The problems related to internal medicine consultations in the emergency department

Abstract

Objectives: Overcrowding in the Emergency Department (ED) is a serious and growing problem during recent years and one of the main causes of it is dysfunctional consultation system. We aimed to determine the problems related to patients who were admitted to the ED and requested consultations from internal medicine (IM) physicians and to contribute to the gap in the literature regarding this isssue.

Methods: In a period of one year, 3601 patients, who were admitted to the ED of a university hospital and were consulted by IM physicians were included in this prospective cross-sectional study. The epidemiological characteristics of patients, length of ED stay and consultation-related problems were investigated.

Results: The most common problems related to consultations were delayed completion of the consultation procedures for 88 (2.4%) patients, and unnecessary consultation requests for 66 (1.8%) patients, and patient referrals with inappropriate indications from IM outpatient clinics to the ED for 53 (1.5%) patients. There were differences of opinion among IM physicians and emergency medicine specialists regarding the need for consultation for 36 (1%) patients. The most important difference was in the various infections seen in patients with histories of hematologic or solid organ malignancies (n = 9).

Conclusions: According to these findings, good collaboration must be established among ED physicians and consultant physicians. Furthermore, physicians must avoid inappropriate referral patients from outpatient clinics to the ED. Additionally, unnecessary consultation requests from the ED must be avoided, and consultation requests must be addressed quickly.

Keywords

• Consultation
• emergency department
• internal medicine

References

1. 1. Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects. Ann Emerg Med 2000;35:63-8.
2. 2. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003;20:402-5.
3. 3. Schiff GD. System dynamics and dysfunctionalities: levers for overcoming emergency department overcrowding. Acad Emerg Med 2011;18:1255-61.
4. 4. Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Intern Emerg Med 2015;10:171-5.
5. 5. Baig MA, Mian A, Najeed F, Shahzad H. Overcrowding in the emergency departments: Challenges and opportunities for improvement. J Pak Med Assoc 2015;65:1344-5.
6. 6. Sears CL, Charlson ME. The effectiveness of a consultation: compliance with initial recommendations. Am J Med 1983;74:870-6.
7. 7. Rosen P. Emergency department disposition and knowledge of other specialties. J Emerg Med 1986;4:325-6.
8. 8. Woods RA, Lee R, Ospina MB, Blitz S, Lari H, Bullard MJ, et al. Consultation outcomes 238 in the emergency department; exploring rates and complexity. CJEM 2008;10:25-31.

9. 9. Kessler CS, Asrow A, Beach C, Cheung D, Fairbanks RJ, Lammers JC, et al. The taxonomy of emergency department consultations-results of an expert consensus panel. Ann Emerg Med 2013;61:161-6.
10. 10. Demircan C, Çekiç C, Akgül N, Odabaşı A, Çalışır N, Kıyıcı S, et al. [Profiles of the patients in the emergency internal medicine unit: one-year experience]. Uludağ Üniv Tıp Fak Derg 2005;31:39-43. [Article in Turkish]
11. 11. Brick C, Lowes J, Lovstrom L, Kokotilo A, Villa-Roel C, Lee P, et al. The impact of consultation on length of stay in tertiary care emergency departments. Emerg Med J 2014;31:134-8.
12. 12. Cortazzo JM, Guertler AT, Rice MM. Consultation and referral patterns from a teaching hospital emergency medicine department. Am J Emerg Med 1993;11:456-9.
13. 13. Geskey JM, Geeting G, West C, Hollenbeak CS. Improved physician consult response times in an academic Emergency Department after implementation of an institutional guideline. J Emerg Med 2013;44:999-1006.
14. 14. 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;5:4-9.
15. 15. Kılıçaslan İ, Bozan H, Oktay C, Göksu E. [Demographic properties of patients presenting to the emergency department in Turkey]. Turk J Emerg Med 2005;5:5-13. [Article in Turkish]
16. 16. Ay D, Akkas M, Sivri B. Patient population and factors determining length of stay in adult ED of Turkish University Medical Center. Am J Emerg Med 2010;28:325-30.
17. 17. Aygencel G, Nas A, Sarıtaş H, Deryal K, Demircan A. [General characteristics of internal medicine consultations in the emergency service of a university hospital]. Fırat Med J 2012;17:219-22. [Article in Turkish]
18. 18. Aydın T, Aydın ŞA, Köksal O, Özdemir F, Kulaç S, Bulut M. [Evaluation of features of patients attending the emergency department of Uludag university medicine faculty hospital and emergency department practices]. Eurasian J Emerg Med 2010:9:163-8. [Article in Turkish]
19. 19. Graff L. Overcrowding in the ED: an international symptom of health care system failure. Am J Emerg Med 1999;17:208-9.
20. 20. Derlet RW, Richards JR. Emergency department overcrowding in Florida, New York, and Texas. South Med J 2002;95:846-9.
21. 21. Shih FY, Ma MH, Chen SC, Wang HP, Fang CC, Shyu RS, et al. ED overcrowding in Taiwan: facts and strategies. Am J Emerg Med 1999;17:198-202.
22. 22. Sanchez M, Miro O, Coll-Vinent B, Bragulat E, Espinosa G, Gomez-Angelats E, et al. [Emergency department overcrowding: quantification of associated factors]. Med Clin (Barc) 2003;121:161-72. [Article in Spanish]
23. 23. Howard MS, Davis BA, Anderson C, Cherry D, Koller P, Shelton D. Patients’ perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding. J Emerg Nurs 2005;31:429-35.
24. 24. Çıkrıklar Hİ, Yürümez Y, Keleş İ, Özdinç Ş, Selvi F, Engindeniz Z, et al. Emergency room consultations: problems and solutions. Eurasian J Emerg Med 2015;14:167-71.