Impact of Inpatient Consults by a Family Medicine Teaching Service.
South Med J. 2019 Jan;112(1):21-24
Authors: Williams MP, Michaudet C, Yang Y, Lynch K, Carek PJ
OBJECTIVES: Inpatient consult rates by family physicians significantly affect many aspects of medical care. Limited research has investigated the consultant rate by family medicine residents and their impact on length of stay (LOS) and direct cost. This study examines the inpatient consultant rate of family medicine residents.
METHODS: We conducted a retrospective electronic chart review of consults associated with hospitalizations on a family medicine teaching service at a large academic medical center during a 12-month period. The primary outcome was the consultant rate. Multivariate regressions were used to predict outcomes of LOS and direct costs while controlling for patient severity with the Charlson Comorbidity Index.
RESULTS: For hospitalized adults on a family medicine teaching service, almost 1 in 2 receives some type of consult (47%), with more than half of those (52%) to physician specialists as opposed to ancillary services. The top physician consults were to cardiology, infectious disease, and gastroenterology. LOS as well as cost significantly increased with any type of consult. After controlling for severity, consults to physician specialists (as opposed to ancillary services) had the greatest impact on LOS and cost.
CONCLUSIONS: Each consult placed for hospitalized adults on a family medicine teaching service resulted in an increase in LOS and direct cost, even after controlling for patient severity. Further analysis to ensure that appropriate referrals are being placed and that residents are receiving full-scope training is needed to ensure primary care graduates are prepared to care for a diverse and complex patient population.
PMID: 30608626 [PubMed - in process]