Appropriateness, Reasons and Independent Predictors of Consultations in the Emergency Department (ED) of a Dutch Tertiary Care Center: A Prospective Cohort Study
Consultations occur frequently in the emergency department (ED) of tertiary care centres and pose a threat for patient safety as they contribute to ED lengths of stay (LOS) and overcrowding. The aim of this study was to investigate reasons and appropriateness of consultations, and the relative impac...
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| Veröffentlicht in: | PloS one 2016-02, Vol.11 (2), p.e0149079-e0149079 |
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| description | Consultations occur frequently in the emergency department (ED) of tertiary care centres and pose a threat for patient safety as they contribute to ED lengths of stay (LOS) and overcrowding. The aim of this study was to investigate reasons and appropriateness of consultations, and the relative impact of specialty and patient characteristics on the probability of a consultation, because this could help to improve efficiency of ED patient care.
This prospective cohort study included ED patients presenting to a Dutch tertiary care centre in a setting where ED physicians mostly treat self-referred and undifferentiated patients and other specialists treat referred patients. Consultations were defined as appropriate if the reason of consultation corresponded with the final advice, conclusion or policy of the consulted specialty. Multivariable logistic regression analysis was used to assess the relative contribution of specialty and patient characteristics on consultation.
In the 344 (24% (95% CI 22 to 26%)) of the 1434 inclusions another specialty was consulted, resulting in a 55% increase of ED LOS. ED physicians more often consulted another specialty with a corrected odds ratio (OR) of 5.6 (4.0 to 7.8), mostly because consultations were mandatory in case of hospitalization or outpatient follow-up. Limited expertise of ED physicians was the reason for consultation in 7% (5 to 9%). The appropriateness of consultations was 84% (81 to 88%), similar between ED physicians and other specialists (P = 0.949). The patient characteristics age, comorbidity, and triage category and complaint predicted consultation.
In a Dutch tertiary care centre another specialty was consulted in 24% of the patients, mostly for an appropriate reason, and rarely because of lack of expertise. The impact of consultations on ED LOS could be reduced if mandatory consultations are abolished and predictors of a consultation are used to facilitate timely consultation. |
| doi_str_mv | 10.1371/journal.pone.0149079 |
| format | Article |
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This prospective cohort study included ED patients presenting to a Dutch tertiary care centre in a setting where ED physicians mostly treat self-referred and undifferentiated patients and other specialists treat referred patients. Consultations were defined as appropriate if the reason of consultation corresponded with the final advice, conclusion or policy of the consulted specialty. Multivariable logistic regression analysis was used to assess the relative contribution of specialty and patient characteristics on consultation.
In the 344 (24% (95% CI 22 to 26%)) of the 1434 inclusions another specialty was consulted, resulting in a 55% increase of ED LOS. ED physicians more often consulted another specialty with a corrected odds ratio (OR) of 5.6 (4.0 to 7.8), mostly because consultations were mandatory in case of hospitalization or outpatient follow-up. Limited expertise of ED physicians was the reason for consultation in 7% (5 to 9%). The appropriateness of consultations was 84% (81 to 88%), similar between ED physicians and other specialists (P = 0.949). The patient characteristics age, comorbidity, and triage category and complaint predicted consultation.
In a Dutch tertiary care centre another specialty was consulted in 24% of the patients, mostly for an appropriate reason, and rarely because of lack of expertise. The impact of consultations on ED LOS could be reduced if mandatory consultations are abolished and predictors of a consultation are used to facilitate timely consultation.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0149079</identifier><identifier>PMID: 26894273</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Cohort analysis ; Cohort Studies ; Comorbidity ; Consultation ; Data collection ; Departments ; Efficiency ; Emergency medical care ; Emergency Medical Services ; Emergency medicine ; Emergency Service, Hospital ; Emergency services ; Engineering and Technology ; Family physicians ; Female ; Health counseling ; Hospital emergency services ; Hospitals ; Humans ; Length of Stay ; Male ; Management ; Medical personnel ; Medical referrals ; Medicine and Health Sciences ; Methods ; Mortality ; Netherlands ; Overcrowding ; Patient Admission ; Patient safety ; Patients ; People and Places ; Physicians ; Prospective Studies ; Referral and Consultation ; Regression analysis ; Statistical analysis ; Tertiary Care Centers</subject><ispartof>PloS one, 2016-02, Vol.11 (2), p.e0149079-e0149079</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Veen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Veen et al 2016 Veen et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-772c86a5039bc31511ab5d1138d301d0035f59a1b2e40f9ec869210fb2f026183</citedby><cites>FETCH-LOGICAL-c692t-772c86a5039bc31511ab5d1138d301d0035f59a1b2e40f9ec869210fb2f026183</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760948/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760948/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23865,27923,27924,53790,53792,79371,79372</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26894273$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Chamberlain, Alanna M</contributor><creatorcontrib>van der Veen, Daniël</creatorcontrib><creatorcontrib>Heringhaus, Christian</creatorcontrib><creatorcontrib>de Groot, Bas</creatorcontrib><title>Appropriateness, Reasons and Independent Predictors of Consultations in the Emergency Department (ED) of a Dutch Tertiary Care Center: A Prospective Cohort Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Consultations occur frequently in the emergency department (ED) of tertiary care centres and pose a threat for patient safety as they contribute to ED lengths of stay (LOS) and overcrowding. The aim of this study was to investigate reasons and appropriateness of consultations, and the relative impact of specialty and patient characteristics on the probability of a consultation, because this could help to improve efficiency of ED patient care.
This prospective cohort study included ED patients presenting to a Dutch tertiary care centre in a setting where ED physicians mostly treat self-referred and undifferentiated patients and other specialists treat referred patients. Consultations were defined as appropriate if the reason of consultation corresponded with the final advice, conclusion or policy of the consulted specialty. Multivariable logistic regression analysis was used to assess the relative contribution of specialty and patient characteristics on consultation.
In the 344 (24% (95% CI 22 to 26%)) of the 1434 inclusions another specialty was consulted, resulting in a 55% increase of ED LOS. ED physicians more often consulted another specialty with a corrected odds ratio (OR) of 5.6 (4.0 to 7.8), mostly because consultations were mandatory in case of hospitalization or outpatient follow-up. Limited expertise of ED physicians was the reason for consultation in 7% (5 to 9%). The appropriateness of consultations was 84% (81 to 88%), similar between ED physicians and other specialists (P = 0.949). The patient characteristics age, comorbidity, and triage category and complaint predicted consultation.
In a Dutch tertiary care centre another specialty was consulted in 24% of the patients, mostly for an appropriate reason, and rarely because of lack of expertise. The impact of consultations on ED LOS could be reduced if mandatory consultations are abolished and predictors of a consultation are used to facilitate timely consultation.</description><subject>Analysis</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Consultation</subject><subject>Data collection</subject><subject>Departments</subject><subject>Efficiency</subject><subject>Emergency medical care</subject><subject>Emergency Medical Services</subject><subject>Emergency medicine</subject><subject>Emergency Service, Hospital</subject><subject>Emergency services</subject><subject>Engineering and Technology</subject><subject>Family physicians</subject><subject>Female</subject><subject>Health counseling</subject><subject>Hospital emergency services</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Management</subject><subject>Medical 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M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Appropriateness, Reasons and Independent Predictors of Consultations in the Emergency Department (ED) of a Dutch Tertiary Care Center: A Prospective Cohort Study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-02-19</date><risdate>2016</risdate><volume>11</volume><issue>2</issue><spage>e0149079</spage><epage>e0149079</epage><pages>e0149079-e0149079</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Consultations occur frequently in the emergency department (ED) of tertiary care centres and pose a threat for patient safety as they contribute to ED lengths of stay (LOS) and overcrowding. The aim of this study was to investigate reasons and appropriateness of consultations, and the relative impact of specialty and patient characteristics on the probability of a consultation, because this could help to improve efficiency of ED patient care.
This prospective cohort study included ED patients presenting to a Dutch tertiary care centre in a setting where ED physicians mostly treat self-referred and undifferentiated patients and other specialists treat referred patients. Consultations were defined as appropriate if the reason of consultation corresponded with the final advice, conclusion or policy of the consulted specialty. Multivariable logistic regression analysis was used to assess the relative contribution of specialty and patient characteristics on consultation.
In the 344 (24% (95% CI 22 to 26%)) of the 1434 inclusions another specialty was consulted, resulting in a 55% increase of ED LOS. ED physicians more often consulted another specialty with a corrected odds ratio (OR) of 5.6 (4.0 to 7.8), mostly because consultations were mandatory in case of hospitalization or outpatient follow-up. Limited expertise of ED physicians was the reason for consultation in 7% (5 to 9%). The appropriateness of consultations was 84% (81 to 88%), similar between ED physicians and other specialists (P = 0.949). The patient characteristics age, comorbidity, and triage category and complaint predicted consultation.
In a Dutch tertiary care centre another specialty was consulted in 24% of the patients, mostly for an appropriate reason, and rarely because of lack of expertise. The impact of consultations on ED LOS could be reduced if mandatory consultations are abolished and predictors of a consultation are used to facilitate timely consultation.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26894273</pmid><doi>10.1371/journal.pone.0149079</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Cohort analysis Cohort Studies Comorbidity Consultation Data collection Departments Efficiency Emergency medical care Emergency Medical Services Emergency medicine Emergency Service, Hospital Emergency services Engineering and Technology Family physicians Female Health counseling Hospital emergency services Hospitals Humans Length of Stay Male Management Medical personnel Medical referrals Medicine and Health Sciences Methods Mortality Netherlands Overcrowding Patient Admission Patient safety Patients People and Places Physicians Prospective Studies Referral and Consultation Regression analysis Statistical analysis Tertiary Care Centers |
| title | Appropriateness, Reasons and Independent Predictors of Consultations in the Emergency Department (ED) of a Dutch Tertiary Care Center: A Prospective Cohort Study |
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