Evaluation of the activity of an academic rheumatology consult service over 10 years: using data to shape curriculum.

OBJECTIVE: We reviewed rheumatology consults over the last 10 years at a major academic medical center and used these data to revise our fellowship curriculum.

METHODS: The medical records of all patient consults from 1994 to 2003 at a university hospital were reviewed with regard to reason for consult, demographic data, and final rheumatologic diagnosis. For comparison we reviewed one year of data from our veterans hospital rheumatology consult service during this same period.

RESULTS: A total of 1409 patients were seen on the university hospital consult service between 1994 and 2003. The 5 top reasons for consultation in descending order were: vasculitis, lupus, gout, rheumatoid arthritis, and soft-tissue rheumatic conditions. Specific diagnoses within each category are presented. The number of consults increased significantly over the 10 year period when compared to total hospital admissions. A total of 163 inpatient consults were seen at our veterans hospital in 2001. Crystal arthritis and noninflammatory regional musculoskeletal conditions were the top 2 reasons for consult requests. Many of these consults came from the primary care clinic and required a procedure or simple treatment plan.

CONCLUSION: The rheumatology consultation service at our university hospital has become busier over the last 10 years. Since many of the patients had complex problems, we have modified our curriculum approach in response to the information. The veterans hospital data suggest that part of our educational efforts might be directed toward the services requesting rheumatology consultation.