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BMJ Open Sep 2021Communication failures between clinicians lead to poor patient outcomes. Critically injured patients have multiple injured organ systems and require complex... (Observational Study)
Observational Study
OBJECTIVE
Communication failures between clinicians lead to poor patient outcomes. Critically injured patients have multiple injured organ systems and require complex multidisciplinary care from a wide range of healthcare professionals and communication failures are abundantly common. This study sought to determine barriers and facilitators to interdisciplinary communication between the consulting trauma, intensive care unit (ICU) team and specialty consultants for critically injured patients at an urban, safety-net, level 1 trauma centre.
DESIGN
An observational qualitative study of barriers and facilitators to interdisciplinary communication.
SETTING
We conducted observations of daily rounds in two trauma surgical ICUs and recorded the most frequently consulted teams.
PARTICIPANTS
Key informant interviews after presenting clinical vignettes as discussion prompts were conducted with a broad range of clinicians from the ICUs and physicians and nurse practitioners from the consultant teams who were identified during the observations. Interviews were recorded and transcribed verbatim. Data of these 10 interviews were combined with primary transcript data from prior study (25 interviews) and analysed together because of the same setting with same themes. Independent coding of the transcripts, with iterative reconciliation, was performed by two coders.
OUTCOMES MEASURES
Facilitators and barriers of interdisciplinary communication were identified.
RESULTS
A total of 35 interview transcripts were analysed. Cardiology and interventional radiology were the most frequently consulted teams. Consulting and consultant clinicians reported that perceived accessibility from the team seeking a consultation and the consultant team impacted interdisciplinary communication. Accessibility had a physical dimension as well as a psychological dimension. Accessibility was demonstrated by responsiveness between clinicians of different disciplines and in turn facilitated interdisciplinary communication. Social norms, cognitive biases, hierarchy and relationships were reported as both facilitators and barriers to accessibility, and therefore, interdisciplinary communication.
CONCLUSION
Accessibility impacted interdisciplinary communication between the consulting and the consultant team.
ARTICLE SUMMARY
Elucidates barriers and facilitators to interdisciplinary communication between consulting and consultant teams.
Topics: Communication; Communication Barriers; Health Personnel; Humans; Intensive Care Units; Interdisciplinary Communication; Qualitative Research; Referral and Consultation
PubMed: 34475150
DOI: 10.1136/bmjopen-2020-046111 -
Pediatric Radiology Apr 2022The field of radiology has benefited greatly from the technological boom that has brought greater precision, efficiency and utilization amid an exponential growth in... (Review)
Review
The field of radiology has benefited greatly from the technological boom that has brought greater precision, efficiency and utilization amid an exponential growth in medical science. The downside is that the same technology that has allowed the field to grow is contributing to an erosion of interpersonal communication and connection with patients and referring physicians. Remote reading has displaced us from the communal reading room, where much interaction and teaching used to take place. The "invisible" radiologist must transcend these barriers in order to preserve and strengthen the role of radiology in medical care. With modest adaptation, radiologists can regain their identity as consultants, where they have the greatest chance to show their value and thwart the drive toward commoditization.
Topics: Communication; Humans; Radiography; Radiologists; Radiology; Referral and Consultation
PubMed: 34173851
DOI: 10.1007/s00247-021-05133-5 -
Rheumatic Diseases Clinics of North... Feb 2020Subspecialty consultation is an increasingly used resource in inpatient medicine. Teaching the primary team is an important element of effective consultation and has... (Review)
Review
Subspecialty consultation is an increasingly used resource in inpatient medicine. Teaching the primary team is an important element of effective consultation and has many potential benefits. However, within academic medical centers many barriers to effective consultation and the consult learning environment exist. High workload, burnout, inexperience, lack of familiarity between teams, quality of the consult requests, and pushback may impede teaching and learning. Herein, the authors review the role of teaching and learning during consultation, challenges to effective consultation facing fellows, and interventions that can enhance primary team-fellow interactions and learning.
Topics: Burnout, Professional; Clinical Competence; Fellowships and Scholarships; Hospitalization; Humans; Inpatients; Interpersonal Relations; Referral and Consultation; Rheumatology; Workload
PubMed: 31757288
DOI: 10.1016/j.rdc.2019.09.003 -
The Journal of the Royal College of... Jul 1986A survey was conducted of the domiciliary consultation service provided in one health district in order to identify the pattern of referral by specialty, the reasons for...
A survey was conducted of the domiciliary consultation service provided in one health district in order to identify the pattern of referral by specialty, the reasons for the consultation and its outcome and to determine whether the service is realizing its original objectives.The district domiciliary consultation service was used in the majority of cases as an initial means of assessment for elderly patients with chronic disease. The majority of patients were kept out of hospital but responsibility for their care was usually transferred to the consultant. The domiciliary consultation service was rarely used as a means for joint consultation between family doctor and hospital specialist. To facilitate the care of patients in the community, it is suggested that domiciliary visiting should be incorporated into a consultant's NHS contract and the present regulations abandoned.
Topics: Adult; Aged; Cost-Benefit Analysis; England; Female; Home Care Services; Humans; Male; Middle Aged; Referral and Consultation
PubMed: 3090242
DOI: No ID Found -
Lancet (London, England) May 2019
Topics: Africa, Southern; Ethics, Medical; General Practitioners; Humans; Male; Medicine; Referral and Consultation; Surgeons; Work Performance
PubMed: 31057157
DOI: 10.1016/S0140-6736(19)30898-0 -
BMJ Open Dec 2021To describe the distribution of consultations at the practice level and examine whether increases are uniform or driven by people who consult more frequently.
OBJECTIVE
To describe the distribution of consultations at the practice level and examine whether increases are uniform or driven by people who consult more frequently.
DESIGN
Retrospective cohort study.
SETTING
UK general practice data from the Clinical Practice Research Datalink (CPRD) GOLD database.
PARTICIPANTS
1 699 709 314 consultation events from 12 330 545 patients, in 845 general practices (1 April 2000 to 31 March 2019).
METHODS
Consultation information was aggregated by financial year into: all consultations/all staff; all consultations/general practitioners (GPs); face-to-face consultations/all staff; face-to-face consultations/GPs. Patients with a number of consultations above the 90th centile, within each year, were classified as frequent attenders. Negative binomial regressions examined the association between available practice characteristics and consultation distribution.
RESULTS
Among frequent attenders, all consultations by GPs increased from a median (25th and 75th centile) of 13 (10 and 16) to 21 (18 and 25) and all consultations by all staff increased from 27 (23-30) to 60 (51-69) over the study period. Approximately four out of ten consultations of any type concerned frequent attenders and the proportion of consultations attributed to them increased over time, particularly for face-to-face consultations with GPs, from a median of 38.0% (35.9%-40.3%) in 2000-2001 to 43.0% (40.6%-46.4%) in 2018-2019. Regression analyses indicated decreasing trends over time for face-to-face consultations and increasing trends for all consultation types, for both GPs and all staff. Frequent attenders consulted approximately five times more than the rest of the practice population, on average, with adjusted incidence rate ratios ranging between 4.992 (95% CI 4.917 to 5.068) for face-to-face consultations with all staff and 5.603 (95% CI 5.560 to 5.647) for all consultations with GPs.
CONCLUSIONS
Frequent attenders progressively contributed to increased workload in general practices across the UK from 2000 to 2019. Important knowledge gaps remain in terms of the demographic, social and health characteristics of frequent attenders and how UK general practices can be prepared to meet the needs of these patients.
Topics: Cohort Studies; General Practice; Humans; Primary Health Care; Referral and Consultation; Retrospective Studies; United Kingdom
PubMed: 34930742
DOI: 10.1136/bmjopen-2021-054666 -
The British Journal of General Practice... Jun 2021
Topics: Humans; Referral and Consultation
PubMed: 34045242
DOI: 10.3399/bjgp21X715709 -
Psychopharmacology Bulletin Sep 2017To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care... (Review)
Review
OBJECTIVES
To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist.
EXPERIMENTAL DESIGN
Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014.
PRINCIPAL OBSERVATIONS
Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36).
CONCLUSIONS
This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery.
Topics: Ambulatory Care; Ambulatory Care Facilities; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Humans; Interprofessional Relations; Mental Disorders; Pharmacists; Physicians; Psychiatry; Referral and Consultation
PubMed: 28936009
DOI: No ID Found -
Applied Ergonomics Nov 2020Consultations entail transitions in care between referrers and consultants, as patients visit different clinicians and care sites. This complex process has been...
Consultations entail transitions in care between referrers and consultants, as patients visit different clinicians and care sites. This complex process has been consistently prone to communication breakdowns. Despite expectations and benefits of electronic health records (EHRs), incomplete, vague, or inappropriate referrals continue to hinder consultations; referrals can be sent to the wrong specialty service; and consultation findings frequently fail to reach referrers. Due to the inadequate support of interpersonal communication afforded by EHRs, these issues persist. Important aspects of ergonomics and human factors engineering frequently appear overlooked during the design and implementation of EHRs. Usability issues have contributed to delays in medical diagnosis, treatment, and follow-up. Some of these delays contribute to patient harms. Our multidisciplinary team of clinicians and ergonomics professionals reflects on referral and consultation. We describe how computerization in healthcare should benefit from approaches informed and developed through applied ergonomics and human factors.
Topics: Electronic Health Records; Ergonomics; Humans; Referral and Consultation; Systems Analysis; Transitional Care
PubMed: 32768721
DOI: 10.1016/j.apergo.2020.103227 -
Korean Journal of Radiology 2017The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists... (Review)
Review
The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.
Topics: Breast Neoplasms; Decision Support Techniques; Female; Humans; Interprofessional Relations; Oncology Service, Hospital; Patient-Centered Care; Precision Medicine; Radiology; Referral and Consultation; Tertiary Healthcare; Tomography, X-Ray Computed
PubMed: 28096715
DOI: 10.3348/kjr.2017.18.1.18