Background/Purpose:

Rheumatologists provide hospital in-patient consultation for urgent and emergency referrals. In an increasingly cost-conscious, accountable, and integrated health-care system, the appropriate role of specialty care is under scrutiny. There is currently little information on the influence of inpatient rheumatology consultation on patient outcome.

 The aims of our study were 1) To describe the nature of the hospital rheumatology consultations 10 years apart for educational merit 2) To determine whether a hospital rheumatology consultation service alters diagnostic accuracy, changes or expedites treatment, and whether treatment recommendations was adopted by the primary service.  3) To evaluate if needs are met by assessing the complexity of the rheumatology consult service referrals

Methods:

Consecutive patients seen on the consultation service at an academic university hospital from July 1 2010 to December 31 2010 were recorded in a logbook. Using a standardized case form, the charts were reviewed and the patient’s demographic information, admitting diagnosis, reason for consultation, referring service, final rheumatologic diagnosis, duration of hospital stay, treatment implemented and outcome were recorded. These were compared to a similar review in 1999

Results:

268 patients were recorded in the log books over the 6 month period in 2010. These included 163 females and 105 males with a mean age of 55 years (range 19 to 92 years). This is more than the 238 consults seen over a 10 month period in 1999.

The most common diagnoses seen included: 62 connective tissue diseases (23%), 59 crystal induced arthritis (22%), 25 vasculitis (9%), 22 polyarthritis (8%); 15 osteoarthritis (6%); 14 regional syndromes (5%); 14 infections (5%); 10 spondyloarthritis (4%), and 8 others (3%).  The remaining 38 had non-rheumatologic conditions (14%). This is similar in breadth as 1999.

The consults were requested from different services, but most commonly internal medicine at 104 (39%). There were 82 emergency referrals (31%), 158 urgent referrals (59%), and 28 non-urgent referrals (10%). The rheumatology team helped establish the diagnosis in 177 patients (66%) and confirmed the diagnosis in 57 consults (21%). 74 of 80 patients with swollen joints had their joints aspirated or injected (93%).  94 patients had steroids or disease modifying therapy initiated or adjusted. 126 patients had follow-up with a rheumatologist (47%). 

Conclusion:

The rheumatology hospital consultation service provides consultation from various specialties for a variety of rheumatic diseases, thus providing an excellent educational experience.   Most referrals were for emergent or urgent rheumatic diseases. The service helped establish or confirm the diagnosis and helped initiate treatment. In general the suggestions were adopted by the team.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-a-rheumatology-consultation-service-in-hospitalized-patients/