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: 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 [...]

Background: The “10 commandments of consultation” were published in 1983 and revised in 2007. Since then, academic medical centers have grown significantly, expanding the number of non-teaching teams. This rapid growth risks straining the current subspecialty consultation services’ teaching and educational models. Overuse of consultations and lack of clarity in the consulting question may increase [...]

Background: Diagnostic consultations between the General Internal Medicine (GIM) departments and specialty departments are becoming increasingly important to achieve team-based diagnosis and diagnostic excellence, but there have been limited studies on the appropriateness of the GIM diagnostic consultations with specialty departments. We conducted this study to clarify the appropriateness of diagnostic consultations from the GIM [...]

Background: The discharge process has been identified as a choke point for efficient patient flow through the hospital1,2. Delayed discharges have been associated with ER overcrowding, increased length of stay, and increased risk for patient harm1-4. Early discharge initiatives such as discharge by noon have been adopted by hospital systems as a way to improve [...]