Characteristics, Burden, and Necessity of Inpatient Consults for Academic and Private Practice Urologists

Zhao, Hanson; Quach, Alan; Cohen, Tara N.; Anger, Jennifer T.

doi:10.1016/j.urology.2020.02.016

Cited by 14 publications

(11 citation statements)

References 18 publications

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“…7 Our analysis, along with other studies, found that overall, inpatient urology consults are increasingdover half of which, in one study, did not require any specialist intervention. 8,9 Inpatient consultations represent a significant source of inpatient and downstream outpatient healthcare cost to both the patient and the healthcare system, as well as delayed discharges and their associated costs. 10,11 Furthermore, over consultation may lead to an additional $4.8 billion of annual healthcare costs annually when considering Medicare patients alone.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Urological Consultations in a Private vs Academic Setting

2023

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Introduction:This study aims to determine the differences between urological consulting service utilization in an academic setting compared to a private setting at a single institution during its transition from private to academic medical center.Methods:A retrospective review of patients undergoing inpatient urology consultation from July 2014 to June 2019 was performed. Consults were weighted using patient-days to account for hospital census.Results:A total of 1,882 inpatient urology consults were ordered, with 763 occurring prior to and 1,187 occurring after transition to academic medical center. Consults were placed more frequently in the academic than private setting (6.8 vs 4.5 consults/1,000 patient-days, P < .00001). The monthly consult rate in the private setting remained steady throughout the year, while the academic rate rose and then fell in accordance with the academic calendar, until statistically equaling the private rate in the final month of the academic year. Urgent consults were more likely to be ordered in the academic setting (7.1% vs 3.1%, P < .001), along with consults for urolithiasis (18.1% vs 12.6%, P < .001). Retention consults were more common in the private setting (23.7% vs 18.3%, P < .001).Conclusions:In this novel analysis, we demonstrated that significant differences exist between inpatient urological consult use in private and academic medical centers. Consults are ordered more frequently in academic hospitals until the end of the academic year, suggesting a learning curve for academic hospital medicine services. Recognition of these practice patterns identifies a potential opportunity to decrease the number of consultations through improved physician education.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Urological Consultations in a Private vs Academic Setting

2023

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“…We recognize that while the true necessity of a consultation is subjective, the need for urologic intervention is a more quantifiable surrogate. Even then, many interventions do not require urologic expertise [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The Hidden Work of Urology Residents - A Cross-Sectional Study

Kazmi

Khan

Ather

2020

Cureus

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Background: In a tertiary care hospital that caters to all kinds of patients in the clinical and emergency setting, consultation is an important service provided by the urology team. Profiling the spectrum of urologic disease encountered by trainees will assist in the planning of residency curricula and is bound to improve patient outcome for procedural education. Methods: All urologic consultation requests received over a period of three months (November 22, 2019, to February 22, 2020) were identified and recorded in a prospectively maintained consult log. Information collected for each encounter included the time, date, reason for consult, primary service and diagnosis along with the final urologic diagnosis, any urologic intervention, and basic patient demographics (gender and age). Results: Over three months, a total of 568 consult requests were reviewed. Of the patients consulted for, 74% were males; the mean age was 58.45 years (SD+/-19.5 years). The most common service seeking urology consult was the Emergency Room (n=240, 42.25%). The most common reason for consultation was hematuria (n=103, 18.13%) followed by obstructive uropathy (n=98, 17.25%). The majority (n=147, 26%) of the calls were placed between mid-day and 4 pm. Of the total, 26% required immediate attention. Urologic intervention was required in 226 (39.8%). The number of consults seen by junior team members was 478 (84.14%). Conclusion: Hematuria and obstructive uropathy are the most common reasons for urologic consultation requests. Nearly two-thirds of the consults either required immediate attention or intervention. Most of the consults were seen by junior residents, who required elaborate training to address these common issues independently. We believe that our results will be helpful in developing a curriculum for training junior residents.

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“…Video visits can be used to evaluate patients without a procedural need or for conditions where physical exam is not a major contributor to clinical decision making. 5 During the COVID-19 emergency, this will facilitate rapid assessment and disposition from the ED and promote essential goals: preserving PPE, limiting potential exposures and the possible spread of disease in the ED and inpatient settings. Although this method of consultation may be new for many providers, video visits have been used for years to assess patients presenting with stroke symptoms to facilitate rapid decisions on tissue plasminogen activator use.…”

Section: Video Visits For Hospitalized and Emergency Room Patientsmentioning

confidence: 99%