Pacitti Kelly, Mathew Anne, Royse Amanda, Elliott John O, Jordan Kim
J Healthc Qual. 2017 Nov/Dec;39(6):367-378. doi: 10.1097/JHQ.0000000000000064.
Hospitalists frequently consult medical subspecialists in the management of inpatients. Given the potential impact on health resource utilization, it is important to understand the working relationship between these groups.
A cross-sectional survey of hospitalists, n = 655, and subspecialists across Ohio (nephrologists and endocrinologists), n = 293, was conducted to investigate perceptions and communication about reasons, timing, and impact of hospital consultations.
Survey response rate was 13.3%. Hospitalists were more likely to report subspecialty request to serve as admitting physician with subsequent consultation 63.2% versus 26.7%, p < .001. Hospitalists with a daily workload ≥15 patients per day were more likely to report that this impeded their ability to manage details of patient care versus hospitalists with <15 patients per day, 53.2% versus 24.1%, p = .02, and resulted in subspecialty consultation for problems manageable by the hospitalist, 38.3% versus 6.9%, p = .003. Hospitalists were less likely than subspecialists to report major impact from consultation 50.0% versus 81.0%, p = .001 and they were more likely to report direct communication for urgent consults 97.3% versus 48.8%, p < .001.
Future work should be aimed at addressing hospitalist workload, improving communication, and ensuring appropriate need and timing of consultation.
住院医师在管理住院患者时经常向医学专科医生咨询。鉴于对卫生资源利用的潜在影响，了解这些群体之间的工作关系很重要。
对俄亥俄州的655名住院医师和293名专科医生（肾病学家和内分泌学家）进行了横断面调查，以调查关于医院会诊的原因、时间和影响的看法及沟通情况。
调查回复率为13.3%。住院医师更有可能报告在担任主治医生后进行专科会诊的请求，比例分别为63.2%和26.7%，p <.001。与每天工作量<15名患者的住院医师相比，每天工作量≥15名患者的住院医师更有可能报告这阻碍了他们管理患者护理细节的能力，比例分别为53.2%和24.1%，p =.02，并且导致因住院医师可处理的问题而进行专科会诊，比例分别为38.3%和6.9%，p =.003。与专科医生相比，住院医师报告会诊产生重大影响的可能性较小，比例分别为50.0%和81.0%，p =.001，他们更有可能报告紧急会诊时进行直接沟通，比例分别为97.3%和48.8%，p <.001。
未来的工作应旨在解决住院医师的工作量问题，改善沟通，并确保会诊的适当需求和时机。
