Perspectives
Inverted Pyramid of Inpatient Consultation in the Academic Hospital
Abstract
A common scenario in inpatient medicine is an admitting team asking another medical team for advice: the inpatient consultation. For many faculty, the next steps are a mystery managed by residents because in the academic hospital, both the initial consultation requisition and the response often are initiated by residents. In any given hospital the mechanisms to find out who is on call for a particular question and how to contact that person is an exercise of human factors engineering and workflow mapping. The internal cognitive tasks rely on human knowledge, experience, and cognitive skill, and the external factors may include hospital operators, lists of telephone numbers, or computer-based order entry or Web-based consultation mechanisms. These external factors should minimize task difficulty by supporting the internal processes of decision making but may increase workload and task difficulty with poor or suboptimal system design. For a given inpatient in your hospital, imagine sketching out the workflow steps for every possible consultation you could request.This content is limited to qualifying members.
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