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Original Investigation
January 05, 2017

Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center

Author Affiliations
  • 1Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina
JAMA Otolaryngol Head Neck Surg. Published online January 5, 2017. doi:10.1001/jamaoto.2016.4056
Key Points

Question  What are the trends in otolaryngology–head and neck surgery consultations performed at a quaternary care center?

Findings  In this analysis of the medical records of 1491 patients receiving consultations from the otolaryngology–head and neck surgery, 66.7% had bedside procedures performed and 16.3% required operative intervention. Consultation requests in the emergency department were more acute than consultation requests in inpatient services.

Meaning  The consultation volume of an otolaryngology–head and neck surgery service requires significant time and resources; future training curriculums can be designed to prepare for the most frequent consultation requests received.

Abstract

Importance  The consultation patterns of an otolaryngology–head and neck surgery service have not previously been reported. The time, resources, and attention required to operate such a consultation service are unknown.

Objective  To assess trends in otolaryngology–head and neck surgery consultations conducted in emergency departments (EDs) and inpatient services.

Design, Setting, and Participants  A retrospective analysis was conducted of the medical records of patients at a quaternary care center receiving inpatient otolaryngology consultations from January 1 to December 31, 2014.

Exposure  Clinical evaluation and bedside and operative procedures performed by the otolaryngology–head and neck surgery service.

Main Outcomes and Measures  Demographics, reason for consultation, diagnosis, bedside procedures, operative interventions, and admission variables.

Results  A total of 1491 consultations were completed for adult (1091 [73.2%]; 854 men and 637 women; mean [SD] age 50.3 [19.3] years) and pediatric (400 [26.8%]; 232 boys and 168 girls; mean [SD] age, 4.0 [5.2] years) patients. Of the 1491 consultations, 766 (51.4%) originated from inpatient teams vs 725 (48.6%) from the ED. A total of 995 of all consultations (66.7%) resulted in a bedside procedure, and 243 (16.3%) required operative intervention. Consultations regarding airway evaluation (362 [47.3%] vs 143 [19.7%]), management of epistaxis (78 [10.2%] vs 33 [4.6%]), and rhinologic evaluation (79 [10.3%] vs 18 [2.5%]) were more frequent from inpatient teams than from the ED. Consultations regarding management of head and neck infections (162 [22.3%] vs 32 [4.2%]), facial trauma (235 [32.4%] vs 16 [2.1%]), and postoperative complications (73 [10.1%] vs 2 [0.3%]) were more frequent in the ED. Of the 725 consultations performed in the ED, 212 patients (29.2%) required hospitalization.

Conclusions and Relevance  The consultation volume of an otolaryngology–head and neck surgery service requires significant time and resources. Consultations are most often for rhinologic or laryngologic issues and are reflective of the clinical setting in which the patient is evaluated. Cost savings may be realized by increasing health care access points for nonurgent concerns that can be evaluated in an outpatient setting.

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