Who Consults Us and Why? An Evaluation of Medicine Consult/Comanagement Services at Academic Medical Centers

Although general medicine consultation is an integral component of inpatient medical care and a requirement of internal medicine training, little is known about current consultative practice. We used a cross-sectional, prospective survey design to examine current practices at 11 academic medical centers over four 2-week periods from July 2014 through July 2015. Out of 11 consult services, 4 had comanagement agreements with surgical services, primarily with orthopedic surgery. We collected data regarding 1,264 consultation requests. Most requests (82.2%) originated from surgical services, with most requests originating from either orthopedic surgery (44.4%) or neurosurgery (11.6%). The most common reason for consultation at sites with a consult and comanagement service was medical management/comanagement (23.3%) and at sites with a consult-only service was preoperative evaluation (16.4%). On average, consultants addressed more than 2 reasons per encounter. Many of these reasons were unidentified by the consulting service. Learners on these services should perform comprehensive evaluations to identify potentially unidentified issues