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PubMed1997

What are consulting services worth? Applying cost analysis techniques to evaluate effectiveness.

1. Occupational health nurse consultants, whether independent consultants or in house occupational health nurses acting as consultants to management and employees, need to document the benefit and effectiveness of programs provided. 2. Occupational health nurse consultants must demonstrate that occupational health and safety services contribute to the achievement of the overall corporate mission and goals. 3. While the value of these services are intrinsic to the occupational health nurse, they must be translated into business or monetary terms in order to be communicated to corporate managers. Cost benefit analysis and cost effective analysis are tools that can be utilized to evaluate and communicate the business value of occupational health and safety services.

Consultants↗
PubMed2002

Dispelling the myths about rural consultant physician practice: the Victorian Physicians Survey.

OBJECTIVE: To quantify the barriers to practising as a rural consultant physician. DESIGN: Cross-sectional postal survey. PARTICIPANTS: All 981 practising consultant physicians in Victoria, Australia, who were Fellows of the Royal Australasian College of Physicians in 1999; 52 (100%) of rural physicians and 634 (68.2%) of metropolitan physicians completed the survey. MAIN OUTCOME MEASURES: Demographic and practice characteristics; barriers to rural practice. RESULTS: There were no rural female consultant physicians, and 35 of the 52 rural consultant physicians (67.3%) were born in a rural area. The most important perceived barriers to rural practice identified by both metropolitan and rural physicians were children's schooling (72.2%), spouse's occupation (65.7%), other issues related to children (66.7%) and difficulties getting back into metropolitan practice (45.7%). Among metropolitan physicians, barriers to rural practice differed by age, sex, place of birth and nationality. Returning to metropolitan practice, children and concern over procedures were more likely to be reported as barriers to rural practice among those aged 40 years or under, 41-50 years and 51 years and over, respectively. CONCLUSION: The major barriers to rural practice identified by physicians lie outside the health sector, and particularly concern a perceived need for wider opportunities in children's education and spouse employment.

Adult↗
PubMed2005

Intraoperative consultation in gynecologic pathology.

CONTEXT: Gynecologic specimens are commonly submitted for intraoperative consultation, primarily to confirm the presence and histologic type of malignancy, as well as to determine the adequacy of resection by examining the surgical margins. OBJECTIVE: To review and discuss the application, indications, contraindications, and limitations of intraoperative consultation regarding gynecologic specimens, as well as the causes of false-positive or false-negative frozen section results. DATA SOURCES: Review of the pertinent literature and the authors' expertise and experience. CONCLUSIONS: In most instances, intraoperative consultation regarding gynecologic specimens accurately determines the type of malignancy, the status of the resection margins or the lymph nodes, and the extent and depth of involvement by a tumor. Although the pathologist and the surgeon must be aware of the limitations, the use of intraoperative consultation represents a highly sensitive and specific technique that can play a critical role in the management of gynecologic disease.

Diagnostic Errors↗
PubMed2005

Intraoperative pathology consultation for kidney and urinary bladder specimens.

CONTEXT: Intraoperative pathology consultation for kidney and urinary bladder specimens is relatively infrequent. Scant literature is devoted to this topic. OBJECTIVE: The clinical indications and diagnostic usefulness and pitfalls of intraoperative pathology consultation of kidney and urinary bladder specimens will be reviewed, based on literature and personally encountered cases. DATA SOURCES: The indications for intraoperative pathology consultation for renal lesions included (1) surgical margins in partial nephrectomy specimens, (2) solid renal mass in unusual clinical or radiologic settings, (3) synchronous renal and extrarenal masses, (4) cystic renal lesions, (5) ureteral surgical margin for transitional cell carcinoma, (6) multiple renal masses, (7) solid mass in a diffusely cystic kidney, and (8) evaluation of renal injury. The indications for urinary bladder included (1) status of the surgical margins, (2) diagnosis of bladder tumor biopsy, (3) diagnosis of extravesical tumors with vesical extension, (4) diagnosis of extravesical mass, including pelvic lymph nodes encountered during cystectomy, and (5) status of bladder neck margin during radical prostatectomy for cancer. The frequent problematic areas for the kidney included misdiagnosis or incorrect classification of cystic tumors or spindle cell tumors, and confusion of clear cell renal cell carcinoma with inflammatory lesions. The problematic areas for urinary bladder included the differential diagnoses of high-grade dysplasia/carcinoma in situ with reactive changes at the ureteral or urethral surgical margins. CONCLUSIONS: Distinctive indications and diagnostic pitfalls are recognized for intraoperative consultation of renal or urinary bladder lesions. Awareness of the pertinent problems should improve diagnostic accuracy and facilitate the proper management of these lesions.

Frozen Sections↗
PubMed1989

Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial.

STUDY OBJECTIVE: To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. DESIGN: Randomized controlled clinical trial. SETTING: University-affiliated referral Veterans Administration Medical Center. PATIENTS: One hundred and seventy-eight hospitalized elderly men 75 years or older admitted to medical, surgical, and psychiatry services, but excluding patients admitted to intensive care units. INTERVENTION: Eighty-eight intervention group patients received multidimensional evaluation by an interdisciplinary geriatric consultation team composed of a faculty geriatrician, geriatrics fellow, geriatric clinical nurse specialist, and a social worker trained in geriatrics. Results of the evaluation, including problem identification and recommendations, were given to the patients' physicians. Ninety control group patients received only usual care. MEASUREMENTS AND MAIN RESULTS: Intervention and control groups were comparable initially. The major outcome variable was the Index of Independence in the Activities of Daily Living (ADL) (Katz). Thirty-nine percent of the total study population was functionally independent on admission, 27% required assistance with one to three ADL, 22% required assistance with four to six ADL, and 12% were completely dependent. Many patients remained unchanged from admission to discharge: intervention group, 38%; control group, 39%. In the intervention group, 34% improved and 28% declined; in the control group, 26% improved and 36% declined. Although these changes reflected a trend toward greater improvement in the intervention group, the results were not statistically significant. CONCLUSIONS: Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in addition to advice if improvements are to be made.

Activities of Daily Living↗
PubMed1999

["The consultation lab"--training clinical communication].

Discourse is the doctor's most essential tool. Since 1992, 500 Danish GPs have participated in "The consultation process I" and videosupervision in Greece. Participants are divided into groups of six. Each group works in a virtual consultation lab in which doctor-patient role plays are videotaped and supervised according to a specific matrix. In this experimental setting we have further sophisticated the nine phases (the P-R-A-C-T-I-C-A-L model) of the consultation process and improved our matrix for group supervision of video sessions. Typical individual pitfalls in doctor-patient communication have been demonstrated. Participant doctors were allowed to freely explore individual styles, and then establish how they were perceived by their "patients'"; they have learned how patient experience of a consultation varies. Furthermore, the courses helped to create networks: several groups met later, and a great many of these GPs have joined medical student tutoring. This way, the courses have contributed to more efficient work practices and job satisfaction, to professional advances, and to a lasting of the quality of upgrading in general practice.

Communication↗
PubMedDate not supplied

Patient dynamics, staff burnout, and consultation-liaison psychiatry.

This paper discusses the valuable role of the consultation-liaison psychiatrist in reducing hospital staff burnout, particularly in working with difficult patients admitted to nonpsychiatric services. Direct patient consultation is a reimbursable service. However, staff-oriented consultation, while not reimbursed by most third-party payers, can be an invaluable means of improving staff-patient relations, reducing liability risk, and alleviating staff stress. The consultation-liaison psychiatrist can be an important element in a hospitalwide, ongoing, comprehensive program to reduce burnout and thereby optimize staff retention and staff effectiveness.

Burnout, Professional↗
PubMed1995

A positive experience with a consultant.

Consulting services would not be the multimillion industry they are if the results were not of value to those using them. Obviously, consulting pays off in some large percentage of cases. But it does not happen automatically, and the consultant used is less important in the process than the advance work that is done by the client in establishing the conditions under which the consultation will take place. In the following example, preplanning led to a result that was immensely satisfying to all involved.

Consultants↗
PubMedDate not supplied

Staphylococcus aureus bacteremia: the cost-effectiveness of long-term therapy associated with infectious diseases consultation.

OBJECTIVE: To investigate the cost-effectiveness of long-term therapy for Staphylococcus aureus bacteremia and to determine if an infectious diseases consultation affected the duration of therapy. METHODS: A decision analysis was performed based on data from the literature. To determine if consultation was related to therapy duration, a retrospective cohort study was performed using tightly matched pairs. RESULTS: The excess cost per life saved by long-term antibiotics was $500,000. The excess cost per life-year saved was $18,000. Nine pairs were matched. Patients who received consultation were more likely to receive long-term therapy than controls (median 41 days vs 15 days for controls, P = .04). CONCLUSIONS: The estimated cost per life-year saved by long-term therapy was similar to other accepted medical interventions. Infectious diseases consultation can encourage prolonged duration of antibiotic therapy for S aureus bacteremia.

Anti-Bacterial Agents↗
PubMedDate not supplied

Consulting is more than giving advice.

Of all the relationships that executives enter into with outsiders, perhaps none is so tainted by misunderstanding as the engagement of management consultants. To executives, consultants may seem concerned mainly with prolonging their assignments and unable to appreciate the practicalities of managerial issues. Conversely, consultants may see their clients as short-sighted and lacking the backbone necessary to make important decisions. How can such stereotypes be done away with? By starting at the beginning of the assignment. Mr. Turner maintains that if managers and outside advisers work out in advance what is expected of each party during their work together, the chances of solving problems are improved. He suggests that managers and consultants structure the engagement according to a hierarchy of goals--which proceeds from the most basic objective, providing information, to the most sophisticated, permanent improvement of organizational effectiveness. The best way to move up that hierarchy is for executives and advisers to work together to identify needs and develop solutions.

Consultants↗
PubMed1985

Home health care: drug-related problems detected by consultant pharmacist participation.

Consultant pharmacists conducted a drug history and regimen review on one-fourth of the patient population served by a community hospital-based home health department. About one-third of study patients had inappropriately stopped taking their medications; over one-fourth of the study patients had changed their schedule or dose without health professional consultation. Fifteen percent of all medications were duplications, and only 8% of prescription medications were correctly identified by name. Consultant pharmacist activities that could reduce drug-related problems were identified as drug therapy consultation with patients and staff, drug regimen review, drug information, and patient medication education.

Consultants↗
PubMedDate not supplied

Psychogeriatric consultation in "reception centres": a descriptive account.

"Centres d'accueil" (reception centres) for the aged will be required to become increasingly involved with seniors presenting psychological or psychiatric problems, because of both the increase in life expectancy and the philosophy of avoiding the institutionalization of such seniors in psychiatric settings. One of the activities of the consulting psychiatrist is to meet the patient to establish a diagnosis and suggest treatment; however, the support of the care-giving team is the consultant's primary concern. The psychogeriatric consultant makes a rapid, on-site decision on suitable treatment for the patient, thus avoiding a potentially upsetting transfer. In addition, the consultant encourages active involvement by staff in the management of the psychiatric problem.

Aged↗
PubMedDate not supplied

A model-based context assessment approach for the informatics nurse specialist consultant.

As the number of informatics nurse specialists (INS) has grown, they have become increasingly involved in information system (IS) consultation practice. Their combined clinical and informatics expertise makes these specialists highly marketable and successful IS consultants. As healthcare settings have shifted their IS development toward interdisciplinary-integrated clinical information systems (CIS) that support a patient-focused care continuum, INS have been required to broaden their consultation approaches beyond a domain-specific focus. This article illustrates a model-based context assessment approach that can be used by INS to expand their consultation repertoire.

Computer Systems↗
PubMedDate not supplied

[Torticollis as a cause of consultation in neuropediatrics].

INTRODUCTION AND OBJECTIVE: Torticollis is a very non-specific symptom occurring in different conditions and may therefore be the reason for consultation in many specialties including neuropaediatrics. Analysis of torticollis as a cause for consultation in neuropaediatrics may contribute to the establishment of a suitable strategy for diagnosis. PATIENTS AND METHODS: We review, from the diagnostic point of view, the clinical histories of cases in which the reasons for consultation included torticollis. These cases were included in the database of all the patients assessed by the neuropaediatric department of the Hospital Miguel Servet in Zaragoza between May 1990 and February 1999. RESULTS: Of the 4,138 new patients evaluated during the period studied, in 60 patients torticollis was either the sole symptom or was one of the symptoms leading to consultation. The diagnoses established were: 30 congenital torticollis (50%), 6 secondary to space-occupying intracranial lesions (10%), 5 benign paroxystic torticollis (8.3%), 4 post-traumatic, 3 secondary to ocular disorders, 3 Sandifer syndrome, 1 focal dystonia of the neck, 1 secondary to a submandibular adeno-phlegmon, 1 secondary to an epidural hematoma of the cervical spine, 1 to encephalomyelitis and 1 to spondylodiscitis, with 4 cases unclassified. CONCLUSIONS: The clinical history, physical examination and follow-up of the course of the disorder orientate or permit the diagnosis to be established in many cases of torticollis. The indications for complementary investigations, particularly neuroimaging, should be considered individually in each case.

Adolescent↗
PubMed1999

[A role of clinical pathologists in Laboratory Information (Consulting) Center].

In the 21st Century, laboratory scientists must change their concepts and attitude in order to supply services and information of great value. The laboratory tests comprise an increasing volume, and medical workers frequently need consultation on these tests. Effective utilization of laboratory data are important aspects of evidence-based medicine, and will also contribute to the efficiency of hospital practice and management. Clinical Laboratory of Kitasato University Hospital opened the "Clinical Laboratory Information (Consulting) Center" in July 1995 to respond to the increasing demand for consultation. It has been supporting medical care and research. The Center is located on the second floor of the Clinical Laboratory building of Kitasato University Hospital, and is staffed by one medical technologist and a clinical pathologist specialized in laboratory medicine. The Center staff consults by telephone from 9 am to 5 pm on weekdays, and get inquiries after-work hours and during weekends either by e-mail or fax. The Center aims to improve medical care by providing accurate and up-to-date information on clinical laboratory tests and interpretations. The clinical pathologist of the Center attempts to advise physicians regarding appropriate tests for particular patients. This avoids the ordering of unnecessary tests, which benefits the patient, the physician, and the hospital. The clinical pathologist should keep abreast of new findings on a wide array of clinical laboratory tests. The clinical pathologist should respond immediately to requests and complaints, thereby always seeking to improve oneself and the Center. Our Center is the first clinical laboratory in Japan staffed by both a clinical pathologist and a medical technologist, and our Center could be a pilot study for a new service of hospital clinical laboratories.

Clinical Laboratory Information Systems↗
PubMed1999

Handling confrontations with consultants in the ED.

Demand respect when consultants second-guess your clinical decisions or behave rudely. Address consultants' specific complaints and don't respond to generalizations about the ED. Establish credibility by having radiologists confirm your X-ray readings in front of consultants. If consultants are rude, don't hesitate to confront them.

Communication↗
PubMed1999

Web-based teledermatology consult system: preliminary results from the first 100 cases.

The TRICARE Region 1 Teledermatology Consortium has developed a secure web-based "store and forward" consult system designed to allow medical treatment facilities throughout the region to submit dermatology consults. Realizing that there is very little objective data on teledermatology, we have begun to evaluate our system through the integration of questionnaires for patients, referring physicians, and consultants in addition to telephonic patient follow up. We report the preliminary data from the first 100 cases received in the first two months since partly deploying the web based teledermatology consult system in the Tricare Region I (Northeast United States). We primarily address system effectiveness (percentage of cases that required follow up to dermatology and/or primary care physicians, adequacy of evaluating pigmented lesions) diagnostic agreement, acceptance, effect on access to care, and educational value to the primary care physicians.

Attitude of Health Personnel↗
PubMed2000

[Words and language used by patients when describing consultation with general practitioners].

Increased knowledge of how patients express their experiences may help physicians to capture their patients' perceptions and agenda. The aim of the present study was to examine words and language used by patients when describing specific primary care consultation experiences. Six focus group sessions with a total of 31 patients were conducted shortly after a general practice consultation. All group sessions were audiotaped and analysed by qualitative ethnographic methodology. Seven distinct grammatical and verbal characteristics were found: The consultations were recited in the first person with little recollection of the doctors' talk or actions. Subjectivity was constantly underlined by the verbs "feel" or "think". When expressing negative emotions, the personal pronoun constantly was changed from the personal singular to the impersonal or plural form. Language tended to be evasive in connection with possible criticism. Negative emotions were diminished by the use of limiting expressions and modest wording. Non-committal expressions, with a wide range of possible meanings, were frequent, and were possible to decipher only by close attention to non-verbal cues. We conclude that doctors may capture more of their patients' hidden emotional messages in the consultation by increased awareness of specific verbal characteristics and non-verbal cues.

Communication↗