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Prospective Assessment of Urologic Consultation at a Tertiary Care Referral Center
Maria Voznesensky, M.D.1, Peter Steinberg, M.D.2, Moritz Hansen, M.D.1. 1Maine Medical Center, Portland, ME, USA, 2Beth Israel Deaconess Medical Center, Boston, MA, USA.
BACKGROUND: Urologic consultation is an essential service provided by urology divisions. We examined urology call coverage diagnoses, acuity and management in our institution. METHODS: Data was prospectively collected for urologic consultations in a 3 month period. Patient’s age, location, diagnosis, level of acuity, encounter time, and management was recorded. Eight attendings, three residents and one PA provided coverage. RESULTS: 869 encounters were recorded, and 857 had analyzable data. Average age was 60.1 years old. There were 85 pediatric calls (10%). Urgent encounters involved 19% of patients; 81% were considered elective. Stones, infection and urinary retention were the most common diagnoses (See Table 1). 93% of encounters involved patients at our institution or the urology practice.
Distribution of diagnosesRetention | 12% | Neoplasm | 10% | Other | 9% | Hematuria | 8% | Pain | 8% | Medication question | 7% | Missing data | 6% | Surgery related question | 4% | Obstruction | 4% | Hydronephrosis | 3% | Of 857 encounters, 180 (21%) required patient contact and 677 (79%) were managed over the telephone. Average phone call was 8 minutes, and 569 (84%) calls were under 10 minutes. Face-to-face encounters lasted 43 minutes on average. Procedures were needed in 63 (35%) encounters: bladder catheterization 27 (43%), transurethral surgery 20(32%) , cystourethroscopy 16 (25%). Management of these procedures was split between inpatient floor 32 (51%) and operating room 31 (49%). CONCLUSIONS: These data show the majority of consults involve common non-emergent conditions, usually manageable over the telephone in a reasonable period of time. Clinical data describing the experience “on-call” informs residency curriculum development and hospital urologic coverage needs.
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