Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel.
Isr J Health Policy Res. 2021 Apr 19;10(1):19. doi: 10.1186/s13584-021-00446-0.
Many in-patients require care from practitioners in various disciplines. Consultations most probably have significant implications for hospitalization outcomes.
To determine key aspects of consultations provided by various departments to formulate an optimal policy.
This study comprised two methods: first, a questionnaire was completed in 2019 by 127 physicians interns, residents and senior doctors) from the medical and surgical departments (64 from the surgical wards, 43 from the medical wards and 22 from the emergency room and General ICU) regarding the availability, timeliness and documentation rate of the consultations they received from different disciplines. The investigators rounded through the various departments that were included in the study and they accosted a sample of interns, residents and attending physicians, who were then asked to fill the questionnaire. Overall compliance of filling the questionnaire was 95%. Residents accounted for 72% of the filled questionnaires, seniors and interns accounted for 15 and 13% respectively. Second, a convenience sample of 300 electronic records of hospitalized patients (135 from the surgical wards, 129 from the Medical wards and 36 from the emergency room and General ICU) of actually carried out consultations was reviewed for validated indicators of quality for both the consultation request and response. We used a 5-point Likert scale, ranging from poor (1) to superb (5), to grade the measured parameters.
The availability, timeliness and documentation rate for medical consultations were 4 ± 0.9, 4.1 ± 0.9 and 4.3 ± 0.9 respectively, as compared with surgical consultations 3.2 ± 1.1, 3.4 ± 1.2 and 3.6 ± 1.2 respectively (P < 0.001). The mean time (in hours) from the consultation request till documentation (of the requested consultation) by consultants in the medical and surgical departments was 3.9 ± 5.9 and 10.0 ± 15.6, respectively (P < 0.001). The quality of requests of consultations from the medical and surgical departments was 3.4 ± 1.1 and 2.8 ± 1.2, respectively (P < 0.001). Two different models of consultations are employed: while each medical department adopts several departments for medical consultations, each day's on-call surgeon provides all the hospital's surgical consultations.
We detected significant differences in key aspects of consultations provided by the departments. The medical model of consultations, in which each medical department adopts several other wards to which it provides consulting services upon request, should probably be adopted as a major policy decision by hospitals directors to enhance inter-departmental consultations.
许多住院患者需要来自不同专业领域的医生提供治疗。会诊很可能对住院治疗结果产生重大影响。
确定各科室提供的会诊的关键方面，以制定最佳政策。
本研究包括两种方法：首先，2019 年，来自内科和外科病房（64 名来自外科病房，43 名来自内科病房，22 名来自急诊室和综合 ICU）的 127 名医师实习生、住院医师和高级医生完成了一份问卷，内容涉及他们从不同科室接受会诊的可用性、及时性和记录率。调查人员在研究中包括的各个科室进行查房，并随机抽取实习医生、住院医师和主治医生填写问卷。填写问卷的总体依从率为 95%。住院医师占已填写问卷的 72%，高级医生和实习医生分别占 15%和 13%。其次，对 300 名实际进行的会诊的住院患者的电子病历（135 名来自外科病房，129 名来自内科病房，36 名来自急诊室和综合 ICU）进行了方便样本回顾，以验证会诊请求和响应的质量验证指标。我们使用 5 分李克特量表（1 分表示差，5 分表示优）对测量参数进行评分。
内科会诊的可用性、及时性和记录率分别为 4±0.9、4.1±0.9 和 4.3±0.9，而外科会诊的可用性、及时性和记录率分别为 3.2±1.1、3.4±1.2 和 3.6±1.2（P<0.001）。内科和外科顾问从会诊请求到记录（请求的会诊）的平均时间（小时）分别为 3.9±5.9 和 10.0±15.6（P<0.001）。内科和外科部门的会诊请求质量分别为 3.4±1.1 和 2.8±1.2（P<0.001）。采用了两种不同的会诊模式：内科部门为每个医疗部门采用了几个部门提供医疗咨询服务，而每天的值班外科医生则提供医院所有的外科咨询服务。
我们发现各科室提供的会诊的关键方面存在显著差异。内科部门采用的医疗咨询模式，即每个医疗部门采用其他几个病房提供请求的咨询服务，可能需要医院院长做出重大政策决策，以加强部门间的会诊。
