Appropriateness of gastrointestinal consultations for hospitalized patients in an academic medical center

Background: Consultation of experts in the internal medicine or surgery subspecialties is needed in the hospitalized population according to decisions of the house staff. Sometimes the referrals are not justified, consuming time and money without a significant change in the patient outcome.
Objectives: The aim of our retrospective study was to evaluate justification of consecutive referrals of hospitalized patients for gastroenterology consultation.
Materials and Methods: Request for consultation was deemed not justified when at least one of the following parameters was found: No contribution to case management, discharge before consultation, cancellation at the last minute, and a recommendation for ambulatory management or surgery.
Results: In August-September 2006, there were 232 requests for gastroenterology consultations. Of them 127 (54.7%) were men. The average age was 64.13±20.33 years. Ninety-four (40.2%) of the cases had been hospitalized because of other reasons than the consultation issue. Consultation was not justified in 60 patients (25.9%). Ambulatory management was a possibility in 151 cases (65.0%). Request for colonoscopy and gastrointestinal background disease were the only significant predictive factors for justification of consultation, P < 0.0001 for both.
Conclusions: In one fourth of the cases, gastroenterology consultation was not justified according to our strict criteria.