This trial was registered at the National Institutes of Health Web site (ClinicalTrials.gov Identifier: NCT01316172).
A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of Transfer of Care between Physicians: The 5 Cs of Consultation
Article first published online: 20 AUG 2012
© 2012 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 19, Issue 8, pages 968–974, August 2012
How to Cite
Kessler, C. S., Afshar, Y., Sardar, G., Yudkowsky, R., Ankel, F. and Schwartz, A. (2012), A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of Transfer of Care between Physicians: The 5 Cs of Consultation. Academic Emergency Medicine, 19: 968–974. doi: 10.1111/j.1553-2712.2012.01412.x
The authors have no relevant financial information or potential conflicts of interest to disclose.
Supervising Editor: John Burton, MD.
- Issue published online: 20 AUG 2012
- Article first published online: 20 AUG 2012
- Received February 1, 2012; revision received March 12, 2012; accepted March 17, 2012.
ACADEMIC EMERGENCY MEDICINE 2012; 19:968–974 © 2012 by the Society for Academic Emergency Medicine
Objectives: The objective was to evaluate whether a standardized consultation model in the emergency department (ED), the 5 Cs of Consultation (Contact, Communicate, Core Question, Collaboration, and Closing the Loop), would improve physicians’ ability to relay appropriate information and communicate successfully during a consultation.
Methods: This was a prospective, randomized study at a large, academic, urban, tertiary care medical center in Chicago. Forty-three emergency medicine (EM) and EM/internal medicine (EM/IM) residents were randomized into two groups, an intervention group and an unstructured group, stratified by postgraduate year (PGY). Intervention group participants received an interactive educational session on the 5 Cs of Consultation, a standardized consultation model. Intervention and unstructured groups placed two simulated consultation phone calls, based on pretested simulated patient cases, to a standardized consultant. Three raters, naive to the consultation model and blinded to group assignments, individually assessed recordings of each call using a seven-item, five-point global rating scale (GRS). Finally, an attending surgeon and an attending psychiatrist each rated respective cases using a single global rating to provide validity evidence for the scale.
Results: Residents trained with the 5 Cs model communicated significantly better, regardless of PGY and clinical case. The intervention group had significantly higher mean GRS scores than the unstructured group (4.1 vs. 3.5, F(1,39) = 33.5, p < 0.0001). Secondary analysis of the recordings suggested that encounters with more 5 Cs behaviors tended to receive higher GRS scores.
Conclusions: A standardized educational model increased the effectiveness of consultation communication from the ED. Residents trained with the 5 Cs of Consultation scored better on consultation assessments compared with untrained residents. Training programs should consider adopting standardized consultation models.