Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical...
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![Page 1: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/1.jpg)
Should We Curb the Curbside?
Marisha Burden, MD
Chief of Hospital Medicine
Denver Health Medical Center
Assistant Professor of Medicine
University of Colorado School of Medicine
![Page 2: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/2.jpg)
Curbside View
![Page 3: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/3.jpg)
Formal Evaluation
![Page 4: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/4.jpg)
Curbsides
![Page 5: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/5.jpg)
Curbsides – Previous Studies
Quantity requested
Subspecialties consulted
Types of questions asked
Time spent
MD perceptions
![Page 6: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/6.jpg)
Curbsides
![Page 7: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/7.jpg)
Hypotheses
INCOMPLETE
INFORMATION
DURING
CURBSIDE
INCORRECT
INFORMATION
DURING
CURBSIDE
DIFFERENT ADVICE/RECS
W/ FORMAL
CONSULT
![Page 8: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/8.jpg)
Methods
Denver Health
Prospective Cohort
1 Year
Intermittent
18 Hospitalist Physicians
![Page 9: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/9.jpg)
Definitions
Consulting provider asked for advice, suggestions, opinions
Did not ask hospitalist to see patient
Excluded: Administrative, patients already being seen by hospitalist
![Page 10: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/10.jpg)
Curbsides – Our studyHospitalist A – “Curbside physician”
Formal ConsultHospitalist B – “Official Consultant”
“Consultee”
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Methods
Curbside consults neither solicited, discouraged
Requesting providers not informed of study or debriefed
Analysis: Chi Square
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Results
215 Study days
50 curbside consults
3 Formal consults declined
47 consults with both curbsides + formal consults
![Page 13: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/13.jpg)
Requesting Service
Psychiatry ER Ob/gyn Neurology Other0
5
10
15
20
25
Nu
mb
er
of
cu
rbs
ide
s
8%11%
19%
45%
17%
![Page 14: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/14.jpg)
Requesting Provider
Resident Intern Attending Other0
5
10
15
20
25
30
Co
ns
ult
s (
N)
53%
17%19%
11%
![Page 15: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/15.jpg)
Consultative Concern
Treatment Evaluation Discharge? Diagnosis Lab0
5
10
15
20
25
30
35
Co
ns
ult
s (
N) 43%
28%
62%
21%
9%
**Consults could be listed in more than 1 category**
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Medical Issue
Cardi
ac
Endoc
rine ID
Pulm
onar
y GI
Elect
rolyt
e/flu
idOth
er0
5
10
15
20
25
30
Co
ns
ult
s (
N)
57%
19% 17%13% 13%
49%
36%
**Consults could be listed in more than 1 category**
![Page 17: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/17.jpg)
Number of Questions Asked
0 to 2 3 to 5 >50
5
10
15
20
25
30
Co
ns
ult
s (
N)
17%
55%
28%
![Page 18: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/18.jpg)
Advice Given
Same Advice Different Advice0
5
10
15
20
25
30
Co
ns
ult
s (
N)
45%
55%
![Page 19: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/19.jpg)
Management Changes
No change Change0
5
10
15
20
25
30
40%
60%3rd Reviewer29/47 (62%)
3rd Reviewer agreed in 24/28 (86%)
Minor: 18 (64%)
Major: 10 (36%)
Con
sults
(N
)
![Page 20: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/20.jpg)
Curbside Sufficient?
Curbside Sufficient Curbside Insuffient0
5
10
15
20
25
30
35
Co
ns
ult
s (
N)
62%
38%
3rd Reviewer agreed 17/18 (94%)
![Page 21: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/21.jpg)
Information Accuracy
Accurate and Complete Inaccurate or incomplete0
5
10
15
20
25
30
49%51%
Incorrect: 8 (33%)
Incomplete: 11 (46%)
Incomplete& Inaccurate: 5 (21%)
Co
nsu
lts
(N)
![Page 22: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/22.jpg)
Advice Given
Same Different Same Different0
2
4
6
8
10
12
14
16
18
20
Co
ns
ult
s (
N)
79%
21%
Information Accurate and
CompleteN=23
Information Inaccurate or Incomplete
N=24
P <0.001
70%
30%
![Page 23: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/23.jpg)
Management Changes
Same Different Same Different0
5
10
15
20
25
Information Accurate and
CompleteN=23
Information Inaccurate or Incomplete
N=24
P <0.0001
92%
8%
26%
74%
Minor: 100%Major: 0%
Major: 45%
Minor: 55%
Co
nsu
lts
(N)
![Page 24: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/24.jpg)
Sufficiency of Curbside
Yes No Yes No0
5
10
15
20
25
Co
ns
ult
s (
N)
Information Accurate and
CompleteN=23
Information Inaccurate or Incomplete
N=24
P <0.0001
91%
9%
33%
67%
Curbside Sufficient
![Page 25: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/25.jpg)
Examples – Management Changes
MINOR MAJOR
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Post Hoc Analysis
Association No Association• Consulting Service• Consulting Provider• Medical Issue• Number of questions• Whether curbside was
felt to be sufficient• Consult issue
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Strengths
1st prospective study
18 Hospitalists
Excellent 3rd Party Agreement
Conducted over 1 year
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Weaknesses
Small N (50)
Teaching hospital
Urban safety net hospital
Hawthorne Effect
![Page 29: Should We Curb the Curbside? Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado.](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c16a5550346b24f8b56dd/html5/thumbnails/29.jpg)
Conclusions
Curbside consults are associated with considerable RISK that the advice provided
and the resulting management decisions made are incorrect.
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InvestigatorsMarisha Burden*Ellen Sarcone*Angela KenistonBarbara StatlandJulie TaubRebecca AllynMark ReidLilia CervantesSarah Stella
Gaby FrankNick ScalettaSmitha ChadagaNancy MallerMargherita MascoloJeff ZouchaMary MaherRick Albert
*Co-Principal Investigators