1
What is a consult?
Consults are often requested in the hospital when a patient develops a condition that the primary team would like assistance in handling. They are especially useful when the primary team’s specialty lies in a field different from that of the problem the patient developed. For example, if a patient who was admitted to the gastroenterology service suddenly develops an arrhythmia, the primary gastroenterology team may consult the cardiology service for recommendations on treating the arrhythmia while the patient is admitted. Of course, if the patient is in an emergency situation, the primary team needs to stabilize the patient first before any consult is made.
2
What should one know before placing a consult?
Medical students are often allowed to place consults. Before a consult is requested, you should be ready to (1) give a quick two- to three-sentence summary of why the patient has been admitted and the clinical course thus far, (2) have a specific question that the team is requesting a consult for, (3) know recent vital signs and current medications, (4) have a contact number or pager available, and (5) provide the patient’s location and registration number.
For example, for a gastroenterology service’s patient who developed an arrhythmia, the cardiology team would be consulted and told “Hi, I have Mr. Smith, 1234567, a 45-year-old male with diabetes who presented with diverticulitis. He has been on IV fluids and antibiotics for the past 2 days, but today he developed atrial fibrillation with rapid ventricular rate on his ECG. We want to know if you could evaluate him.” The cardiology team may ask about his vital signs, which antibiotics and other medications the patient is taking, and whether the patient has had any past history of cardiac illness.
When preparing to place a consult request be sure to have the rest of the patient’s information easily available. It is also important to keep in mind which service is being consulted. If you are contacting the cardiology service, it is important to have conducted a thorough cardiovascular examination and to have diagnostic test results (e.g., electrocardiogram [ECG] or echocardiogram) readily available.
3
How is a consult requested?
The method for placing a consult depends on the hospital. In some hospitals, you can search for the consult team’s pager number and page the consult team, or call the consult request line designated by the service. In other hospitals, you will need to fax a request to the consult team, use the tubing system to tube the request, or even simply write the order in the chart (and the nurse or clerk will call the consult team). In many hospitals, you may have to use a variety of these methods as different teams may request being contacted through different forms of communication.
As an example, if you are paging the cardiology service regarding the previous GI patient who developed an arrhythmia, an example of the page would be “Hi, re: Smith, L (1234567). 45 yo M w/ diabetes presented w/ diverticulitis. Developed afib w/RVR, would like consult. Please call x5-5555. Thanks, John.” Consult teams appreciate knowing exactly what your concern is and where they can look up more information about the patient, which is why the patient’s registration number (1234567 above) is especially useful.
4
What are examples of common situations requiring a consult?
Although the primary team should, of course, attempt to diagnose and treat the problem, they should be ready to request a consult when they need help. Several common consults and who is usually contacted in those situations are listed in Table 7-1 .
| Consult Service | Example Situations |
|---|---|
| Cardiology | Cardiac arrhythmias such as atrial fibrillation or heart block; congestive heart failure exacerbation; myocardial ischemia/infarction |
| Dermatology | Unclear cause of rash or for specialized treatment for a skin condition |
| Endocrine | Thyroid storm; severe hypercalcemia; adrenal failure; persistent hypoglycemia |
| Gastroenterology | Acute gastrointestinal bleeding episodes; choledocholithiasis; cholangitis; emergency esophagogastroduodenoscopy or colonoscopy |
| Hematology/oncology | Any unexplained white blood cell, hemoglobin, platelet abnormalities; any newly diagnosed hematologic or oncologic malignancies |
| Infectious disease | Persistent fever; infection of unclear origin; treatment for rare infections |
| Neurology | Stroke; new focal neurologic deficit; seizure |
| Ophthalmology | Herpes zoster ophthalmicus; sudden loss in visual acuity |
| Physical therapy/occupational therapy | Evaluation of patient’s physical condition and ability to take care of activities of daily living at home or at an extended care facility |
| Plastic surgery | Severe decubitus ulcers; nonhealing wounds; severe skin burns (caused by chemicals, toxic substances, fire, etc.) |
| Psychiatry | Delirium; psychosis; suicidal ideation |
| Pulmonary | Need for a bronchoscopy; management of severe pleural effusions |
| Renal | Etiology of acute renal failure; etiology of electrolyte abnormality; acute and chronic hemodialysis; hemofiltration; plasmapheresis; dialysis catheter placement |
| Social work | Aid if patient is unable to afford medications; needs transportation to home; need assistance regarding code status review, competency, custody, or power of attorney |
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