Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
BMC Health Serv Res. 2023 Feb 10;23(1):142. doi: 10.1186/s12913-023-09134-y.
There is recent concern regarding the documented mismatch between demand and supply, vis-à-vis the growing need for trained endocrinologists unmet by parallel rise in the world workforce of endocrinologist. Due to the increasing complexity of disease in inpatients, in recent years we have experienced a growing demand for inpatient endocrine consults. Surprisingly, the need for the endocrinology subspecialty in the overall care of inpatients in the current setting of general hospitals has received little attention.
A retrospective analysis of endocrine consult service based on solicited consults carried out during 3 consecutive months.
During 3 months, there were 767 consults, comprised of 156 diabetes referrals and 611 endocrine/metabolic consult requests. The 611 "non-glucocentric" consult requests were related to 295 inpatients (2.1 ± 2.7 consults/patient). Mean patient age was 58.9 ± .18 years (range 21-92), with some F/M preponderance (58/42%). Requests for endocrine consults were evenly distributed (49.8%, 50.2%) between internal medicine and surgery wards. Case distribution was as follows: thyroid 45.4%, calcium & bone 11.5%, pituitary 12%, adrenal 10% and all others 8.1-0.7%. The mean response time was 4.4 ± 2.7 h. The consults had a discernible effect on the patients' disease management in 60% of the patients. Of these, the consults modified the hospital treatment in 74%, the discharge treatment recommendations in 19% and the diagnosis in 7%.
At a large medical center, endocrine consults were requested for ~ 3.3% of all admitted inpatients. The endocrine consults modified pre-consult diagnosis or treatment in ~ 60% of the cases. Contrary to its common image as an exclusively outpatient-based subspecialty, endocrinology practiced by specialists and endocrine trainees has a notable role in the daily care of inpatients admitted to a referral general hospital.
目前，人们越来越关注培训内分泌学家的需求与世界范围内内分泌学家人数增加之间的明显不匹配。由于住院患者疾病的复杂性不断增加，近年来我们对住院内分泌会诊的需求不断增加。令人惊讶的是，在当前综合医院的背景下，内分泌学亚专业在住院患者整体治疗中的作用几乎没有得到关注。
对连续 3 个月进行的内分泌会诊服务进行回顾性分析。
在 3 个月期间，有 767 次会诊，其中包括 156 次糖尿病转诊和 611 次内分泌/代谢会诊请求。611 次“非糖心”会诊请求与 295 名住院患者相关（每位患者 2.1±2.7 次会诊）。患者平均年龄为 58.9±0.18 岁（范围为 21-92 岁），存在一定的男女比例倾向（58/42%）。内分泌会诊请求在内科和外科病房之间均匀分布（49.8%，50.2%）。病例分布如下：甲状腺 45.4%、钙与骨 11.5%、垂体 12%、肾上腺 10%，其他所有疾病占 8.1%-0.7%。平均响应时间为 4.4±2.7 小时。会诊对 60%的患者的疾病管理产生了明显的影响。其中，74%的会诊改变了医院治疗方案，19%改变了出院治疗建议，7%改变了诊断。
在一家大型医疗中心，内分泌会诊请求占所有住院患者的 3.3%左右。在大约 60%的病例中，内分泌会诊改变了会诊前的诊断或治疗。与作为一个纯粹的门诊亚专业的常见形象相反，内分泌专家和内分泌培训生的实践在转诊综合医院住院患者的日常护理中发挥了显著作用。
