Table 6

Potential Solutions to Address Inappropriate Consults and Select Quotes

ThemeMajor subthemesFrequencySelect quotes
Technological solutionsLeveraging the electronic medical record (EMR)12/14“It's hard to gather… who is the consulting physician—what if there was a line in Epic [EMR] that showed the multiple teams involved and the contact information for the consultant?” (INT 8)
“We need systematic protocols for consults… maybe putting it in writing, maybe even all in the EMR. These would prompt specific questions and enforce closure so you hear back on the plan.” (INT 5)
Enhance how teams communicate through telecommunication and cell phone service improvement5/14“Some services don't respond and are hard to page. Sometimes, a person has the direct cell number of a surgeon, it makes a big difference.” (INT 8)
“There has to be a better way to relay information to each other than paging them… [it] is archaic and inefficient.” (INT 7)
Educational solutionsEnhance rotations on other services to emphasize interdisciplinary collaboration9/14“The calls after consults to explain the notes and recs provide an important avenue for education—what if we had the medicine rotators who are on neuro for a few weeks actually learn what information is helpful for both parties involved?” (INT 9)
“I know neurosurgeons spent a month with neuro—endless training of 7 years. But the attendings that did this saw the relationships between departments—less adversarial and more collegial… residents [should be] changing shoes for learning experiences. Colleagues do not have to be at odds with each other.” (INT 11)
Administrative solutionsStreamline workflows and protocols with regard to particular clinical scenarios8/14“We have 2 separate consults services for stroke and other consults—for other departments it seems so disjointed… Let's streamline consults within our own departments.” (INT 9)
“It's also confusing how there are so many different subservices, so this should be streamlined.” (INT 6)
Attending-directed services for noneducational consults3/14“Pulm[onology] does non-teaching consults. The attending triages all and does [consults] him/herself if [they are] not educational.” (INT 9)
“Have a neurologist in the ER to triage and teach.” (INT 13)
  • Frequency: number of participants who reflected corresponding subthemes, of the 14 participants who were interviewed.