title: Analysis of emergency vascular surgery consults within a tertiary health care system.
abstract: OBJECTIVE
  Patients with vascular disease often have multisystem atherosclerosis and multiple comorbidities requiring comprehensive interdisciplinary specialty care. Consultation is a critical component of a tertiary vascular surgery practice, but analysis of this service is under-reported in the literature. After-hours inpatient consultations and interhospital transfers are associated with urgent patient care.
  
  
  METHODS
  A retrospective analysis of vascular surgery consultations was carried out from January 1, 2013, to December 31, 2013. Consultations included inpatient services, the emergency department, surgical and medical intensive care unit, and interhospital transfers. Data analysis included number of consults, time of consultation (during hours, 0700-1859; after hours, 1900-0659), referring service, nature, and outcome of consultation. Consultations were then classified as urgent if vascular surgical intervention was required as an intraoperative consultation, within 24 hours, or during the same hospitalization. Patients without a same-hospital vascular surgical intervention were classified as nonurgent.
  
  
  RESULTS
  During a 1-year period, 823 independent consult requests of 749 patients were analyzed. It was found that 57.8% of after-hours consults resulted in urgent patient care (P = .003); 29.7% of medicine, 33.3% of medical intensive care unit, 41.9% of trauma surgery, and 60% of emergency department after-hours consultations were urgent; 73% of surgery and 79.2% of interhospital after-hours consults required urgent vascular surgical intervention. Extremity ischemia, aortic disease, and iatrogenic consults accounted for 44.8%, 20.4%, and 11.1% of after-hours consults, with 57.9%, 56.4%, and 70% requiring urgent vascular surgical intervention, respectively.
  
  
  CONCLUSIONS
  After-hours consultations are not always associated with an urgent vascular surgical intervention. Nonurgent after-hours consultations are requested more frequently from some services and may present an opportunity for education that could improve workflow of the vascular workforce.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Leithead
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala. Electronic address: tcmatthews@uabmc.edu.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Matthews
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Pearce
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Novak
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Mark
authors.initials: M
authors.lastname: Patterson
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Passman
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: William D
authors.initials: WD
authors.lastname: Jordan
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data / Q000639:trends*; D000407:Alabama; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data / Q000639:trends*; D061847:Hospitals, High-Volume / Q000639:trends; D006801:Humans; D010348:Patient Care Team / Q000639:trends; D010360:Patient Transfer / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D063128:Tertiary Health Care / Q000706:statistics & numerical data / Q000639:trends*; D013997:Time Factors; D014652:Vascular Diseases / Q000175:diagnosis* / Q000628:therapy; D057188:Workflow