Multisite Medicine Consults/Co-management Project Emily Wang, Chris Moreland, Mike Shoffeitt, Bret Simon and Luci Leykum

Objectives To identify the questions posed in Medicine consults/co-management (MCC) requests at academic medical centers To refine the MCC curriculum to ensure coverage of adequate breadth of knowledge required to train Internal Medicine residents in MCC

Background Consultation experience required by ACGME – Not necessarily as a MCC rotation MCC part of core of IM practice What questions are asked of IM consultants? – And what additional issues do we address?

Data Collection Consult Data – 2 weeks every 3 months for one year = 8 weeks – Flexible time frame at each institution – Collecting consults daily 24/7 – Staff physicians will preferentially enter data

Data Collection (cont) Consult Data – # of consult requests, date/time – Service requesting consult – Reason for requested consult – Other issues addressed not specifically requested by consultant (e.g., bacteremia addressed during consult for diabetes) – Whether pt transferred to medicine – How often topic is addressed on inpatient medicine ward service – Whether consultant verbally discussed findings with requestor team

Data Collection (cont) Institutional Data – Type of hospital, # beds – Associated with a residency – MCCS rotation length, frequency – # residents, fellows – Formal curriculum or teaching plan – Coverage of MCCS and by whom – Associated pre-op clinics – Other resident responsibilities while on MCCS – Separate co-management services – Faculty staffing MCCS – POC for the initial consult

Timeline 2010: idea discussed at research meeting – Abstract and objectives defined – IRB submission and approval: exempt status due to QI – Initial data collection via Surveymonkey – Discussion and refinement of survey by perioperative experts within and outside of our institution

Timeline (cont) – Recruitment of academic centers nationwide by convenience sample with regional selection Mass General University of Michigan Johns Hopkins University of Colorado at Denver Denver Health UCSF UC Davis Columbia

Timeline (and cont…) : participant conference call – Further survey refinement – Separate IRB submissions at each academic institution – Addressed academic product authorship 1-2 PIs per institution, all staff assisting with consult data collection member of the “Medicine Consult Consortium” – 1:1 participant calls for baseline program demographics, follow-up on IRB progress 2014: Start consult data collection…soon hopefully

Future Plans Manuscript with multi-site consult data collection, analysis Possible descriptive paper about MCCS variation (and similarities) across programs Data shared with all institutions and possible further products or ideas resulting from this project