Trends in pediatric urologic consultations in a tertiary care hospital setting.

BACKGROUND: There is growing interest in the general activities of a pediatric urologist, whose specialty remains young in the spectrum of modern, organized medicine. Unplanned activities, which are more commonly referred to as consultations, can represent significant additional workload for the urologist seeing scheduled clinic patients or completing elective operative cases.

OBJECTIVES: This study sought to better understand the practice patterns surrounding inpatient consultations of pediatric urology, and to describe patterns in reasons, timing, patient and service factors that may lead to patient intervention.

STUDY DESIGN: Consultations at a tertiary care center were prospectively tracked using a consult note template with embedded data collection fields directly within the Epic electronic medical record. Bivariate and multivariate logistic regression were used to predict need for intervention.

RESULTS: A total of 351 eligible consultations were completed during the 15-month study period. A total of 174 (50%) consultations originated from the emergency department, with 26% of those having been transferred from another institution (Figure). Consults occurred more frequently at the beginning of the week than at the end of the week (R2  = 0.7545) and at the end of the day rather than the beginning (R2  = 0.2504). Of these consults, 36% required an intervention, defined as bedside procedure, operative procedure or study in interventional radiology. Factors associated with intervention on multivariate analysis included consultation from the emergency department, pertinent radiologic or laboratory findings, and consultation after hours.

DISCUSSION: With the introduction of subspecialty certification in pediatric urology there has been growing concern about a shift in the number and type of consultations seen by pediatric urology. Unlike prior examinations of pediatric urology consultation, the present study recorded diagnoses that appeared to more commonly result in urology consultation than in the past, such as testicular torsion. It highlighted a small subset of children with medical complexity and who were frequently admitted to the hospital, and accounted for nearly one fifth of all consultations. Repeat consultations underscored a need for ongoing education of the family, primary care and emergency department providers, and other services who interface with complex patients with ongoing healthcare needs.

CONCLUSIONS: The pediatric urology service averaged about one formal consultation per day, with the most common diagnoses being hydronephrosis, urinary tract infection, urolithiasis, testicular torsion, and retention. One third of consults required intervention. Improved understanding of pediatric urology consultation would be helpful to facilitate physician education and improve service efficiency in the hospital setting.