The role of ophthalmic hospitalists in managing pediatric consults

This single-center retrospective study analyzes consultations managed by an ophthalmic hospitalist covering a children's hospital.

Study design

The authors reviewed medical records of all inpatient and emergency room consults managed at a pediatric hospital by the weekday daytime consultation service between July 1 and August 31, 2018. The consultation service was managed by a non-pediatric trained ophthalmic hospitalist. During the study period, the ophthalmic hospitalist provided consultation services at 3 institutions, 2 adult hospitals and 1 pediatric hospital. Data surrounding the experience with pediatric consultations are the primary focus of the study.

Outcomes

A total of 61 patients were evaluated by the ophthalmic hospitalist service within the children's hospital and pediatric emergency room during the 2-month study period, accounting for 23% of the total consults seen by the hospitalist service. The 2 most common reasons for consulting the hospitalist were to rule out nonaccidental trauma and papilledema.

A pediatric ophthalmologist was consulted by the hospitalist on 15 (25%) cases. In 5 of these cases, it was necessary for the pediatric ophthalmologist to examine the patient in person, while in the remaining 10 patients, the issues were handled indirectly by discussion. The authors concluded that the ophthalmic hospitalist role limited the use of outpatient resources and provider time for inpatient care. In addition, a dedicated inpatient provider allows for efficient care with increased quality of care for both the patients and the hospital.

Limitation

The major limitation of this study is the short 2-month duration of data reported. In addition, the hospitalist service was only operational during the day. It would be valuable to know how a hospitalist service functions during evening and weekend hours.

Clinical significance

The authors note the hospitalist held a faculty position within a residency program and worked directly with a post-graduate year 3 resident while seeing consults. The impact of this position on resident education is not fully addressed. The value of managing a consult service during residency training can provide a valuable educational opportunity for trainees. The daytime hospitalist service will certainly have an impact on resident and fellow training. Resident feedback from exit surveys will be valuable additional data to report.

Finally, we will need to see the long-term impact of a non-pediatric trained ophthalmologist running a hospitalist service on decreasing costs and increasing access to care for pediatric patients in our current health care environment. Two months of data is not robust enough to address this issue.