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Consultation outcomes in the emergency department: exploring rates and complexity

Published online by Cambridge University Press:  21 May 2015

Robert A. Woods ,
Renee Lee ,
Maria B. Ospina ,
Sandra Blitz ,
Harris Lari ,
Michael J. Bullard  and
Brian H. Rowe
Robert A. Woods
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
Renee Lee
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
Maria B. Ospina
Affiliation:
University of Alberta Evidence-based Practice Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
Sandra Blitz
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
Harris Lari
Affiliation:
Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
Michael J. Bullard
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Capital Health, Edmonton, Atla.
Brian H. Rowe*
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. University of Alberta Evidence-based Practice Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. Capital Health, Edmonton, Atla.
*
Department of Emergency Medicine, University of Alberta, 1G1.43 Walter C. Mackenzie Centre, 8440-112 St., Edmonton AB T6G 2B7; brian.rowe@ualberta.ca

Abstract

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Objective:

Consultation is a common and important aspect of emergency department (ED) care. We prospectively examined the consultation rates, the admission rates of consulted patients, the emergency physician (EP) disposition prediction of consulted patients and the difficult consultations rates in 2 tertiary care hospitals.

Methods:

Attending EPs recorded consultations during 5 randomly selected shifts over an 8-week period using standardized forms. Subsequent computer outcome data were extracted for each patient encounter, as well as demographic data from the ED during days in which there was a study shift.

Results:

During 105 clinical shifts, 1930 patients were managed by 21 EPs (median 17 patients per shift; interquartile range 14–23). Overall, at least 1 consultation was requested in 38% of patients. More than one-half of the patients (54.3%) who received a consultation were admitted to the hospital. Consultation proportions were similar between males and females (51% v. 49%, p = 0.03). Consultations occurred more frequently for patients who were older, had higher acuity presentations, arrived during daytime hours or arrived by ambulance. The proportion of agreement between the EP's and consultant's opinion on the need for admission was 89% (κ = 0.77, 95% confidence interval 0.72–0.83). Overall, 92% of patents received 1 consultation. Six percent of the consultations were perceived as “difficult” by the EPs (defined as the EP's subjective impression of difficulties with consultation times, accessibility and availability of consultants, and the interaction with consultants or disposition issues).

Conclusion:

Consultation is a common process in the ED. It often results in admission and is predictable based on simple patient factors. Because of perceived difficulty with consultations, strategies to improve the EP consultation process in the ED seem warranted.

Résumé

RÉSUMÉObjectif:

La consultation est un aspect courant et important des soins prodigués à l'urgence. Nous avons étudié prospectivement, dans deux centres de soins tertiaires, les taux de consultation, les taux d'admission des patients vus en consultation, les prédictions du médecin d'urgence quant à l'issue des patients vus en consultation ainsi que les taux de difficulté des consultations.

Méthodes:

Les médecins d'urgence traitants ont consigné, sur des formulaires normalisés, les consultations réalisées pendant cinq quarts de travail choisis au hasard sur une période de huit semaines. Subséquemment, des données informatiques des résultats ont été extraites pour chaque rencontre avec un patient, de même que des données démographiques de la salle d'urgence pour les jours où un quart de travail faisait partie de l'étude.

Résultats:

Au cours des 105 quarts de travail observés, 21 médecins d'urgence ont vu 1930 patients (médiane : 17 patients par période de travail; écart interquartile : 14 à 23). Dans l'ensemble, au moins une consultation a été demandée pour 38 % des patients. Plus de la moitié des patients (54,3 %) qui ont reçu une consultation ont été admis à l'hôpital. Les pourcentages de consultation étaient semblables chez les femmes et les hommes (51 % contre 49 %, p = 0,03). La fréquence des consultations était plus élevée chez les patients plus âgés, chez ceux qui se présentaient à l'urgence avec un problème plus grave ainsi que chez ceux qui arrivaient de jour ou par ambulance. Le médecin d'urgence et le consultant étaient d'accord quant à l'admission du patient dans 89 % des cas (κ = 0,77; intervalle de confiance à 95 %, 0,72 à 0,83). Dans l'ensemble, 92 % des patients ont reçu une consultation. De l'avis des médecins d'urgence, 6 % des consultations étaient jugées « difficiles » (terme défini comme l'impression subjective du médecin d'urgence d'avoir eu des difficultés quant au temps de consultation, à l'accessibilité et à la disponibilité des consultants, à l'interaction avec ces derniers ou à l'issue de la consultation).

Conclusion:

La consultation est monnaie courante dans les salles d'urgence. Elle mène souvent à l'admission des patients et elle est prévisible d'après des facteurs élémentaires relatifs aux patients. Il ressort de cette étude que des stratégies d'amélioration du processus de consultation en salle d'urgence s'imposent, et ce, en raison des difficultés perçues relativement aux consultations.

Keywords

consultationemergency medicinedisposition
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 1 , January 2008 , pp. 25 - 31
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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