Type, source, adequacy and outcome of consultations requested from the department of general surgery: a retrospective cohort study

Yıl 2021, Cilt: 7 Sayı: 6, 658 - 666, 04.11.2021

Metin Leblebici , Orhan Alimoğlu

https://doi.org/10.18621/eurj.866546

Öz

Objectives: To evaluate consultations requested from the department of general surgery in terms of type, source and adequacy and outcome regarding general surgery practice.

Methods: A total of 4706 consultations requested from the department of general surgery during the 2019 calendar year were included in this retrospective study. Data on patient demographics, type of consultation (urgent, routine), the requesting clinic, time of request, response time to consultation request (min), diagnosis and management of consulted patients by general surgery clinic and survivorship status were recorded.

Results: Consultations were urgent (69.0%) and made outside office hours (66.0%) in most of cases and more commonly requested by the emergency department (67.5%). The surgical pathology was confirmed only in 1338 (28.4%) consultations, while more commonly for urgent vs. routine requests (37.4 vs. 8.5%, p = 0.001), for consultations requested by emergency department (ranged 30.9 to 40.0%) vs. other clinics (ranged 0.0% to 19.1%, p = 0.001) and for diseases of colon-rectum-anus (100.0%, p = 0.001) than other disorders. The likelihood of urgent consultations (72.0% vs. 37.3%, p = 0.001) and post-consultation inpatient management (90.5% vs. 24.7%, p = 0.001) and were more likely among survivors vs. non-survivors.

Conclusions: In conclusion, our findings revealed that most of the consultations were urgent, outside the office hours and outpatient consultations requested by the emergency department, while surgical pathology was confirmed only in one third of consultations. Our findings indicate improved consultation practice particularly for routine requests by non-emergency clinics to prevent the incompatible or unnecessary consultation requests and related healthcare resource utilization.

Anahtar Kelimeler

Consultation request, General surgery, urgent, routine, adequacy of request

Kaynakça

• 1. Lee RS, Woods R, Bullard M, Holroyd BR, Rowe BH. Consultations in the emergency department: a systematic review of the literature. Emerg Med J 2008;25:4-9.
• 2. Woods RA, Lee R, Ospina MB, Blitz S, Lari H, Bullard MJ, et al. Consultation outcomes in the emergency department: exploring rates and complexity. CJEM 2008;10:25-31.
• 3. Kahramanca Ş, Kaya O, Azılı C, Güzel H, Özgehan G, İrem B. The role of general surgery consultations in patient management. Ulus Cerrahi Derg 2013;29:20-4.
• 4. Jung KY, Kim S, Kim K, Lee EJ, Kim K, Lee J, et al. Frequent mobile electronic medical records users respond more quickly to emergency department consultation requests: Retrospective Quantitative Study. JMIR Mhealth Uhealth 2020;8:e14487.
• 5. Tuot DS, Leeds K, Murphy EJ, Sarkar U, Lyles CR, Mekonnen T, et al. Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations. BMC Health Serv Res 2015;15:568.
• 6. Ulloa JG, Russell MD, Chen AH, Tuot DS. A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield. BMC Health Serv Res 2017;17:433.
• 7. Irfan M, McGovern M, Robertson I, Waldron R, Khan I, Khan W, et al. Operative surgical yield from general surgical outpatient clinics; time to change the way we practice? Ir Med J 2013;106:209-11.
• 8. Gupta PJ. Ambulatory proctology surgery-an Indian experience. Eur Rev Med Pharmacol Sci 2006;10:257-62.
• 9. Sobrado CW. Outpatient surgical proctology--past, present and future. Arq Gastroenterol 2005;42:133-5.
• 10. Siau K, Hodson J, Ingram R, Baxter A, Widlak MM, Sharratt C, et al. Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit. United European Gastroenterol J. 2019;7:199-209.
• 11. NICE. Acute upper gastrointestinal bleeding in over 16s: management, 2012. Available from: https://www.nice.org.uk/guidance/cg141. Accessed 20 February 2019.
• 12. Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015;47:1-46.
• 13. Montero Ruiz E, Barbero Allende JM, Melgar Molero V, Rebollar Merino Á, García Sánchez M, López Álvarez J. Do surgeons have more difficulties in the hospital care of non-surgery patients than with surgery patients? Cir Esp 2015;93:334-8.
• 14. Hexter DA, Henry GL. Working with consultants. Foresight 2002;53:1-7.
• 15. Yılmaz E, Yılmaz MA, Cander B. Evaluation of the request for consultations in the emergency department of Okmeydani Training and Research Hospital between 2014 and 2015. Eur Arch Med Res 2018;34:182-7.
• 16. Çobanoğlu U. [Evaluation of the cases consulted by chest surgery department in a university hospital]. Tur Toraks Der. 2009;11:117-21. [Article in Turkish]