The Taxonomy of Emergency Department Consultations—Results of an Expert Consensus Panel

Abstract

INTRODUCTION AND NECESSITY FOR TAXONOMY OF CONSULTATIONS The basis of all consultations is communication between clinicians. Consultation is a “service type provided by a physician whose opinion or advice regarding evaluation or management of a specific problem is requested by another physician or other appropriate source.” Patient safety is a major concern in physician-to-physician communication, with evidence showing that transitions of care, specifically during consultations, are high-risk periods. Effective interpersonal communication is fundamental to safe patient care. It lies at the core of the continuum of care from clinician to clinician, shift to shift, between departments and between hospitals. In the emergency department (ED), there is a high frequency of consultations on a wide spectrum of disease processes and medical conditions facing emergency physicians. Additionally, with the increasing scrutiny of resource use and transfers of care, including consultants in crowded EDs, improving safety during consultations grows increasingly important. Consultations may have a place early in what often becomes a transfer of responsibility for patients, yet they are distinct from handoffs or transfers of care. Like transfers in care, there is no current agreement on the definition of a “standard” consultation between an emergency physician and the wide variety of specialists with whom they regularly consult (M. Cohen, B. Hilligoss, unpublished data, 2010). Consultations vary in type and content within and across EDs. They range from questions to requests for procedural assistance, can occur in person or by telephone, and are performed by various types of providers. According to the National Hospital Ambulatory Medical Care Survey, there were 117 million ED visits in 2007. A recent review found that 20% to 40% of patients admitted from the ED received at least 1 specialist consultation during their ED course. In addition, a recent study showed a 94% increase in the probability that an ED’s patient visit would result in a consultation or referral to a specialist between 1999 and 2009. (