Claire Dawson
In a hospital setting, a consult occurs when a patient's primary care team encounters a complex clinical scenario that requires the expertise of a specialist beyond their level of expertise or available resources. This could involve seeking advice or opinions from another physician or specialist regarding the diagnosis, management, or treatment of a patient. Consults are distinct from referrals as they occur while the patient is an inpatient, and the patient continues to receive care from their primary team. The process of consultation involves open communication and established professional relationships to facilitate effective collaboration. The referring practitioner initiates the consultation process, provides relevant information, and coordinates the patient's overall care unless primary clinical responsibility is transferred. The consultant then offers timely advice, communicates their findings and recommendations, and discusses continuing care options with the referring practitioner. Consultations can take various forms, including formal consultations, curbside consultations, and remote evaluations through telemedicine. Effective consultation practices are essential to ensure optimal patient care and prevent medical errors.
| Characteristics | Values |
|---|---|
| Definition | To seek advice or opinion from a specialist |
| Who initiates | The patient's primary team |
| When | When the patient's primary team has a complicated clinical scenario beyond their expertise or resources |
| How | By phone |
| Who is contacted | A specialist, e.g. cardiology, infectious disease, endocrinology |
| What happens next | The fellow fields the consult, sees the patient, writes a note with recommendations, and staffs it with their attending |
| Time taken | 1.5–2 hours |
| Cost | Private consultations cost money, e.g. £95 at Practice Plus Group |
| Waiting time | A few days to a couple of weeks |
| What happens during the consultation | Diagnosis, treatment options, medical tests, questions about medical history, and the patient can ask questions |
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What You'll Learn
When to call a consult
A consult in a hospital refers to the process of seeking advice or guidance from a specialist regarding a patient's care. It involves open communication and collaboration between healthcare professionals to provide optimal patient care.
Calling a consult is warranted when a patient's primary care team encounters a complicated clinical scenario beyond their level of expertise or available resources. This could include situations where:
- Specialised Knowledge is Required: The patient presents with a condition or situation that requires specialised knowledge or skills outside the scope of practice of the primary team. For example, a patient with a suspected myocardial infarction may require a cardiology consult, or a patient with an incidental adrenal mass could benefit from an endocrinology consult.
- Management of Emergencies: In emergency departments, consultations are often sought for immediate critical interventions when managing a medical emergency. For instance, emergency medicine physicians may consult with neurosurgical subspecialists on the surgical management of a patient with a subdural hematoma.
- Diagnostic Uncertainty: When the primary team has difficulty interpreting diagnostic results or needs assistance in diagnosing a complex or unusual condition. For example, the oncology team in the example above called a consult to interpret pituitary lab results and determine the next steps in patient management.
- Treatment Planning: Consults can aid in developing a comprehensive treatment plan, especially when multiple medical disciplines are involved. This ensures that the patient receives holistic care and that all relevant specialists are involved in decision-making.
- Patient Referrals: Consultations may also be initiated by patient referrals, either from within the hospital or from external sources. These referrals can come from various sources, including self-referrals, GP referrals, or specialist services.
- Continuity of Care: Consults should be called early in the process of care to ensure continuity of care and avoid disadvantages to both patients and consultants. Sufficient background information and clear reasons for the consultation should be provided to ensure effective collaboration.
It is important to note that while consultations are essential for optimal patient care, they should be used judiciously, respecting the consultant's time and expertise. Primary care teams should strive to manage concerns independently before calling a consult, ensuring that the consult request is warranted and accompanied by the necessary information for effective collaboration.
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How to call a consult
A consult in a hospital refers to the process of seeking the advice or opinion of a specialist regarding a patient's care. This usually occurs when the patient's primary care team encounters a complicated clinical scenario beyond their expertise or available resources.
Know When to Call a Consult
Before calling a consult, the patient's primary care team typically attempts to manage the situation independently. However, once it becomes evident that additional expertise is required, a consult is warranted. This usually occurs when the patient's condition or situation is beyond the level of expertise or resources available to the practitioners with primary clinical responsibility.
Identify the Appropriate Specialist
Determine the specific area of specialty required for the patient's care. This could be a particular medical specialty, such as cardiology, infectious disease, or endocrinology. Identifying the correct specialty ensures that the consult request reaches the most suitable specialist.
Gather Relevant Information
Before contacting the specialist, it is essential to gather and review all pertinent patient information. Conduct a thorough chart review and obtain a complete patient history, focusing on details relevant to the reason for the consult. This step ensures that you have a clear understanding of the patient's condition and helps the specialist provide more informed recommendations.
Establish a Professional Relationship
Building a good rapport with consultants and their teams in your hospital can make the process more pleasant and efficient. Familiarize yourself with the specialists and their colleagues, which can also help when you need to reach out unofficially for advice. Introducing yourself politely and providing a brief background of your role and team can contribute to establishing a positive relationship.
Make the Consult Request
When calling or contacting the specialist, introduce yourself and provide a concise overview of the patient's situation. Clearly state the patient's name, any relevant identifiers (like MRN), and a summary of the clinical scenario. Explain the reason for the consult request and any specific questions or concerns you have. It is essential to provide sufficient background information and context to ensure the specialist has a comprehensive understanding of the case.
Follow-Up and Coordination
After the initial consult request, the consultant may ask for additional information or provide preliminary recommendations. They typically have 24 hours to see the patient, write a note with recommendations, and discuss these recommendations with the referring practitioner. The referring practitioner should continue to coordinate overall patient care unless primary clinical responsibility is transferred.
Additional Considerations
- Timing: Be mindful of the timing of your consult request. While urgent matters may require immediate attention, recognize that calling at unusual hours may wake the specialist up, so ensure the urgency is justified.
- Courtesy: Remember to be courteous and polite throughout the process. Introducing yourself, expressing gratitude, and maintaining open communication can go a long way in fostering positive relationships.
- Professional Dialogue: Sometimes, a professional dialogue or informal discussion with a colleague may lead to a formal request for consultation. If a second opinion is sought, and a review of the patient's records or an examination is required, a formal consultation process should be initiated.
- Referral vs. Consult: Understand the difference between a referral and a consult. A referral typically pertains to outpatient matters, while a consult occurs when the patient is an inpatient and continues to receive care under their primary team.
By following these steps and guidelines, you can effectively call a consult, leveraging the expertise of specialists to provide optimal patient care.
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What happens during a consult
A consult in a hospital refers to the process of seeking advice or guidance from a specialist regarding a patient's care. This typically occurs when the patient's primary care team encounters a complex or unusual clinical situation beyond their expertise or resources.
During a consult, the following steps are generally taken:
Initiating the Consult
The primary care team recognises a situation that requires additional expertise. They contact a specialist, providing relevant information about the patient's condition and any specific queries or concerns. This information exchange ensures that the specialist has the necessary context to provide informed advice.
Specialist Assessment
The specialist reviews the provided information and may request additional details or preliminary tests to gain a comprehensive understanding of the patient's condition. This could include reviewing medical records, test results, or conducting a physical examination if necessary.
Formulating Recommendations
Based on their assessment, the specialist offers recommendations, opinions, or guidance to the primary care team. This may involve suggesting further diagnostic tests, proposing treatment options, or providing insights into the patient's care and management.
Communicating Findings
The specialist communicates their findings and recommendations to the referring practitioner. Effective communication is crucial to ensure a shared understanding of the patient's care plan. The consultant may also discuss continuing care options and coordinate with the primary care team to ensure seamless patient management.
Patient Involvement
During a consult, the patient is typically under the continued care of their primary team. However, in some cases, the patient may be directly involved in the consultation process. This could include discussions about their medical history, performing specialised tests, or providing informed consent for specific procedures or treatments.
Documentation and Follow-up
The consultant documents the consultation, ensuring that relevant information is recorded in the patient's medical record. This helps track the patient's care journey and facilitates continuity of care. Follow-up consultations or referrals may be scheduled as needed, depending on the patient's progress and the specialist's recommendations.
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The different types of consults
A consult in a hospital refers to the process of seeking advice or input from a specialist or another healthcare professional regarding a patient's care. This typically occurs when the patient's primary care team encounters a complex or unusual clinical scenario beyond their expertise or resources. The primary team initiates the consultation process by contacting the relevant specialist or healthcare provider.
Specialty Consults
Specialty consults involve a primary care physician or general practitioner seeking input from medical specialists with advanced education and training in specific fields of medicine, such as cardiology, endocrinology, or infectious diseases. These specialists provide insights and recommendations based on their expertise, helping to improve the patient's overall care.
Formal Consultations
Formal consultations are structured interactions between healthcare providers, typically involving a referring practitioner and a consultant. They are characterised by established protocols and ethical guidelines. During a formal consultation, the referring practitioner provides pertinent patient information, requests timely consultation, and continues to coordinate overall patient care unless primary clinical responsibility is transferred.
Informal or Curbside Consultations
Curbside consultations, also known as unstructured consultations, are informal interactions where a consultant is asked to provide recommendations without a formal patient assessment or comprehensive communication. While historically common, these consultations are considered high-risk due to the potential for inaccurate or incomplete information exchange, which may adversely affect patient care.
Telemedicine or Remote Consultations
Telemedicine consultations, or "remote evaluation and management inquiries," involve seeking advice or diagnosis from another healthcare provider without an in-person encounter. This is particularly useful in rural or remote areas, where specialists may not be readily available. An example is a rural emergency medicine physician consulting with a neurosurgical subspecialist at a tertiary care hospital regarding a patient's surgical management.
Immediate Critical Interventions
These consultations are typically sought in emergency situations that require immediate medical attention and are outside the scope of practice of the initial treating physician. For instance, an emergency medicine physician may consult a specialist to manage a critical condition like a subdural hematoma.
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The cost of a consult
A consult, or consultation, is when a patient's primary care team encounters a complicated clinical scenario beyond their expertise or resources and seeks advice from a specialist. This could be in the form of a formal consultation, where the consultant examines the patient or their medical records, or an informal consultation, where the consultant provides recommendations without a formal assessment.
For example, an unexpected visit to the emergency room that results in an overnight admission can result in expenses ranging from $10,000 to $30,000, depending on the specific circumstances and insurance coverage. On the other hand, planned procedures may have lower costs, with an average hospital stay of two to three days starting at around $7,000. However, surgery prices can vary significantly, with a total knee replacement ranging from $20,000 to $195,000.
Additionally, there may be extra charges for consultations with specialists or surgeons, which can be substantial. These costs can be unexpected, even with laws like the No Surprises Act in place, which aims to ensure fair billing practices for emergency care. For patients without insurance, payment plans, medical loans, or crowdfunding options may be available to help cover these expenses.
It is important to note that the cost of a consult is just one component of overall medical expenses, which may also include fees for laboratory tests, medications, hospital stays, and other services provided during the patient's care. Therefore, it is advisable to check with your healthcare provider and insurance plan to understand the potential costs and coverage for different services, as well as to explore payment options if needed.
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Frequently asked questions
A consult is when a patient's primary care team encounters a complicated clinical scenario beyond their expertise and seeks advice from a specialist.
The patient's primary care team or the practitioner with primary clinical responsibility can request a consult.
The consultant will diagnose the issue, figure out treatment options, and carry out medical tests. The patient can also ask the consultant any questions they may have.
A referral is for outpatient matters, while a consult takes place when the patient is an inpatient and will continue to receive care from their primary care team.
Consultations with NHS hospitals are free, but there may be a long wait. Private consultations typically cost money and are available within a week or so of the initial inquiry.
