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Acad Med. 2019 Jul 9. doi: 10.1097/ACM.0000000000002867. [Epub ahead of print]

What Makes the "Perfect" Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives.

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1
S. Pavitt is child neurology resident, Department of Neurology, Stanford School of Medicine, Palo Alto, California. A. Bogetz is associate program director, pediatric residency program, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California. R. Blankenburg is program director and associate chair of education, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California.

Abstract

PURPOSE:

To characterize the methods of inpatient consult communication, given new communication modalities; to explore residents' and fellows' perspectives on the ideal consult and how this affects their teaching, learning, and patient safety; and to identify barriers to and strategies for optimizing consultations.

METHOD:

Using qualitative grounded theory, the authors conducted semistructured focus groups with pediatric residents and fellows at Lucile Packard Children's Hospital at Stanford University from October 2016 to September 2017, using questions developed by expert consensus to address study objectives. Sessions were audio recorded and transcribed verbatim. Two authors independently coded the transcripts and reconciled codes to develop categories and themes using constant comparison. The third author validated the codes, categories, and themes. To ensure trustworthiness, participants edited the themes for accuracy.

RESULTS:

Twenty-seven residents and 16 fellows participated in seven focus groups (three with residents, four with fellows). Four themes emerged: (1) many forms of communication are successfully used for initial inpatient consult recommendations (in person, phone, text messages, notes in electronic medical records); (2) residents and fellows prefer in-person communication for consults, believing it leads to improved teaching, learning, and patient safety; (3) multiple strategies can optimize consults regardless of communication modality; (4) how residents request the initial consult affects the interaction and can increase fellow engagement, which leads to more fellow teaching, resident's improved understanding, and better patient care.

CONCLUSIONS:

Residents and fellows believe that structured initial consults conducted in person improve teaching, learning, and patient care. Several strategies exist to optimize this process.

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