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OBJECTIVES -Patients with vascular disease often have multisystem atherosclerosis and multiple comorbidities requiring comprehensive interdisciplinary specialty care. Consultation is a critical component of a tertiary Vascular Surgery practice, but analysis of this service is under
reported in literature. After hour (AH) inpatient consultations and interhospital transfers are associated with urgent patient care.
METHODS -A retrospective analysis of Vascular Surgery consultations was carried out from January 1, 2013 to December 31, 2013. Consultations included inpatient services, the Emergency Department (ED), Surgical and Medical Intensive Care Unit (ICU) and interhospital transfers. Data analysis included number of consults, time of consultation (during hours [DH] = 0700-1859 and AH= 1900-0659), referring service, nature, and outcome of consultation. Consultations were then classified as urgent if vascular surgical intervention (VSI) was required as an intraoperative consultation, within 24 hours, or during the same hospitalization. Patients without a same hospital VSI were classified as non-urgent.
RESULTS -Over a 1 year period, 823 independent consult requests
on 749 patients were analyzed. It was found that 57.8% of AH consults resulted in urgent patient care (p=0.03). 66.7% of Medical ICU, 70.3% of Medicine, 58.1% of Trauma Surgery and 40% of ED AH consultations were non-urgent; 73% of Surgery and 79.2% of interhospital AH consults required urgent VSI. Extremity ischemia, aortic pathology and iatrogenic consults accounted for 44.8%, 20.4% and 11.1% of AH consults, with 57.9%, 56.4% and 70% requiring urgent VSI, respectively.
CONCLUSIONS -After hour consultations are not always associated with an urgent vascular surgical intervention. Non-urgent AH consultations are requested more frequently from some services and may present an opportunity for education that could improve efficiency of the vascular workforce.