Endocrine Inpatients Consult Service Revisited: A Growing Role for Inpatient Care for an "Outpatient Subspecialty"

Presentation Number: SUN 277
Date of Presentation: April 2nd, 2017

Etty Osher*1, Danna Zeid2, Michal Yaacobi-Bach2, Dror Cantrell2, Yael Sofer2, Naomi Even Zohar2, Merav Serebro2, Yona Greenman1, Karen Michele Tordjman1 and Naftali Stern1
1Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Abstract

Background: Endocrinology/metabolism is traditionally viewed as an "outpatient subspecialty". However, in recent years we have experienced a growing demand for inpatient endocrine consults, rising from 2007 to 2016 from a monthly average of 85 to 235. Surprisingly, the role of an endocrine consult service in the setting of a modern general hospital has not been formally evaluated to date.

Goal: To assess patient load, disease profile, service availability and the impact of the endocrine consults in a tertiary referral hospital.

Methods: A retrospective analysis of unsolicited adult endocrine consults carried out during 2 consecutive months (April-May, 2015) at the Tel Aviv -Sourasky Medical Center, Tel Aviv, Israel (TASMC). The consult service operates via a computerized system, with a three tier system comprised of a fellow, rotating senior endocrinologist in charge and endocrine subspecialists (e.g., neuroendocrine tumors).

Results:

Within 2 months, 557 consult requests were received. Consults requested exclusively to assist with the control of glycemia were excluded from this analysis, thus leaving "non-glucocentric" 447 consults requests of relating to 205 inpatients, representing 0.27% (of the 75,367 non-pediatric hospital admissions during the survey period. Mean patient age was 59.3±.18.5yrs (range 21-92), with some F/M preponderance (57/43%). Request for endocrine consults were evenly distributed (50.7%, 49.3%) between internal medicine and surgery wards. With the exclusion of diabetes, case distribution was as follows: thyroid- 45.9%, calcium & bone 11.7 %, pituitary 10.7%, adrenal 9.8% and all others 7.8-1 %. There were 2.2±3 consultations per patient and the mean response time was 4.4±3 h. There was no correlation between severity of the endocrine anomaly (arbitrarily graded as 1-3) and the response time, but a borderline correlation was seen between the number of consultations/patient and disease severity (R=0.27; P<0.05). Effects of the interventions were assessed according to whether or not (yes/no; 1/0) diagnosis, treatment mode or treatment outcome were modified (yes/no; 1/0 for each). Change in any of these parameters was evident in 56% of the patients. Among the subjects whose course was thus modified by the consult, a change was recorded in: in-hospital treatment-76.5%; post-hospitalization treatment- 8.4%; diagnosis-8.4%; and treatment outcome-6.4%.

Conclusion: At the TASMC, a 1400 bed tertiary referral center, endocrine consultation is requested in a small minority of patients, but nevertheless generates a work load of ~10 consults/ weekday. Notably, endocrine consultation significantly affected inpatient care and clinical outcome. These results call for a more widespread monitoring and analysis of current endocrine care in the inpatient setting to enhance patient care quality and endocrine training opportunities. 

 

Nothing to Disclose: EO, DZ, MY, DC, YS, NE, MS, YG, KMT, NS