Análisis de las interconsultas solicitadas en un hospital general

Abstract

The profile of the inpatient is changing towards elderly patients with an elevated comorbidity and in need of more complex care. This, together with the progressive medical superspecialization among other reasons, has favoured a progressive increase in the health care support services given between one service and another. The current existing information concerning medical consultation is scarce and descriptive. This paper sets out to define and therefore clarify a doctors’ role outside his/her service, such as shared care (comanagement), consultative medicine, perioperative medicine and also medical consultation. Furthermore, the different types of medical consultation are defined. The principal objective is to analyze the total number of requests for medical consultation in a general hospital. We conducted a descriptive study of all the consultations requested in the hospital in the year 2010, with data obtained from the ¨ Basic Minimun Set of Data¨ (European medical data base) and also from the specific computer application used for consultations. 21.120 patients participated in the study and a total of 8.377 consultations were requested for 4.720 of those patients. One consultation is requested for each two hospitalized patients and one in five patients have at least one consultation requested. More women are hospitalized than men however more consultations are requested for men. The Medical Area (no surgical) is the field in which most consultations are requested. There is monthly and week day variability for consultation requests. The patients who have received a consultation request are in need of more complex medical care than those who have not. In general, the consultations are requested with the medical complication already established; these consultations have many problematic factors which make it a system which doesn’t work well, is ineffective and expensive. The consultations result in a heavy workload for the consultants, something which should be taken into account when planning the activities of each service. The study and better knowledge of the characteristics and behaviour associated with consultation requests could allow us to take measures to improve its performance and results.