Improving the Inpatient Consultation Process in a Pediatric Hospital

Background:

Communication problems between medical providers contribute to sentinel events among hospitalized children. Effective communication is particularly important when consultants are involved. Improving communication effectiveness among caregivers is a JCAHO 2006 National Patient Safety Goal. Consultants may not be notified in a timely fashion or may not know how rapidly they need to evaluate the patient. Consultants may not understand what aspect of medical care they are being asked to provide. The primary care team may misinterpret input from consultants. We reviewed the inpatient pediatric consultation process and implemented changes to improve communication problems.

Purpose:

A multidisciplinary taskforce, comprised of physicians, nurses, administrators, information systems specialists and clerical personnel, reviewed inpatient consult documentation and medical staff preferences to quantify problems with the consultative process. Based on this analysis, changes in the process of obtaining and documenting consults were implemented.

Description:

Medical Staff Survey: A survey of 229 members of the Hospital Medical Staff was conducted using a Likert scale to determine the level of physician satisfaction with the inpatient consultation process. A 47% response rate was achieved. Only 58% of physicians were satisfied with the process of requesting a consult. Only 35% of physicians were satisfied with the process of providing a consult. Physician preferences differed regarding important aspects of consults including whether the consultant should write patient care orders and how consultant findings should be communicated.

Inpatient Chart Consult Review: A retrospective chart review was performed on 110 consults. Multiple problems were found in the documentation of inpatient consults. Only 77% of consults were legible or contained appropriate recommendation detail. Less than half of all inpatient consults had clear contact information. Documentation of direct communication between the primary care team and consultants was present in only 23% of charts.

Summary of Results:

A new inpatient consult process was developed and implemented to address these problems. Important features of this new process include:

• 1)

  Computer Physician Order Entry for consult orders to facilitate communicate between the primary care team and consultants by specifying in mandated fields: Reason for consult, Time frame for consult completion, Primary care team and consultant contact information, Primary care team choice for whether the consultant may write patient care orders or should communicate directly with the family.

• 2)

  Implementation of a rapid transcription service to improve legibility and communication. Dictated and transcribed consult reports are available in the electronic medical record. Consults are automatically faxed to primary care providers.

Author Disclosure Block:

D. Pressel, Astra Zenica Consulting fees or other remuneration (payment); R. Meek, None; M. Szymborski, None; M. Zier, None; T. Steinberg, None; C. Rossi‐McLaughlin, None.