Relationship Between Intern Experience and Inpatient Consults to Radiation Oncology

Abstract

Each July, the nation’s newest physicians arrive on the wards to begin their practice of medicine. During a patient’s hospital course, it is common to consult specialty services to assist in management. Radiation Oncology (RO) is a specialty which receives little attention in most medical school curriculums. Unlike other specialties, inpatient consultations are usually reserved for urgent cases where routine management is deferred to the outpatient setting. Understanding which patients can benefit from inpatient RO evaluation is a nuanced skill that is difficult to acquire quickly. Minimal research has been conducted in this area. Therefore, we sought to compare after-hours consults placed by “experienced” versus “novice” interns, with the hypothesis that novice interns would request inpatient consults more frequently. At our institution, “after-hours” is from 5 PM - 8 AM on weeknights, the entire weekend, and on national holidays. During this time, calls to the department are forwarded to an answering service who pages an on-call resident. The answering service keeps logs of all calls received. Call records from May - August 2018 were analyzed. For each call, the following information was obtained: date and time, patient date of birth, was the call from a provider or a patient, and, if the call was from a provider, was it an inpatient consult or some other issue (e.g. critical test result). Using the time of the academic year as a surrogate, calls were separated into “experienced” (May and June) or “novice” (July and August) groups, with July 1st, 2018 as the division point. Descriptive statistics and a two-proportion two-sided Z-test were performed using Statistical analysis software. Statistical significance was set at p-value <0.05. A total of 161 after-hours phone calls were received in the four-month study period. The majority of calls were received on a Sunday (24.8% of total calls). The average time to receive a call was 2:15 PM (range: 02:30 AM - 12 AM). The average patient age was 65 (range: 15 to 95). From May 1st to June 30th a total of 89 phone calls were received. 72 calls were received from July 1st to August 31st. Significantly fewer after-hours inpatient consults were placed in July and August (5 calls, 6.9%) compared to May and June (16 calls, 17.9%) (z = 4.272, p = 0.039). Contrary to our hypothesis, significantly fewer after-hours inpatient consults were received during the period staffed by novice interns compared to experienced interns. This could be attributed to the fact that consultation to RO was not considered in the after-hours period where house staff have less oversight. Instead, inpatient consults might be more likely to be placed during the day at the suggestion of senior residents, fellows, or attendings, and these consults would not be captured by this database. More research into the understanding of inpatient RO consultation is warranted.