Abstract 233: Quality of Collaboration Between Cardiologists and Internists During Inpatient Consultations

Abstract

Background: Collaboration between cardiologists and internists is essential to providing safe, effective, and patient-centered cardiovascular care. The objective of this study was to determine the quality of collaboration between these clinicians during inpatient consultations and identify areas for improvement. Methods: We surveyed hospitalists, general internal medicine faculty, and resident physicians from inpatient general medicine services and consulting cardiology attendings and fellows at a large tertiary care hospital over a two month period. Respondents were asked to rate each other’s level of collaboration on a 5-point ordinal response scale and answer multiple choice and free-response questions on consultation practices and personal preferences. Results: Overall, 92 of 155 (59%) eligible hospitalists, general internal medicine faculty, and resident physicians completed the primary survey. Collaboration with cardiology consultants was rated as high or very high quality by 72% of respondents. There was no significant difference between ratings of collaboration quality based on respondents’ level of training. Internists identified resistance or disagreement with indication for consultation, difficulty receiving a timely response, and poor follow-up communication as the largest barriers to high quality collaboration. Most internists preferred receiving recommendations by page, phone, or written in a consult note, rather than in person. Internists appreciated close communication throughout the consultation process. For longitudinal consultations, internists preferred when an intention to sign-off was communicated by page or wrote in that day’s consult note. In total, 9 cardiology attendings and fellows completed the specialty survey. Cardiologists reported providing recommendations the same day for routine consultations, or within 2-3 hours when urgent. Most consultants communicated their recommendations thru page, phone conversations, or written consult note. Providing recommendations in person was rare. Half of cardiology attendings and fellows rated collaboration with internists as high or very high quality. There was no significant difference between their ratings of collaboration with hospitalists and residents. Cardiologists appreciated when outside hospital records had already been obtained. They identified receiving an unclear reason for consult, consulting prior to initial work-up, late in the day, or when an outpatient appointment was more appropriate as the largest barriers to high quality collaboration. Conclusions: While cardiologists and internists appear to agree on modes of communication, they have different perceptions of timeliness and disagreements on appropriateness of consultations. Further research is needed to design and study interventions that address these barriers to high quality collaboration.