is a significant difference between the male and female hospital medicine providers with males finding it easy to determine how to contact the consulting attending 65% of the time and females 47% of the time (p=.004). How comfortable providers are with direct communication with the attending physician also differs by gender (p<.001) with 70% of males and 40% of females reporting they are “always” or “most of the time” comfortable with escalating a consult question to the attending. Types of pushback offered by consultant services were analyzed. Deferring the consult to a “curbside” was noted to be the most common by 45.3%(34), followed by deferring to outpatient by 26.7%(20) of respondents.Outright refusal to see the patient was rare. 72.3% of female hospitalists noted they relayed their consult question to a surgical resident always or most of the time while only 52.5% of males stated they did always or most of the time (P< 0.001). We noted a significant difference between male and female hospitalist responses when asking if the surgical attending performs the consult: 49% of females noted surgical attendings never perform a consult while 23% of males state that the surgical attending is never the one responding to the consult. When looking at experience as a hospitalist, the only statistically significant difference noted was that 18.6% of hospitalists with less experience (< 6 years) state they know how to contact the consult attending while 37.2% of hospitalists with >6 years knew how to contact the attending.

Conclusions: While our initial hypothesis and objectives of the survey were to study how experience and training settings impact communication between hospitalists and consultants, our results were enlightening. Male and female hospital medicine providers have differing levels of comfort when it comes to discussing a consult with the attending provider. We were able to recognize services that offer pushback more frequently than others at a multi-hospital system with both academic and community hospital medicine sites. We captured only a few APP responses, however, which is a limitation of our data. Our colleagues also perceived that pushback negatively impacts patient care; however, the survey does not identify where the impact is (length of stay, adverse outcomes, patient satisfaction etc). This is the first study to highlight communication barriers between hospitalists and their consultant colleagues.

IMAGE 1: Characteristics and demographics of hospitalist survey respondents