140: Subspecialty Consultations on the General Paediatrics Ward
Bibliographic record
Abstract
Inpatient subspecialty consultations are a crucial part of patient care on the general paediatrics wards and constitute a significant workload. Process, timeliness, communication, and overall quality of the consultation are longstanding issues. Recent published studies suggest that degree of completeness, timeliness, educational value, interaction between referring and consulting physicians, and overall consultation quality are important factors that impact patient care. The objectives of this study are to: a) describe the current nature of subspecialty consultations on the general paediatrics ward of a tertiary care teaching hospital in Canada, b) audit compliance with a new hospital policy from 2013 governing consultations, and c) identify some of the major limitations in the current process. The study involved a chart review, questionnaires completed by trainees from the general paediatrics ‘referring’ teams, and focus groups attended by the consulting and referring teams. Ethics approval was granted by the hospital Quality Management group. Descriptive statistical analysis was performed on the chart review and questionnaire data. Audio recorded data from the focus groups will be analyzed according to grounded theory methodology of open, axial and selective coding, constant comparison analysis, and cross comparison of themes among focus groups. Charts from two 2-week blocks were reviewed (n=123). Consults were requested for 70% of patients. The three most commonly consulted services were Neurology, Critical Care, and General Surgery, representing 10%, 9% and 7% of consults respectively. Compliance with essential documentation for initiating consultations according to hospital policy was variable; for example a staff consultant note was only found on 30% of consults. Teams requested advice on diagnosis (23%), treatment (15%) and both diagnosis and treatment (53%). Preliminary questionnaire responses (n=14) revealed that 86% of consultants provided initial recommendations within 12 hours of consult request. Referring teams found follow-up frequency to be ‘appropriate’ in 86% of cases. All consults were thought to have affected patient management. Only 25% of consultants who discussed initial recommendations directly with the patient/family communicated first with the referring team. Overall, 71% of referring individuals were satisfied with the consultation process. Focus group analysis is ongoing and will be completed in time for the poster. Subspecialty consultations are requested frequently on the general paediatrics ward and are viewed by referring teams as integral to patient care. Despite varying adherence to new consultation policy guidelines with some clear areas for potential improvements, overall satisfaction is currently running at 71% amongst trainees.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".