SHM Converge Scientific Abstract ePoster Gallery-Internal Friction: Drivers of Conflict Between Medicine Primary and Subspecialty Teams

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This study examined conflict between hospital medicine primary teams and subspecialists at Yale New Haven Hospital, a large academic center. Using anonymous Qualtrics surveys of hospitalists (n=76, 42% response rate) and subspecialists in cardiology, GI, heme-onc, infectious disease, and nephrology (n=78, 38% response rate), the authors assessed communication quality, frequency and timing of conflict, and perceived drivers.<br /><br />Both groups reported that communication problems and conflict were common, especially at the time consults were first placed. Communication was rated as fair or awful by 51% of primary teams and 37% of consultants. Despite differences in what each group saw as the main causes, both agreed that conflict harmed patient care, including care coordination, length of stay, and patient satisfaction.<br /><br />Primary teams most often blamed inadequate consultant staffing, consultant burnout, unclear consult questions, and frequent interruptions. Consultants most often pointed to unclear consult questions, communication gaps, excessive consult volume, and frequent interruptions. Conflict was reported most often with cardiology, and GI and cardiology consultants experienced the most conflict with medicine teams.<br /><br />The study suggests that differences in training, communication norms, cognitive load, and expectations may drive tensions between teams. Misaligned expectations can lead to delays, dissatisfaction, and worse care. The authors note that prior efforts to improve question clarity and communication have not necessarily improved perceived consult quality or reduced “pushback.”<br /><br />Strengths included high response rates, inclusion of advanced practice providers, and representation from both procedural and non-procedural specialties. Limitations included the single-center, academic setting, which may limit generalizability to other hospitals or consultant practice models.

Asset Subtitle

Anisha Advani

Meta Tag

Author List Anisha Advani, Sarwat Chaudhry

Category Research

Concept Hospital Medicine

Concept Medicine Subspecialist

Concept Consultation

Concept Conflict

Concept Consult Question

Distinguished Non-Finalist

Presenter Organization Yale New Haven Health

Presenting Author Anisha Advani

Track Communication

Keywords

hospital medicine

subspecialists

communication problems

consult conflict

Yale New Haven Hospital

consultation quality

patient care coordination

cardiology

consult timing

interdisciplinary communication

Hospital Medicine

Medicine Subspecialist

Consultation

Conflict

Consult Question