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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. Should We Curb the Curbside?. Curbside View. Formal Evaluation. Curbsides. Curbsides – Previous Studies. Curbsides. Hypotheses. Methods.

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Should We Curb the Curbside?

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  1. Marisha Burden, MD Chief of Hospital Medicine Denver Health Medical Center Assistant Professor of Medicine University of Colorado School of Medicine Should We Curb the Curbside?

  2. Curbside View

  3. Formal Evaluation

  4. Curbsides

  5. Curbsides – Previous Studies

  6. Curbsides

  7. Hypotheses

  8. Methods

  9. Definitions

  10. “Consultee” Hospitalist A – “Curbside physician” Hospitalist B – “Official Consultant” Formal Consult Curbsides – Our study

  11. Methods

  12. Results

  13. 45% 19% 17% Requesting Service 11% 8%

  14. 53% 19% 17% Requesting Provider 11%

  15. **Consults could be listed in more than 1 category** 62% 43% 28% 21% Consultative Concern 9%

  16. 57% **Consults could be listed in more than 1 category** 49% 36% 19% 17% 13% 13% Medical Issue

  17. 55% 28% 17% Number of Questions Asked

  18. 55% 45% Advice Given

  19. 60% 3rd Reviewer 29/47 (62%) Major: 10 (36%) 40% Consults (N) 3rd Reviewer agreed in 24/28 (86%) Minor: 18 (64%) Management Changes

  20. 3rd Reviewer agreed 17/18 (94%) 62% 38% Curbside Sufficient?

  21. 51% 49% Incomplete & Inaccurate: 5 (21%) Consults (N) Incorrect: 8 (33%) Information Accuracy Incomplete: 11 (46%)

  22. Information Inaccurate or Incomplete N=24 Information Accurate and Complete N=23 70% P <0.001 30% Advice Given

  23. Information Inaccurate or Incomplete N=24 Information Accurate and Complete N=23 92% 74% Major: 45% P <0.0001 Consults (N) 26% Management Changes Minor: 55% Minor: 100% Major: 0% 8%

  24. Information Inaccurate or Incomplete N=24 Information Accurate and Complete N=23 91% 67% P <0.0001 33% Sufficiency of Curbside 9% Curbside Sufficient

  25. Examples – Management Changes

  26. Post Hoc Analysis

  27. Strengths

  28. Weaknesses

  29. Curbside consults are associated with considerable RISK that the advice provided and the resulting management decisions made are incorrect. Conclusions

  30. Marisha Burden* Ellen Sarcone* Angela Keniston Barbara Statland Julie Taub Rebecca Allyn Mark Reid Lilia Cervantes Sarah Stella Gaby Frank Nick Scaletta SmithaChadaga Nancy Maller MargheritaMascolo Jeff Zoucha Mary Maher Rick Albert Investigators *Co-Principal Investigators

  31. Marisha.Burden@dhha.org Questions?

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