Article Text

Download PDFPDF
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}


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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • 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.