King Fahad National Guard Hospital Internal Medicine Consultation Service: Contributing Co-Morbidities and Reasons for Consultation

Background: Inpatient medical consultations have become an essential service in the specialty of Internal Medicine. Research in this new subspecialty will help improve the quality as well as the cost-effectiveness of this vital service. Method: Data for all patients who were referred to the service were entered in a pre-designed form. Results: One hundred and seventy-six adult patients with an average age of 53.3 years were seen by the service over a 4 months period. Consultations to the service were primarily from the departments of Surgery (110, 62.50%), Obstetrics and Gynecology (57, 32.39%). Co-morbidities were common specially diabetes mellitus (59.1%) and hypertension (41.5%). Most of the consultations were for emergency patients (99, 56.3%) rather than for electively (77, 43.7%) admitted cases. For operative patients, there was an equal share between pre- and post-operative cases (58.8% and 58.0% respectively). Prior referral to outpatient pre-operative clinics was unsatisfactory with the service requesting postponements of surgery for 22.1 percent of pre-operative cases. The major reasons for referral to the service were diabetes mellitus (49.4%), hypertension (30.7%) and respiratory problems (22.7%). Thirty-three percent of cases had more than one reason for referral. Active intervention by the service was frequent. The average length of care under the service was 5.2 days with a range of 1 to 90 days. Conclusions: The service needs to be structured with regards to staff education and training; emphasizing on diabetes mellitus, hypertension and respiratory problems care. A joint interdepartmental effort along the above lines and better use of the pre-operative outpatient clinics are recommended.