title: Lack of genitourinary physical examination before urologic consultation--a quality of care issue.
abstract: OBJECTIVE
  To quantify the frequency of genitourinary (GU) physical examinations obtained by the emergency department or primary hospital team before obtaining a urologic consultation and evaluate the role of the different demographic and clinical factors.
  
  
  METHODS
  For 6 weeks, from July to August 2010, 420 consecutive patients evaluated by the urology consultation service had their medical charts reviewed retrospectively, with the frequency of GU physical examination performed by the emergency department or primary hospital team recorded.
  
  
  RESULTS
  Of 357 patients requiring a urologic consultation, 88 of 324 (27%) had a GU physical examination performed by the emergency department and 98 of 319 (31%) had a GU physical examination performed by the primary hospital team before the urologic consultation. The emergency department was 6 times more likely to perform a GU physical examination on a male patient than a female patient, and the primary team was twice as likely to perform a GU physical examination on a male patient than a female patient. The likelihood of examination by either team decreased as patients became older. Race was not significantly associated with the likelihood of examination.
  
  
  CONCLUSIONS
  The results of our study indicate that examinations are performed less than one-third of the time before obtaining a urologic consultation, with the frequency related to age and sex. The low rate of preconsultation examination creates concern for quality of care, the correctness of billing, and unnecessary urologic consultations.
authors.affiliation: Detroit Medical Center, Detroit, Michigan 48201, USA. awylitalo@gmail.com
authors.forename: Adam W
authors.initials: AW
authors.lastname: Ylitalo
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Ylitalo
authors.forename: Richard A
authors.initials: RA
authors.lastname: Santucci
mesh_terms: D000289:Admitting Department, Hospital / Q000592:standards; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010808:Physical Examination / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012017:Referral and Consultation; D014570:Urologic Diseases / Q000175:diagnosis*; D055815:Young Adult