title: Do Consultants Follow Up on Tests They Recommend? Insights from an Academic Inpatient Gastrointestinal Consult Service.
abstract: Inpatient care is a fundamental part of gastroenterology training and involves the recommendation, performance, and interpretation of diagnostic tests. However, test results are not always communicated to patients or treating providers. We determined the process of communication of test results and recommendations in our inpatient gastroenterology (GI) consult service.
  
  
  
  Test recommendations on 304 consecutive new GI consults (age 60.2 ± 1.0 year) over a 2-month period were recorded. Demographic factors (age, race, gender, zip code, insurance status) were extracted from the electronic medical record (EMR). Charts were independently reviewed 6 months later to determine results of recommended tests, follow-up of actionable test results, 30-day readmission rates, and predictors of suboptimal communication.
  
  
  
  Of 490 recommended tests, 437 (89.2%) were performed, and 199 (45.5%) had actionable findings. Of these, 48 (24.1%) did not have documented follow-up. Failure of follow-up was higher for upper endoscopy (31.9%) compared to colonoscopy (18.0%, p = 0.07). Women (p = 0.07), patients on Medicare (p = 0.05), and procedures supervised by advanced GI fellows (p = 0.06) were less likely to receive follow-up. Median income and identification of a primary provider did not influence follow-up rates; 30-day readmission rates were not impacted. Female gender, insurance (Medicare) status, and attending type remained independent predictors of failure of follow-up on multivariate regression (p ≤ 0.03).
  
  
  
  Failure to follow up test results on inpatient services at a large academic center was unacceptably high. Maximizing personnel participation together with diligence and technology (EMR) will be required to improve communication.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA. Benjamin.cassell@ucdenver.edu.|Division of Gastroenterology and Hepatology, University of Colorado, 1055 Clermont St MS 111-E, Denver, CO, 80218, USA. Benjamin.cassell@ucdenver.edu.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Cassell
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Walker
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Saad
authors.initials: S
authors.lastname: Alghamdi
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Bill
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Blais
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Boutté
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Brown
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.|Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.|John Cochran VA Medical Center, St. Louis, MO, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sayuk
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000592:standards / Q000706:statistics & numerical data*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States; D055815:Young Adult
keywords: Endoscopy; Gastroenterology training; Gastrointestinal tests; Quality improvement