Thursday, August 30, 2012

Why Don’t They Listen?- ID Consults and Recommendations

At times I am vexed after spending a fair amount of time on an infectious diseases consults only to have the recommendations either ignored or partially heeded by the primary team.

Here is an article (free full text) in Clinical Infectious Diseases on adherence to recommendations of infectious diseases consults.

The authors reviewed 465 consultations at 2 academic institutions. The overall adherence was 80%, with 85% adherence to crucial recommendations. Using multivariate analysis, adherence to ID recommendations was highest for therapeutic recommendations instead of diagnostic recommendations, when they related to a specific clinical question, and when recommendations were deemed crucial by the ID service. Not surprisingly,  adherence was greater if the primary service was medicine.

I have always felt that for a consult to be meaningful it must be focused, answer the clinical question(s) in a prioritized fashion, and, be succinct. In a busy hospital, no one has the time or inclination to read an overly verbose consult.

Brevity is key.

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