SHM Converge Scientific Abstract ePoster Gallery-Rethinking the Consulting Paradigm: Validity Evidence for a New Framework

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This mixed methods study validated a proposed framework for classifying consultation requests into seven types: ideal, obligatory, procedural, S.O.S., confirmatory, inappropriate, and curbside. Researchers randomly selected 100 consult requests from five medicine subspecialties in the electronic medical record and anonymized them. Three hospitalists and three specialists from each specialty participated in focus groups and then independently categorized consults using the framework. Concordance was defined as either partial agreement (4–5 of 6 participants agreeing) or perfect agreement (6 of 6).<br /><br />The framework showed strong validity evidence. Overall concordance was 88.8% (95% CI: 85.7–91.4), exceeding the study’s hypothesized 70% threshold. Perfect concordance was 46.6% (95% CI: 42.2–51.1). Concordance varied significantly by specialty: hematology and nephrology had the highest perfect concordance, while gastroenterology and infectious diseases had the lowest. There were also significant differences between hospitalists and specialists overall, with hospitalists showing higher perfect concordance than specialists.<br /><br />Qualitative focus groups found broad agreement that current consult practices can create miscommunication and frustration. Participants generally felt the framework improved communication, workflow efficiency, and education. The study concludes that this consulting framework is a valid tool for organizing and interpreting consultation requests and may help improve consultative efficiency and interdisciplinary communication in clinical practice.

Asset Subtitle

Josephine Cool

Meta Tag

Author List Alison Trainor, Andrew Hale, Brian Persaud, Daniel N. Ricotta, Elise Merchant, Jason A. Freed, Josephine Cool, Larissa Kruger Gomes, Laura E. Dodge, Lauren M. Yang, Rushad Patell

Category Research

Concept Consultation Classification Framework

Concept Concordance

Concept Validation Study

Concept Mixed-Methods

Concept Consult Request

Distinguished Non-Finalist

Presenter Organization Harvard Medical School- Beth Israel Deaconess Medical Center

Presenting Author Josephine Cool

Track Consultative Medicine

Keywords

mixed methods study

consultation requests

consult framework

validity evidence

concordance

hospitalists

specialists

electronic medical record

clinical communication

interdisciplinary efficiency

Consultation Classification Framework

Concordance

Validation Study

Mixed-Methods

Consult Request