Experience with ConsultWiz – The Simultaneous Electronic Notification, Documentation, and Tracking of Inpatient Consult Requests

Abstract

ConsultWiz is a component of Vanderbilt's electronic order-entry system that facilitates and documents requests for medical and surgical consult services in the adult and children's hospitals. Piloted in the Dept of Medicine in Spring, 2005, ConsultWiz was expanded to include all remaining adult services in July, 2005 and all pediatric consult services in October, 2005. By February, 2006, over 10,000 consult requests were placed. Details and issues in the development and implementation of ConsultWiz are discussed.

Background

Audits of thoroughness and accuracy of inpatient documentation and billing for inpatient consultations repeatedly revealed a 5–10% lost opportunity related to the current paper method of requesting and serving consultations. Clinical leadership also believed that consult requests were often poorly focused. Finally, agreed upon response times for consultations were not well understood and rarely followed. Effective January 1, 2006, Change Request 4215 (Transmittal 788) from the Centers for Medicare and Medicaid Services (CMS) mandated documentation requirements for providers requesting consultation.

Methods

Each consultant service to be included in ConsultWiz was identified with a designated pager number to be available 24 hours a day and rolled over, as necessary, to the appropriate person covering the service. Free, ‘virtual’ pager numbers, without physical beepers, were provided by the local pager service and used by most consultant services as the primary contact number.

Within Vanderbilt’s order-entry system, a ‘Consult Med/Surg Request’ order displays a screen in which the user selects the consult service and a priority (Routine, Urgent, or Emergent) and then enters data including the specific reason for the consult, the call-back number, and other relevant clinical information. Yes/No questions are posed concerning whether the consultant can enter orders and should contact the team before and/or after seeing the patient. Prefilled information includes the name of the person requesting the consult, his/her beeper number, and the name of the attending.

Upon submission of the consult request order:

1. a text page is sent to the consult service's designated pager number, with the priority of the consult, the inpatient unit and bed number, the last 4 digits of the medical record number, the name and beeper number of the person requesting the consult, the call-back number, and the reason for the consult;

2. a consult request document, with all of the data entered in the consult request order plus the date/time the order was placed and the number that was paged, is placed in the patient's electronic chart; and

3. the same consult request document is added to an online worklist for the respective consult service in reverse chronological order.

Routine consults between 10 pm and 7 am are not paged, but the consult request documents are still electronically placed in the chart and the worklist. Worklists are managed at the discretion of each consult service. When patients are removed from a consultant’s worklist, a related worklist retains the consult data for billing and auditing purposes.

Discussion

Several currently-implemented features of ConsultWiz were discussed in a previously proposed process to improve inpatient consultations¹. The January 2006 CMS guidelines have resulted in policy changes to mandate the use of ConsultWiz for accurate documentation of inpatient consult requests. Preliminary feedback from users has been positive, but issues raised during implementation have included: 1) the accurate ‘rolling over’ of pagers to ensure the correct person is notified; 2) the education of providers and consultants that ConsultWiz is not replacing provider-consultant communication; and 3) the change of culture in defining a ‘curbside’ consult versus one to be entered into ConsultWiz. Additional studies are underway to characterize and evaluate the use of ConsultWiz among departments and providers.