Audit of the consultation process on general internal medicine services.
OBJECTIVE
To determine the proportion of consultations requested by general internal medicine services that communicate key components of the consultation process to medical subspecialists.


METHODS
Retrospective chart review by two researchers, using a standardised chart abstraction instrument (93.1% agreement, kappa 0.85).


METHODS
Calgary, Alberta, Canada.


METHODS
A random sample of medical consultations was selected from those generated on two medical teaching units (MTUs) from 2003 to 2004.


METHODS
The primary measure of interest was whether a "clear clinical question" was posed to the subspecialist, a binary variable.


RESULTS
Two hundred consultations were sampled from the 2885 subspecialty consultations. Of the selected consultations, 94.0% (188/200) were available for review. A clear clinical question was posed in 69.7% (131/188) of consultations (CI 0.63 to 0.74). In a secondary analysis involving a larger sample permitting comparison across subspecialties, 95.1% (368/387) of the consultations, representative of the subspecialties, were available for review. An MTU member contacted the subspecialist for 74.2% of consultations. If a consultation was urgent, a member of the MTU contacted the subspecialist in 81.0% of consultations. Of these urgent consultations, 63.3% had a clear clinical question.


CONCLUSIONS
More than one in four consultations does not contain a clear clinical question, illustrating suboptimal communication between physicians. Innovative strategies that provide a sustainable solution for overcoming barriers to communication could have a significant impact on quality of care.
Conley
J
J
Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada.
Jordan
M
M
Ghali
W A
WA
D000328:Adult; D000368:Aged; D000416:Alberta; D003142:Communication; D005260:Female; D006801:Humans; D007388:Internal Medicine; D007400:Interprofessional Relations; D008297:Male; D008485:Medical Audit; D008511:Medicine; D008875:Middle Aged; D012017:Referral and Consultation; D013038:Specialization