Practice Standards
New policy stresses timely responses
Critical care specialist Peter Marshall, MD, discusses a patient with cardiologist Joseph Akar, MD, in the Yale-New Haven Hospital emergency room.
Critical care specialist Peter Marshall, MD, discusses a patient with cardiologist Joseph Akar, MD, in the Yale-New Haven Hospital emergency room.
Thanks to a new policy, a physician caring for a hospital patient with a curious rash may request that a dermatology consult take place within 24 hours. If the problem is more urgent, such as an otherwise stable patient complaining of palpitations, the doctor can request a cardiologist visit within 12 hours. If it’s an emergency—such as sudden abdominal bleeding—the doctor caring for the patient can call a GI specialist or surgeon and expect a response within an hour.
The policy gives the referring physician responsibility for initiating a consultation within a time frame that he or she decides matches the severity of the clinical problem. It’s up to the consulting physician to respond promptly and with, in the words of the policy, “a thank you mentality.”
“The whole premise of the consultation is that more expert care is needed, and if a consultant is called for, they should respond in a time frame that is appropriate,” said Alan Friedman, MD, interim chief of pediatric cardiology and a member of the Yale Medical Group Board of Governors Practice Operations and Standards Committee, which developed the policy. “We felt as a committee that this policy shouldn’t vary from department to department.”
Committee is a diverse group
The Practice Operations and Standards Committee is co-chaired by Ronald Vender, MD, chief medical officer for Yale Medical Group, and Marianne Dess-Santoro, chief operating officer, and comprises a spectrum of physicians, including obstetrician Joshua Copel, MD; trauma surgeon Kimberly Davis, MD; internist Matthew Ellman, MD; orthopaedist Michael Medvecky, MD; emergency physician Ian Schwartz, MD; pulmonologist Lynn Tanoue, MD; therapeutic radiologist Lynn Wilson, MD; and Peter Herbert, MD, chief of staff for Yale-New Haven Hospital. Yale Medical Group administrative staff members Kelly Aingworth, Deborah Broadwater, Marie Follo and Beth Lynch also serve on the committee.
Other recent committee projects include new or updated policies on no-show patients, discharging patients from Yale Medical Group and physician departures. “We’re looking to see how we can deliver the best services to our various customers, not just patients—although patients come first—but to other doctors and staff as well,” said Dr. Copel.
New policy stresses service
Those expectations are clear in the inpatient consultation policy. In the words of the policy, physicians should maintain a “respectful, collaborative, and service-oriented approach to hospital consultations, which is consistent with our values of patient-centered care and professionalism.” Committee members wanted to extend the same standards and expectations to residents and fellows, who may request consults as long as they are approved in advance by the attending physician.
“Sometimes when we think about consultations we tend to think of it as a vertical approach—someone is asking for an expert’s opinion in a sort of one-way transmission of information,” said Dr. Friedman. “The committee felt that consultation is not a vertical process, it’s a horizontal process where information needs to be shared between the referring and consulting doctors so that the highest-quality care can be provided.
“As a physician who provides consultations, I know it’s very important that the referring physician provide salient medical information with a formulated question as to what the referring team is looking for in the consultation,” said Dr. Friedman. “Having the perspective of the referring physician’s sense of urgency and a clear understanding of the questions involved allows us to better meet the referring physician’s expectations and contributions in a way that is meaningful to patient care.”
The new policy includes a checklist of information that referring physicians must provide. The committee established the following guidelines to help referring physicians determine the timing of a consult response:
| Nature of Consult | Time Frame |
| Emergency | Within 1 hour of request |
| Urgent | Within 1-12 hours of request, depending on urgency |
| Routine/Elective | Within 24 hours of request |
A copy of the complete inpatient consultation policy is available online by clicking here.
