The Courteous Consult: A CONSULT Card and Training to Improve Resident Consults

摘要

Editor's Note: The online version of this article contains the survey instrument used in this study.;Introduction Physician engagement in interprofessional consults that involve high-quality communication and courtesy is a critical aspect of patient care.1,2 Clear communication is critical for conveying the reason for the consultation and requires understanding of pertinent medical information as well as displaying good interpersonal skills.3 With the Accreditation Council for Graduate Medical Education's new milestones,4 skills in consultation are more explicitly defined, requiring that medical residents “[provide] consultation services for patients with basic and complex clinical problems.”5 Yet physician trainees often are undertrained and underprepared for consult interactions.3,4,6,7 Standardizing the information communicated during consultations may improve the quality of consults, and through this, patient care.3,8–10 The aim of this study was to develop and assess the feasibility of a training session and pocket guide for calling consults. The goals were (1) to assess residents' views on calling and responding to consults and the impact of consults on patient care, and (2) to develop a feasible, robust, and innovative method of training in calling consultations.;Methods The study was performed at the Icahn School of Medicine at Mount Sinai in New York between October 2010 and December 2011. The 1001 eligible participants were all medical, surgical, and other residents and fellows. Intervention Our intervention development began with trainee focus groups about consults from October 2010 to January 2011 (results will be reported in a separate manuscript). Next, we developed a survey using the focus group findings, the literature,1 and institutional guidelines.11 The survey was reviewed by experts in the field and was pilot tested with 33 medicine residents to assess understanding and ease of completion. The survey assessed trainees' views on the importance and frequency of experiencing specific consult components during initial consult calls and a consultant's response using a 4-point Likert scale. The final section consisted of 6 questions on the impact of consultation interactions on patient care (provided as online supplemental material). The survey was fielded to trainees from April to May 2011 using SurveyMonkey. Using the results from the focus group and the survey, the authors developed a mnemonic tool to guide trainees in calling consults. Two investigators determined items using an iterative process via consensus; disagreements were resolved via negotiation or with the help of the third author when needed. Authors determined components that were most critical to the consult call by reviewing items rated “most important” by approximately 50% or more of the trainees in both the consult call and the response sections (table?1). The items rated most highly in our survey were compared with components addressed in Goldman's 10 Commandments1 and our institutional policy11 to create items in 7 categories. Investigators then ordered the categories. For example, because “reason for consult” is the most critical component of the consult call, yet is often overlooked, this should happen early on during the consult call, right after the introduction of the team and patient. Finally, the categories were crafted into phrases that fit into the CONSULT mnemonic (a word easily remembered in this context): Contact the consultant courteously, Orient (to the patient), Narrow question, Story (history of present illness and hospital course), Urgency, Later (plan for follow-up), and Thank you. The CONSULT card included the mnemonic, examples of phrasing, and important tips for the caller (figure). View larger version (40K) FIGURE CONSULT Card (Front and Back);Results Of 1001 residents and fellows, 403 (40%) responded. Trainees were evenly distributed across sex, postgraduate year, and residency type. Although many of the items were dee