Methods: Discharge data was obtained for patients discharged with a principal diagnosis of acute CHF over 3 year period from a tertiary care center. Data on demographics, number of consultations, length of stay (LOS), readmissions within 30 days of discharge, cost of care and mortality were compared according to number of subspecialty consultations. Premier’s Care Science methodology was used for risk adjustment.
Results: 1554 patients were included in the analysis. 103(6.6%) patients had no consultation, 482(31%) patients had 1 consult, 365(23.5%) patients had 2 consults, and 229(14%) patients had 3 consults, and 375(24%) had 4 or more consults. On multivariate linear regression analysis teaching service, age and black race were independently associated with decreased consultation (p<0.001 for all of them) while case mix index (CMI) was associated with increased consultation (p<0.001). Risk adjusted LOS and cost significantly increased with increased number of consults (p<0.001 for both). This remained significant after adjusting for age, gender, CMI, practice type, and insurance type (P<0.001 for both). There was no difference in risk adjusted mortality or 30 day readmission rate based on number of consults (p=0.35 and 0.98 respectively).
Conclusions: Consultation occurs frequently in patients admitted with acute CHF. Increased consultation is associated with increased cost and LOS that is not explained by increased complexity of patients. Decreased utilization of consultation by teaching service in our institution suggests that there is an opportunity to decrease utilization of health care resources by streamlining the utilization of consultations in the inpatient setting.