Consultations in the emergency department: a systematic review of the literature

Objectives: Consultation is a common and important aspect of emergency department (ED) practice which can lead to delays in patient flow. Little is known about ED consultations and this review systematically evaluated the literature on ED consultations. Methods: Comprehensive searches of MEDLINE, PUBMED, SCIRUS, Cochrane Library, Web of Science, Health Star and other databases from 1966 to 2007 were performed. The grey literature and reference lists were searched and authors were contacted to identify other eligible studies. Published and unpublished studies reporting the proportion of consultations in the ED using any type of design were considered for this review. Eligible studies were required to involve patients presenting to the ED. Studies reporting on the proportion of consultation in a specific subpopulation of patients and interventions to improve consultations were also considered for inclusion. Two reviewers independently selected studies and extracted data from included studies regarding the proportion of consultations in the ED or the patient subgroup. Individual study proportions were calculated together with 95% confidence intervals (CI). Results: From more than 15 000 pre-screened citations, 12 studies were finally included in the review. All but three of the included studies were published. Overall, four studies examined ED consultation proportions, six identified the rate of consultation for special populations of ED presentations and two examined interventions to improve consultations. Consultation varied from 20% to 40% for all patients, with lower proportions in the selected populations studied and a high rate of hospitalisation for consulted patients. Limited research on interventions to improve the ED consultation process has also been completed. Conclusions: Consultation research in the emergency setting is limited and variable; however, high consultation rates exist in some centres. This systematic review outlines the current state of the literature and suggests that further research is urgently needed.

[1]  D. Richards,et al.  Enhancing medical student consultation request skills in an academic emergency department. , 1998, Journal of Emergency Medicine.

[2]  J. Potter.  Consultants in A. and E. , 1972, Lancet.

[3]  L. Goldman,et al.  Impact of inter-physician communication on the effectiveness of medical consultations. , 1983, The American journal of medicine.

[4]  C. Nager,et al.  A comparison of two models of gynecology service consultation to the emergency department in an academic medical center. , 2003, American journal of obstetrics and gynecology.

[5]  C. Reid,et al.  Referral patterns: an audit into referral practice among doctors in emergency medicine , 2005, Emergency Medicine Journal.

[6]  J. Murphy,et al.  Factors That Predict Psychiatric Consultation in the Emergency Department , 1985, Medical care.

[7]  T. Bradley,et al.  Paediatric consultation patterns in general practice and the accident and emergency department. , 1995, The Ulster medical journal.

[8]  B. Krauss,et al.  General trauma in a pediatric emergency department: Spectrum and consultation patterns , 1993, Pediatric emergency care.

[9]  G. R. Schwartz,et al.  Principles and practice of emergency medicine , 1978 .

[10]  L. Goldman,et al.  Ten commandments for effective consultations. , 1983, Archives of internal medicine.

[11]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.

[12]  J. Tintinalli,et al.  Importance of emergency physicians as referral sources for academic medical centers. The Gallup Organization Healthcare Group. , 1994, Annals of emergency medicine.

[13]  Ruth Brown.  Activities of accident and emergency consultants—a time and motion study , 2000, Journal of accident & emergency medicine.

[14]  M. Beaudet,et al.  A Two‐Year Follow‐Up of Geriatric Consults in the Emergency Department , 1998, Journal of the American Geriatrics Society.

[15]  J. Chamberlain,et al.  The art of referral. Pediatricians and the emergency department. , 1993, American journal of diseases of children.

[16]  J. Dale,et al.  Emergency department senior house officers' consultation difficulties: implications for training. , 1998, Annals of emergency medicine.

[17]  L. Stebbins,et al.  A survey of psychiatric consultations at a suburban emergency room. , 1993, General hospital psychiatry.

[18]  Gilles Reinhardt,et al.  Analysis of factors influencing length of stay in the emergency department. , 2003, CJEM.

[19]  M. Lambert,et al.  Five-year outcomes following psychiatric consultation to a tertiary care emergency room. , 2003, The American journal of psychiatry.

[20]  Karin V Rhodes,et al.  A conceptual model of emergency department crowding. , 2003, Annals of emergency medicine.

[21]  R. J. Sullivan,et al.  Factors related to an effective referral and consultation process. , 1982, The Journal of family practice.

[22]  D Kaufman,et al.  Working with consultants. , 1992, Dental economics - oral hygiene.

[23]  M. Charlson,et al.  The effectiveness of a consultation. Compliance with initial recommendations. , 1983, The American journal of medicine.

[24]  Beaudry Ml.  Use of consultants. , 1980 .

[25]  C. Holliman.  The art of dealing with consultants. , 1993, The Journal of emergency medicine.

[26]  J. Schuster.  Psychiatric consultation in the general hospital emergency department. , 1995, Psychiatric services.

[27]  B. Kumar,et al.  Evaluation of emergency dermatological consultations in a tertiary care centre in North India , 2003, Journal of the European Academy of Dermatology and Venereology : JEADV.

[28]  James W. Campbell,et al.  Geriatric outcomes are improved by a geriatric trauma consultation service. , 2006, The Journal of trauma.

[29]  M. Rice,et al.  Consultation and referral patterns from a teaching hospital emergency department. , 1993, The American journal of emergency medicine.

[30]  A. Drummond,et al.  No room at the inn: overcrowding in Ontario's emergency departments. , 2002, CJEM.

[31]  P. Rosen.  Emergency department disposition and knowledge of other specialties. , 1986, The Journal of emergency medicine.

[32]  M. Rice,et al.  Referral and consultation in emergency medicine practice. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[33]  P. Rosen.  Emergency medicine : concepts and clinical practice , 1983 .

[34]  N. Fothergill,et al.  Audit of patients with chest pain presenting to an accident and emergency department over a 6-month period. , 1993, Archives of emergency medicine.

[35]  L. Curtis,et al.  Analyzing patient time in the emergency department. , 1986, QRB. Quality review bulletin.

[36]  G F Abercrombie.  The Art of Consultation. , 1959, Journal of the College of General Practitioners and research newsletter. College of General Practitioners.

[37]  S. Chaturvedi,et al.  A STUDY OF EMERGENCY PSYCHIATRIC REFERRALS IN A TEACHING GENERAL HOSPITAL1 , 1982, Indian journal of psychiatry.

[38]  Astor L. Jenkins,et al.  Emergency department organization and management , 1978 .

[39]  S. Asch,et al.  Predictors of on-call specialist response times in California emergency departments. , 2006, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.