Characteristics, Burden, and Necessity of Inpatient Consults for Academic and Private Practice Urologists

Abstract

Objective: To compare differences in the characteristics and outcomes of inpatient consults between academic and private practice urologists.

Materials and methods: We performed a retrospective review of urology consults at a large tertiary-care hospital from June 1st, 2017 to June 30th, 2018. Patient demographics, timing of consult, location of consult, reasons for consult, requesting physicians, and procedures performed were analyzed and compared.

Results: A total of 613 consults were identified. The most common consults were for a Foley catheter/suprapubic tube (16%), urinary retention (15%), kidney/bladder stones (11%), and hematuria (11%). Seventy-seven percent of the consults were seen in the day time and 79% were seen on the weekdays. One hundred and ten (18%) consults resulted in an operative intervention during the same admission. The others required a Foley catheter placement or suprapubic exchange (17%), bedside procedure (9%), or interventional radiology procedure (4%). The remaining 319 consults (52%) required no intervention and were considered potentially unnecessary. There were no differences in the timing of the consults and the need for intervention between academic and private practice urologists (P = .20). Only 37% of patients followed up as an outpatient. These potentially unnecessary consults resulted an annual loss of 265.8 hours for the urologists and $44,376.09 in excess health care costs.

Conclusion: Over half of inpatient urologic consultations required no urologic intervention and therefore represented potential overuse of urgent inpatient specialty care. This may contribute towards the growing epidemic of burnout in urology. Further work needs to be done to educate other hospital services and nurses to minimize these unnecessary consults.