Who Consults Us and Why? An Evaluation of Medicine Consult/Comanagement Services at Academic Medical Centers.

Although general medicine consultation is an integral component of inpatient medical care and a requirement of internal medicine training, little is known about current consultative practice. We used a cross-sectional, prospective survey design to examine current practices at 11 academic medical centers over four two-week periods from July 2014 through July 2015. Out of 11 consult services, four had comanagement agreements with surgical services, primarily with orthopedic surgery. We collected data regarding 1,264 consultation requests. Most requests (82.2%) originated from surgical services, with most requests originating from either orthopedic surgery (44.4%) or neurosurgery (11.6%). The most common reason for consultation at sites with a consult and comanagement service was medical management/ comanagement (23.3%) and at sites with a consultonly service was preoperative evaluation (16.4%). On average, consultants addressed more than two reasons per encounter. Many of these reasons were unidentified by the consulting service. Learners on these services should perform comprehensive evaluations to identify potentially unidentified issues.