Is There a Urologist in the House? Trends in the Management of Consults Based on Shift, Location and Resident Organization.

Introduction: Consultations represent a significant workload for inpatient urology providers, yet consult patterns are poorly described. We report trends in billable urology consult activity by location, time and organization of consult residents at a single institution.

Methods: Using a secure database urology consults between 2011 and 2018 at an academic center were recorded. Consult time, location and management were documented. Consults were considered eligible for billing if seen by faculty at time of consult in the emergency room or within 24 hours in the inpatient or operating room settings. Furthermore, in 2016 consult responsibilities overnight were given to an in-house resident. An interrupted time series was used to evaluate trends in consultations.

Results: Ultimately 18,431 consults were seen, 40.8% in the inpatient setting and 55.2% in the emergency room setting. The overall number of consults increased annually. The majority of consults (64.8%) were made during the day. Around 88.7% of inpatient and 88.2% of operating room consults were eligible for billing, yet only half (54.43%) of emergency room consults were eligible. After the addition of an in-house consult resident there was a significant (12%) increase in the number of billable consults.

Conclusions: Ultimately, nearly half of emergency room consults were not eligible for billing. Initiation of an in-house overnight consult resident significantly increased the fraction of total billable consults. Understanding patterns in consult data offers insight into quality improvement measures that maximize departmental labor efficiency.