Background/Purpose: Rheumatology consultations are essential for managing complex inpatient cases, yet patterns and outcomes remain understudied. Prior work has shown that consult data can inform fellowship curricula. This study characterizes the timing, indications, and diagnoses of inpatient rheumatology consults at a large academic hospital, with the goal of informing future educational initiatives and improving inpatient rheumatology care and training.

Methods: We performed a retrospective cohort study of inpatient rheumatology consults at a tertiary academic medical center from July 2021 to July 2024. Adult patients (≥18 years) admitted to non-rheumatology services and received an inpatient rheumatology consult were included. We analyzed timing, diagnostic categories, and impact using descriptive statistics. Mann–Whitney U tests compared hospital stay duration and time to consult between patients with and without prior outpatient rheumatology follow-up. Significance was set at p < 0.05. All analyses were performed using RStudio (version 2023).

Results: Among 503 consults reviewed, the median time to consult was 1 day (mean 3.0), and average length of stay was 12.5 days. Most consults occurred on day 4 or later. The most common consult indications were suspected new rheumatic disease (40%) and flares of known disease (36%) (Figure 1). New rheumatic diagnoses were made in 21% of cases, most often crystalline arthritis (18), SLE (11), and necrotizing myopathy (8). Suspected new disease consults frequently resulted in non-rheumatic diagnoses (50%), while SLE (22%) and crystalline arthritis (10%) were the most common diagnoses among flares.The most common rheumatic diagnoses were SLE (75), crystalline arthritis (36), RA (36), ANCA-associated vasculitis (15), spondylarthritis (14), OA (10), sarcoidosis (10), antisynthetase syndrome (9), GCA (9), and APS (8). Among these, APS had the longest average hospital stay (25.8 days) and longest mean time to consult (6.0 days). Crystalline arthritis and sarcoidosis also had delayed consultations (5.5 and 3.4 days, respectively), while antisynthetase syndrome and SLE were linked to longer stays (14.2 and 13.4 days, respectively) (Figure 2).Among patients with these diagnoses, those with outpatient rheumatology follow-up within 12 months were evaluated more promptly, with a median time to consultation of 2.0 days (IQR 1.0–3.0) versus 3.0 days (IQR 2.0–5.0) for those without (p = 0.001). Median length of stay was similar between groups (9.0 days; p = 0.873) (Table 1).

Conclusion: Inpatient rheumatology consults are often delayed and frequently involve diagnostic uncertainty, particularly for suspected new disease. Among the most common rheumatic diagnoses, conditions like APS, crystalline arthritis, and SLE were associated with longer consult times and extended stays, highlighting opportunities for earlier recognition. Patients with recent outpatient rheumatology follow-up were seen significantly earlier, underscoring the value of continuity. We hope to use these findings to identify data-driven educational targets for hospital providers and improve inpatient rheumatology care.

Figure 1: Distribution of the primary reasons for inpatient rheumatology consults

Figure 2: Average time to rheumatology consultation and hospital length of stay for the ten most common rheumatic diagnoses among inpatient consults.

Table 1: Impact of prior outpatient rheumatology follow up on inpatient consult timing and hospital stay

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inpatient-rheumatology-consultations-at-a-tertiary-academic-medical-center-a-retrospective-cohort-study/