SHM Converge Scientific Abstract ePoster Gallery-Appropriateness of Diagnostic Consultations From General Internal Medicine Physicians

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This single-center retrospective study examined the appropriateness of diagnostic consultations from General Internal Medicine (GIM) physicians to specialty departments in Japan during 2021. It included outpatient and hospitalized patients aged 15 years or older, while excluding routine, institution-mandated, reordered, uncompleted, or declined consultations.<br /><br />Consultations were classified as diagnostic or non-diagnostic. Diagnostic consultations were further divided into two types: those seeking a definitive diagnosis and those with an undetermined diagnosis. A consultation was considered appropriate if it met predefined criteria, such as the final diagnosis being included in the GIM consultation letter or the consultation leading to a final diagnosis in the specialty department.<br /><br />Among 352 diagnostic consultations (58% of all consultations), 277 were outpatient and 75 were inpatient consultations. Overall, 65% of diagnostic consultations were judged appropriate. Appropriateness rates were similar between outpatients and inpatients: 64% (177/277) vs 69% (52/75), with no statistically significant difference (OR 1.3, 95% CI 0.7–2.3).<br /><br />The study found that about 30% of diagnostic consultations had room for improvement. The main reasons for inappropriate consultations were nonspecific, undifferentiated conditions and insufficient or poorly interpreted diagnostic tests. The findings suggest that diagnostic consultation quality is comparable between outpatient and inpatient settings, and that problems related to patient information gathering are less prominent in hospitalized patients.<br /><br />Overall, the study highlights the need to improve diagnostic consultation practices between generalists and specialists, especially in clarifying the diagnostic question and ensuring appropriate test use and interpretation.

Asset Subtitle

Ren Kawamura

Meta Tag

Author List Masashi Yokose, Ren Kawamura, Shinichi Katsukura, Taro Shimizu, Tetsu Sakamoto, Yudai Suzuki, Yukinori Harada, Yumi Otaka

Category Research

Concept Consultation

Concept Appropriateness

Concept Definite Diagnosis

Concept Undetermined Diagnosis

Concept General Internal Medicine

Distinguished Non-Finalist

Presenter Organization Dokkyo Medical University

Presenting Author Ren Kawamura

Track Consultative Medicine

Keywords

diagnostic consultation

general internal medicine

specialty departments

retrospective study

Japan

appropriateness

outpatient

inpatient

final diagnosis

diagnostic tests

Consultation

Appropriateness

Definite Diagnosis

Undetermined Diagnosis

General Internal Medicine