Qual Saf Health Care 18:59-62 doi:10.1136/qshc.2007.025486
  • Original Article

Audit of the consultation process on general internal medicine services

  1. J Conley,
  2. M Jordan,
  3. W A Ghali
  1. University of Calgary, Calgary, Alberta, Canada
  1. Dr W A Ghali, Centre for Health and Policy Studies, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1; wghali{at}
  • Accepted 2 March 2008


Objective: To determine the proportion of consultations requested by general internal medicine services that communicate key components of the consultation process to medical subspecialists.

Design: Retrospective chart review by two researchers, using a standardised chart abstraction instrument (93.1% agreement, κ 0.85).

Setting: Calgary, Alberta, Canada.

Sample: A random sample of medical consultations was selected from those generated on two medical teaching units (MTUs) from 2003 to 2004.

Measurements: The primary measure of interest was whether a “clear clinical question” was posed to the subspecialist, a binary variable.

Results: Two hundred consultations were sampled from the 2885 subspecialty consultations. Of the selected consultations, 94.0% (188/200) were available for review. A clear clinical question was posed in 69.7% (131/188) of consultations (CI 0.63 to 0.74). In a secondary analysis involving a larger sample permitting comparison across subspecialties, 95.1% (368/387) of the consultations, representative of the subspecialties, were available for review. An MTU member contacted the subspecialist for 74.2% of consultations. If a consultation was urgent, a member of the MTU contacted the subspecialist in 81.0% of consultations. Of these urgent consultations, 63.3% had a clear clinical question.

Conclusion: More than one in four consultations does not contain a clear clinical question, illustrating suboptimal communication between physicians. Innovative strategies that provide a sustainable solution for overcoming barriers to communication could have a significant impact on quality of care.


  • Funding: WG is funded by the government of Canada Research Chair in health services research and by the Health Scholar Award from the Alberta Heritage Foundation for medical research.

  • Competing interests: None.