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Should We Curb the Curbside?
Marisha Burden, MD
Chief of Hospital Medicine
Denver Health Medical Center
Assistant Professor of Medicine
University of Colorado School of Medicine
Curbside View
Formal Evaluation
Curbsides
Curbsides – Previous Studies
Quantity requested
Subspecialties consulted
Types of questions asked
Time spent
MD perceptions
Curbsides
Hypotheses
INCOMPLETE
INFORMATION
DURING
CURBSIDE
INCORRECT
INFORMATION
DURING
CURBSIDE
DIFFERENT ADVICE/RECS
W/ FORMAL
CONSULT
Methods
Denver Health
Prospective Cohort
1 Year
Intermittent
18 Hospitalist Physicians
Definitions
Consulting provider asked for advice, suggestions, opinions
Did not ask hospitalist to see patient
Excluded: Administrative, patients already being seen by hospitalist
Curbsides – Our studyHospitalist A – “Curbside physician”
Formal ConsultHospitalist B – “Official Consultant”
“Consultee”
Methods
Curbside consults neither solicited, discouraged
Requesting providers not informed of study or debriefed
Analysis: Chi Square
Results
215 Study days
50 curbside consults
3 Formal consults declined
47 consults with both curbsides + formal consults
Requesting Service
Psychiatry ER Ob/gyn Neurology Other0
5
10
15
20
25
Nu
mb
er
of
cu
rbs
ide
s
8%11%
19%
45%
17%
Requesting Provider
Resident Intern Attending Other0
5
10
15
20
25
30
Co
ns
ult
s (
N)
53%
17%19%
11%
Consultative Concern
Treatment Evaluation Discharge? Diagnosis Lab0
5
10
15
20
25
30
35
Co
ns
ult
s (
N) 43%
28%
62%
21%
9%
**Consults could be listed in more than 1 category**
Medical Issue
Cardi
ac
Endoc
rine ID
Pulm
onar
y GI
Elect
rolyt
e/flu
idOth
er0
5
10
15
20
25
30
Co
ns
ult
s (
N)
57%
19% 17%13% 13%
49%
36%
**Consults could be listed in more than 1 category**
Number of Questions Asked
0 to 2 3 to 5 >50
5
10
15
20
25
30
Co
ns
ult
s (
N)
17%
55%
28%
Advice Given
Same Advice Different Advice0
5
10
15
20
25
30
Co
ns
ult
s (
N)
45%
55%
Management Changes
No change Change0
5
10
15
20
25
30
40%
60%3rd Reviewer29/47 (62%)
3rd Reviewer agreed in 24/28 (86%)
Minor: 18 (64%)
Major: 10 (36%)
Con
sults
(N
)
Curbside Sufficient?
Curbside Sufficient Curbside Insuffient0
5
10
15
20
25
30
35
Co
ns
ult
s (
N)
62%
38%
3rd Reviewer agreed 17/18 (94%)
Information Accuracy
Accurate and Complete Inaccurate or incomplete0
5
10
15
20
25
30
49%51%
Incorrect: 8 (33%)
Incomplete: 11 (46%)
Incomplete& Inaccurate: 5 (21%)
Co
nsu
lts
(N)
Advice Given
Same Different Same Different0
2
4
6
8
10
12
14
16
18
20
Co
ns
ult
s (
N)
79%
21%
Information Accurate and
CompleteN=23
Information Inaccurate or Incomplete
N=24
P <0.001
70%
30%
Management Changes
Same Different Same Different0
5
10
15
20
25
Information Accurate and
CompleteN=23
Information Inaccurate or Incomplete
N=24
P <0.0001
92%
8%
26%
74%
Minor: 100%Major: 0%
Major: 45%
Minor: 55%
Co
nsu
lts
(N)
Sufficiency of Curbside
Yes No Yes No0
5
10
15
20
25
Co
ns
ult
s (
N)
Information Accurate and
CompleteN=23
Information Inaccurate or Incomplete
N=24
P <0.0001
91%
9%
33%
67%
Curbside Sufficient
Examples – Management Changes
MINOR MAJOR
Post Hoc Analysis
Association No Association• Consulting Service• Consulting Provider• Medical Issue• Number of questions• Whether curbside was
felt to be sufficient• Consult issue
Strengths
1st prospective study
18 Hospitalists
Excellent 3rd Party Agreement
Conducted over 1 year
Weaknesses
Small N (50)
Teaching hospital
Urban safety net hospital
Hawthorne Effect
Conclusions
Curbside consults are associated with considerable RISK that the advice provided
and the resulting management decisions made are incorrect.
InvestigatorsMarisha Burden*Ellen Sarcone*Angela KenistonBarbara StatlandJulie TaubRebecca AllynMark ReidLilia CervantesSarah Stella
Gaby FrankNick ScalettaSmitha ChadagaNancy MallerMargherita MascoloJeff ZouchaMary MaherRick Albert
*Co-Principal Investigators
Questions?
Marisha.Burden@dhha.org
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