Traci N Adams1, Joanna Bonsall2, Daniel Hunt2, Alberto Puig3, Jeremy B Richards4, Liyang Yu5, Jakob I McSparron6, Nainesh Shah7, Jonathan Weissler8, Eli M Miloslavsky9. 1. Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. tnfadams@gmail.com. 2. Department of Medicine, Emory University, Atlanta, Georgia, USA. 3. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. 4. Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA. 5. Division of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. 6. Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 7. Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 8. Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 9. Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Medicine subspecialty consultation is becoming increasingly important in inpatient medicine. OBJECTIVE: We conducted a survey study in which we examined hospitalist practices and attitudes regarding medicine subspecialty consultation. DESIGN AND SETTING: The survey instrument was developed by the authors based on prior literature and administered online anonymously to hospitalists at 4 academic medical centers in the United States. MEASUREMENTS: The survey evaluated 4 domains: (1) current consultation practices, (2) preferences regarding consultation, (3) barriers to and facilitating factors of effective consultation, and (4) a comparison between hospitalist-fellow and hospitalist-subspecialty attending interactions. RESULTS: One hundred twenty-two of 261 hospitalists (46.7%) responded. The majority of hospitalists interacted with fellows during consultation. Of those, 90.9% reported that in-person communication occurred during less than half of consultations, and 64.4% perceived pushback at least "sometimes " in their consult interactions. Participants viewed consultation as an important learning experience, preferred direct communication with the consulting service, and were interested in more teaching during consultation. The survey identified a number of barriers to and facilitating factors of an effective hospitalist-consultant interaction, which impacted both hospitalist learning and patient care. Hospitalists reported more positive experiences when interacting with subspecialty attendings compared to fellows with regard to multiple aspects of the consultation. CONCLUSION: The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.
BACKGROUND: Medicine subspecialty consultation is becoming increasingly important in inpatient medicine. OBJECTIVE: We conducted a survey study in which we examined hospitalist practices and attitudes regarding medicine subspecialty consultation. DESIGN AND SETTING: The survey instrument was developed by the authors based on prior literature and administered online anonymously to hospitalists at 4 academic medical centers in the United States. MEASUREMENTS: The survey evaluated 4 domains: (1) current consultation practices, (2) preferences regarding consultation, (3) barriers to and facilitating factors of effective consultation, and (4) a comparison between hospitalist-fellow and hospitalist-subspecialty attending interactions. RESULTS: One hundred twenty-two of 261 hospitalists (46.7%) responded. The majority of hospitalists interacted with fellows during consultation. Of those, 90.9% reported that in-person communication occurred during less than half of consultations, and 64.4% perceived pushback at least "sometimes " in their consult interactions. Participants viewed consultation as an important learning experience, preferred direct communication with the consulting service, and were interested in more teaching during consultation. The survey identified a number of barriers to and facilitating factors of an effective hospitalist-consultant interaction, which impacted both hospitalist learning and patient care. Hospitalists reported more positive experiences when interacting with subspecialty attendings compared to fellows with regard to multiple aspects of the consultation. CONCLUSION: The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.
Authors: Stephanie D Roche; Alyse M Reichheld; Nicholas Demosthenes; Anna C Johansson; Michael D Howell; Michael N Cocchi; Bruce E Landon; Jennifer P Stevens Journal: PLoS One Date: 2019-04-11 Impact factor: 3.240
Authors: Stephanie D Roche; Anna C Johansson; Jaclyn Giannakoulis; Michael N Cocchi; Michael D Howell; Bruce Landon; Jennifer P Stevens Journal: JAMA Netw Open Date: 2022-04-01