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Abstract: SA-PO015

Timing and Type of Nephrology Consults in an Academic Medical Center: A Springboard for Quality Improvement

Session Information

  • Educational Research
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 800 Educational Research

Authors

  • Gipson, Graham Thomas, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States
  • Radwi, Faisal Rashidhaider K., Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States
  • Schwartz, Benjamin, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States
  • Kothari, Niraj R., Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States
  • Kidd, Jason M., Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States
Background

Inpatient consultation is a common part of nephrology practice. Give our decreased work force and increasing clinical demand, knowing the type and timing of consult requests can improve the quality of care that we provide.

Methods

VCU Health is a large tertiary-care hospital with a clinical nephrology fellowship and 15 faculty members. An electronic consult request process was implemented in 2017. For nephrology, inpatient consult requests were submitted to 1 of 4 services: Floor (non-ICU), ICU, Chronic Dialysis, or Transplant. We used a health care informatics platform to abstract data for 3087 consults over a 12-mo period. Data included time of consult request and free-text reasons for consult (RFC); the latter were categorized using 1 or more of 16 prespecified categories.

Results

The most common RFC was maintenance HD, followed by AKI (Figure 1). The maximum frequency (mode) of nephrology consultation occurred between 08:00 and 09:00, though a second mode arose between 15:00 and 16:00 (Figure 2). The frequency distribution of consultation was not different between the 4 consult services. Limitations include subjectivity and interrater variability in RFC categorization, and inability to capture consult requests that were not submitted electronically.

Conclusion

We identified the timing and type of consults requested over a 12-mo period. Our hope is to identify consultation patterns that place workload strain on the available nephrology staff. From that, we seek to undertake quality improvement initiatives to alter these patterns in order to maximize the quality of care rendered by our limited workforce.

Consult frequency by reason-for-consult.

Consult frequency by time of day