Üçüncü basamak bir hastanede yatan hastaların endokrin konsultasyonlarının değerlendirilmesi, dahili ve cerrahi bölümler arasında fark var mı?

Öz

Amaç: Bazı yetişkin yatan hasta endokrin konsültasyon sonuçlarında, hastanın endokrin tanısı veya tedavisi aynı kalır, yani hasta yönetimini iyileştirmez. Bu konsültasyonların sayısını ve endokrin nedenlerini tıbbi ve cerrahi bölümler arasında karşılaştırmayı amaçladık. Gereç ve Yöntemler: Merkezimizde ardışık 7 ay boyunca mesai saatleri içinde yatan yetişkin endokrin konsültasyonları retrospektif olarak incelendi. Konsültasyona cevap verilmeden taburcu edilen, COVID servisinden konsülte edilen ve tiroid ultrasonu, biyopsi ve reçete için konsülte edilen hastalar çalışmaya alınmadı. Bulgular: Toplam 361 konsültasyon değerlendirildi, 46'sına ait veriler çalışma kriterlerini karşılamadığından çalışmaya alınmadı. Kalan 315 konsültasyon ve 214 hasta analiz edilmiştir. Hasta yönetimini iyileştirmeyen konsültasyon oranları, kemik ve kalsiyum metabolizması hariç tüm endokrin konularında dahili bölümlerde önemli ölçüde daha yüksekti. En fazla konsültasyon yapılan bölüm dermatoloji olmuştur. Hem dahili hem de cerrahi bölümlerde en çok danışılan endokrin konu diyabet olurken, ikinci sırada dahili bölümlerde tiroid, cerrahi bölümlerde ise hipofiz yer almıştır. Hasta yönetimini iyileştirmeyen konsültasyonların ortalama HbA1c değeri ve tekrarlanan konsültasyonların ortalama TSH düzeyi sırasıyla anlamlı derecede düşük ve yüksekti. Sonuç: Gelecekte endokrin hastalıkların görülme sıklığının artması beklendiğinden, özellikle dahili departmanlardan gelen konsültasyonlar için ilgili endokrin konusuna göre yapılacak eğitim, hasta yönetimini iyileştirmeyen konsültasyon oranlarını azaltabilir.

Anahtar Kelimeler

• endokrin
• konsultasyon
• yatan hasta

Comparison of adult inpatient endocrine consultations between non-surgical and surgical departments in a tertıary care hospital: is there any difference?

Öz

Aim: We aimed to compare the number and endocrine reasons of consultations between non-surgical departments (NSDs) and surgical departments (SDs). Material and Methods: Adult inpatient endocrine consultations during working hours for 7 consecutive months in our center were retrospectively reviewed. Patients who were discharged before consultation, consulted by the coronavirus disease 2019 (COVID-19) service, or referred for consultation for thyroid ultrasound, biopsy, and prescription were excluded. The patients' age and gender, the consultation department (NSDs and SDs), the endocrine issue for consultation, and preoperative or other consultations were recorded. If the consultation recommends a new medication, discontinuation of a medication, or a change in medication dosage, or provides advice on the preoperative management of endocrine diseases, such as suggesting a glucose-insulin infusion protocol, the consultation was considered improvement management (IM). If the consulted physician did not make a new diagnosis or prescribe a new therapy other than to support the present plan, it was accepted as no improvement management (NIM). Results: A total of 361 consultations were received, but data from 46 were excluded. The remaining 315 consultations and 214 patients were analysed. The rates of consultations that NIM were significantly higher in NSDs in all endocrine issues except bone and calcium metabolism. The department with the highest consultations was dermatology. The most consulted endocrine issue was diabetes in both NSDs and SDs, the second one was thyroid in NSDs and pituitary in SDs. The mean glycated hemoglobin (HbA1c) of consultations that NIM and the mean thyroid stimulating hormone (TSH) level of patients with repeated consultations were significantly low and high, respectively. Conclusion: Since the incidence of endocrine diseases is expected to increase in the future, training to be conducted according to the related endocrine issue, especially for consultations from the NSDs, could reduce NIM consultation rates.

Anahtar Kelimeler

• inpatient
• endocrine
• consultations

Kaynakça

1. Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab 2009; 94: 1853-78.
2. Osher E, Zohar NE, Yacobi-Bach M Osher E, Zohar NE, Yacobi-Bach M, Cantrell D, Serebro M, Sofer Y et al. Endocrinology specialty service for inpatients: an unmet growing need. BMC Health Serv Res 2023; 23: 142.
3. Vamvakopoulos J, Ayuk J, Boelaert K, Gittoes N, Karavitaki N, Mtemererwa B et al. Inpatient Endocrinology: a comprehensive specialty service audit and Quality Improvement Project in a large tertiary care centre. In: Endocrine Abstracts. Vol 44. Bioscientifica; 2016.
4. Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40: 711-67.
5. Goldstein MB, Islam S, Piccione J, Migasiuk L, Rothberger GD. Utility of Thyroid Function Testing in the Inpatient Setting. Endocr Pract 2022; 28: 853-8.
6. Rushakoff RJ, Rushakoff JA, Kornberg Z, MacMaster HW, Shah AD. Remote Monitoring and Consultation of Inpatient Populations with Diabetes. Curr Diab Rep 2017; 17: 70.
7. Mandel SR, Langan S, Mathioudakis NN, Sidhaye AR, Bashura H, Bie JY, Mackay P et al. Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital. J Community Hosp Intern Med Perspect 2019; 9: 64-73.
8. Zilbermint M. The Endocrine Hospitalist: Enhancing the Quality of Diabetes Care. J Diabetes Sci Technol 2021; 15: 762-7.

9. Levetan CS, Salas JR, Wilets IF, Zumoff B. Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes. Am J Med 1995; 99: 22-8.
10. Kleinhans M, Albrecht LJ, Benson S, Fuhrer D, Dissemond J, Tan S. Continuous Glucose Monitoring of Steroid-Induced Hyperglycemia in Patients With Dermatologic Diseases. J Diabetes Sci Technol 2024; 18: 904-10.
11. Chai ZT, Tan C, MeiQi Liau M, Kaur H, Pang SM, Phoon YW et al. Diabetes mellitus and hyperglycemic complications in bullous pemphigoid. J Am Acad Dermatol 2020; 82: 1234-7.
12. Torky A, LaRue M, Kaplowitz P. Low Value of Thyroid Testing in the Pediatric Inpatient Setting. Hosp Pediatr 2019; 9: 24-9.
13. Spencer CA. Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients. Mayo Clin Proc 1988; 63: 1214-22.
14. Dogra P, Paudel R, Panthi S, Cassity E, Tannock LR. Low Yield of Thyroid-Function Tests in Adult Hospitalized Patients - A Retrospective Analysis. Int J Gen Med 2020; 13: 343-9.
15. Marques P, Sagarribay A, Tortosa F, Neto L, Tavares Ferreira J et al. Multidisciplinary Team Care in Pituitary Tumours. Cancers (Basel) 2024; 16: 950.
16. Clarke DB, Hebb ALO, Massoud E, Imran SA. In-Hospital Endocrinology Consultation After Transsphenoidal Surgery: Is It Always Necessary? Can J Neurol Sci 2021; 48: 534-9.