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Characteristics of Unscheduled Pediatric Urology Consultations: Effects of Day, Month and Diagnosis

Sunday, October 21, 2012: 2:48 PM
Grand Ballroom B (Hilton Riverside)
Julian Wan, MD, Chang He, Heather Crossley, Vesna Ivancic, John M. Park, Kate H. Kraft and David A. Bloom, Urology, University of Michigan, Ann Arbor, MI

Purpose

Much data are available about the planned clinical activities of pediatric urologists from the logs of scheduled operations and clinic appointment lists. Little however is known about unplanned clinical activity, which we term consultations. We wondered if the frequency of consultations varied with the day of the week or month of the year. Would frequency be affected by holidays? Would the method of consult staffing (same day, within 24 hours, by phone) vary with day or month? Were some diagnoses more likely to occur in patients with repeat consultation?

Methods

We retrospectively reviewed data of patients in our consult database for years 2008-2010. The age, date, and diagnostic category were noted. Statistical analysis was done using Tukey multiple comparison adjustment and a negative binomial distribution model.

Results

There were 932 consults from 736 patients over 1095 days. The mean age was 8.9 years. There were 512 (47%) days with no consults, 32% with 1, 19% with 2-3, and 2% with 4+. Statistical significance was found in the following: more consults were made on Monday and Tuesday than Saturday and Sunday, more consults were in July, August and January, staffing method was found to be related to day of week and month. Phone management was 1.47 more likely on the weekend as compared to a weekday (95% CI 1.24, 1.75). The attending staff was more likely to staff consults out the same day or within 24 hours during July or August as compared to other months. (p = 0.001) It was 1.7 times more likely to be staffed out directly (95% CI 1.23, 2.33) as opposed to any other month. Holidays (religious, national, secular) had no effect. There was no pre-holiday or post-holiday effect seen.  The three most common diagnoses overall were infection (UTI), hydronephrosis, and lower urinary tract symptoms/neurogenic bladder. Calculi were only 7thmost common overall. The diagnosis of UTI (p=0.004) and calculi (p =0.02) were the most common diagnoses in the patients with 4 or more consults. The diagnosis of UTI was 2.1 times more likely in these repeat patients (95% CI 1.28, 3.51), and stones was 2.33 times more likely (95% CI 1.13, 4.80).

Conclusion

Consults were more frequent in July, August and January and on Mondays and Tuesdays. There was a corresponding rise in staffing the same day or within 24 hours. This may be partly related to new residents starting in July. There was no holiday effect.  UTI and calculi were the diagnoses most common in recurrent patients with 4 or more consults. Calculi are disproportionally represented in recurrent patients being 2.1 times likely to occur. Patterns of unplanned consultations should be considered in future staffing and treatment planning. They may also assist in identifying changing trends in diagnoses.