Original Article

Development and Implementation of an Inpatient Otolaryngology Consultation Service at an Academic Medical Center

Authors: Matthew G. Huddle, MD, Nyall R. London, MD, PhD, C. Matthew Stewart, MD, PhD


Objectives: To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation.

Methods: This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June 2014.

Staged interventions included adding fellow coverage (July 2007 onward), intermittent hospitalist coverage (July 2010 onward), and a physician assistant (October 2011 onward). Billing data were collected for incidences of new patient and subsequent consultation charges. The 2-year preimplementation period (July 2005–June 2007) was compared with the postimplementation periods, divided into 2-year blocks (July 2007–June 2013). Outcome measures of patient encounters and work relative value units were compared between pre- and postimplementation blocks.

Results: Total encounters increased from 321 preimplementation to 1211, 1347, and 1073 in postimplementation groups (P < 0.001). Total work relative value units increased from 515 preimplementation to 2090, 1934, and 1273 in postimplementation groups (P < 0.001).

Conclusions: A formal inpatient consultation service was designed with supervisory oversight by non–Accreditation Council for Graduate Medical Education fellows and then expanded to include intermittent hospitalist management, followed by the addition of a dedicated physician assistant. These additions have led to the formation of a sustainable consultation service that supports the mission of high-quality care and service to consulting teams.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Castellanos P. The laryngology hospitalist. J Voice 2005;19:470-475.
2. Russell MS, Eisele D, Murr A. The otolaryngology hospitalist: a novel practice paradigm. Laryngoscope 2013;123:1394-1398.
3. Adil E, Xiao R, McGill T, et al. A chief of service rotation as an alternative approach to pediatric otolaryngology inpatient care. JAMA Otolaryngol Head Neck Surg 2014;140:809-814.
4. Zalzal GH, Shah RK. The chief of service rotation: for each, their own. JAMA Otolaryngol Head Neck Surg 2014;140:815-816.
5. Berwick DM. A user’s manual for the IOM’s "Quality Chasm" report. Health Aff (Millwood) 2002;21:80-90.
6. Centers for Medicare & Medicaid Services. Revisions to consultation services payment policy. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm6740.pdf. Published December 2009. Accessed September 15, 2015.
7. Hoffman SA, Manaker S. Consultations after elimination of payments for evaluation and management consultation codes. Chest 2011;139:933-938.
8. Stewart CM. Inverted pyramid of inpatient consultation in the academic hospital. South Med J 2015;108:370-371.
9. Wheelock A, Suliman A, Wharton R, et al. The impact of operating room distractions on stress, workload, and teamwork. Ann Surg 2015;261:1079-1084.
10. Weigl M, Antoniadis S, Chiapponi C, et al. The impact of intra-operative interruptions on surgeons’ perceived workload: an observational study in elective general and orthopedic surgery. Surg Endosc 2015;29:145-153.