A Prospective, Randomized, Controlled Study Demonstrating a Novel, Effective Model of Transfer of Care between Physicians: The 5 Cs of Consultation

Authors

  • Chad S. Kessler MD, MHPE,

    1. From the Departments of Emergency Medicine, Jesse Brown VA Hospital, and University of Illinois-Chicago (CSK), Chicago, IL; the College of Medicine (YA, GS), University of Illinois-Chicago, Chicago, IL; the Department of Medical Education (RY, AS), College of Medicine, University of Illinois-Chicago, Chicago, IL; and the Department of Emergency Medicine, University of Minnesota Medical School (FA), Minneapolis, MN. Dr. Afshar is currently with the Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
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  • Yalda Afshar PhD,

    1. From the Departments of Emergency Medicine, Jesse Brown VA Hospital, and University of Illinois-Chicago (CSK), Chicago, IL; the College of Medicine (YA, GS), University of Illinois-Chicago, Chicago, IL; the Department of Medical Education (RY, AS), College of Medicine, University of Illinois-Chicago, Chicago, IL; and the Department of Emergency Medicine, University of Minnesota Medical School (FA), Minneapolis, MN. Dr. Afshar is currently with the Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
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  • Gurkiran Sardar MD,

    1. From the Departments of Emergency Medicine, Jesse Brown VA Hospital, and University of Illinois-Chicago (CSK), Chicago, IL; the College of Medicine (YA, GS), University of Illinois-Chicago, Chicago, IL; the Department of Medical Education (RY, AS), College of Medicine, University of Illinois-Chicago, Chicago, IL; and the Department of Emergency Medicine, University of Minnesota Medical School (FA), Minneapolis, MN. Dr. Afshar is currently with the Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
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  • Rachel Yudkowsky MD, MHPE,

    1. From the Departments of Emergency Medicine, Jesse Brown VA Hospital, and University of Illinois-Chicago (CSK), Chicago, IL; the College of Medicine (YA, GS), University of Illinois-Chicago, Chicago, IL; the Department of Medical Education (RY, AS), College of Medicine, University of Illinois-Chicago, Chicago, IL; and the Department of Emergency Medicine, University of Minnesota Medical School (FA), Minneapolis, MN. Dr. Afshar is currently with the Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
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  • Felix Ankel MD,

    1. From the Departments of Emergency Medicine, Jesse Brown VA Hospital, and University of Illinois-Chicago (CSK), Chicago, IL; the College of Medicine (YA, GS), University of Illinois-Chicago, Chicago, IL; the Department of Medical Education (RY, AS), College of Medicine, University of Illinois-Chicago, Chicago, IL; and the Department of Emergency Medicine, University of Minnesota Medical School (FA), Minneapolis, MN. Dr. Afshar is currently with the Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
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  • Alan Schwartz PhD

    1. From the Departments of Emergency Medicine, Jesse Brown VA Hospital, and University of Illinois-Chicago (CSK), Chicago, IL; the College of Medicine (YA, GS), University of Illinois-Chicago, Chicago, IL; the Department of Medical Education (RY, AS), College of Medicine, University of Illinois-Chicago, Chicago, IL; and the Department of Emergency Medicine, University of Minnesota Medical School (FA), Minneapolis, MN. Dr. Afshar is currently with the Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
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  • This trial was registered at the National Institutes of Health Web site (ClinicalTrials.gov Identifier: NCT01316172).

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: John Burton, MD.

Address for Correspondence and reprints: Chad S. Kessler, MD, MHPE; e-mail: chad.kessler@va.gov.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19:968–974 © 2012 by the Society for Academic Emergency Medicine

Abstract

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.

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