Background: Subspecialty consultation among hospitalists varies significantly across and within hospitals. While in many cases consultation is clinically necessary, in other cases it may represent overuse. Recent studies have explored predictors of consultation using observational administrative and EHR data. Qualitative methods may generate knowledge about additional factors and complex processes influencing consultation behavior not ascertainable [...]

Background: Subspecialty consultation among hospitalists varies significantly across and within hospitals. While in many cases consultation is clinically necessary, in other cases it may represent overuse. Recent studies have explored predictors of consultation using observational administrative and EHR data. Qualitative methods may generate knowledge about additional factors and complex processes influencing consultation behavior not ascertainable [...]

Background: Mental illness is common among hospitalized patients and is associated with increased length of stay, higher costs, and worse clinical outcomes. Inpatient psychiatry consultations have traditionally held a reactive model, in which primary teams obtain consultation for patients that have developed active psychiatric symptoms. The reactive model has frequently led to missed opportunities to [...]

Background: Comanagement is a structured collaboration between hospitalists and a surgical service to improve outcomes of surgical patients perioperatively. We identified the potential to improve patient safety and throughput metrics on the Surgical Oncology and Otolaryngology (ENT) services at our institution. We partnered with these two services to create a novel Surgical Oncology Comanagement Service. [...]

Background: Consultation in hospital is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consult utilization on hospital outcomes and resource utilization of acute CHF is unknown.   Methods: Discharge data was obtained for patients discharged with a principal diagnosis of acute CHF over 3 [...]

Background:    Electronic consults (“e-consults”) are commonly used in the outpatient setting to allow subspecialists to provide documented recommendations to primary care doctors without a face-to-face patient encounter. In the inpatient setting, a consult that does not require a patient encounter is often handled via informal conversation (“curbside consult”) – the consultant is not reimbursed [...]

Background: Consultative medicine is an important part of Internal Medicine (IM) resident education. According to the Accreditation Council for Graduate Medical Education, residents are expected to “act in a consultative role to other physicians and health professionals.” However, individual programs each have the ability to integrate the consultative experience into training in their own unique [...]

Background: Hospitalists nationwide are faced with complex patient and family behaviors that interfere with medical care. In the acute inpatient setting, few resources are available for physicians to address maladaptive behaviors and many physicians report significant discomfort managing these disruptive behaviors. We implemented a Nurse Practitioner-Led Psychiatric Consult Service to provide education and recommendations for [...]

Background: Consultative medicine has been identified as a core part of internal medicine (IM) resident education by providing the opportunity for residents to care for the non-medical patient. In the early 1980s, two separate academic institutions detailed the initiation of their General Medicine Consultation service. They described who consulted them and the reason for consultation. [...]

Background: Communication is recognized by the LCME and ACGME as an essential competency with significant patient safety implications; the Joint Commission cites communication errors as a major cause of sentinel events. Consultation is a near-universal method of communication between physicians of all disciplines. However, formal education in requesting a consultation is inconsistent in undergraduate medical education [...]