Preamble

Research on the Current Status of Interdepartmental Consultations in General Hospitals

Abstract

Objective: To investigate the current status and characteristics of interdepartmental consultations in general hospitals, analyze existing problems, and provide a scientific basis for optimizing the consultation management system and improving the quality of medical services.

Methods: A retrospective analysis was conducted on the interdepartmental consultation data from a large tertiary general hospital over a specific period. The study analyzed several dimensions, including the volume of consultations, departmental distribution, response times, and the types of consultations (emergency vs. routine). Statistical analysis was performed using $\chi^2$ tests and descriptive statistics to identify patterns and significant differences across departments.

Results: The data revealed a steady increase in the demand for interdepartmental consultations. Internal medicine departments were the primary initiators of consultation requests, while specialized departments such as Cardiology, Endocrinology, and Intensive Care Units (ICU) were the most frequently invited. A significant portion of consultations were categorized as "emergency," requiring a response within 10 to 30 minutes. While the overall fulfillment rate was high, delays were observed during peak hours and in specific surgical-to-medical requests.

Conclusion: Interdepartmental consultation is a critical component of integrated clinical care in general hospitals. To improve efficiency, hospitals should leverage information technology to streamline the request process, establish clearer criteria for emergency consultations, and strengthen the multidisciplinary team (MDT) approach for complex cases.

Introduction

In the modern healthcare landscape, the increasing specialization of medical disciplines and the rising complexity of patient conditions—particularly among the aging population with multiple comorbidities—have made interdepartmental consultation an indispensable part of clinical practice. Interdepartmental consultation refers to the process where a physician in charge of a patient requests the expertise of specialists from other departments to assist in diagnosis and treatment.

Effective consultation not only ensures patient safety and improves diagnostic accuracy but also facilitates the exchange of knowledge between different medical specialties. However, as the volume of patients in general hospitals grows, the consultation system faces challenges such as high workloads for consultants, inconsistent response times, and varying quality of consultation opinions. This study aims to analyze the current status of these consultations to identify bottlenecks and suggest systemic improvements.

Methods

1.1 Data Source

The data for this study were extracted from the Hospital Information System (HIS) of a representative tertiary general hospital. The dataset includes all electronic consultation records generated between January 2021 and

1.518116 广东省深圳市龙岗中心医院全科医学科

Shenzhen Clinical Medical School, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong Province, China; Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China. Chief Physician.

背景

Study on the Current Status of Interdisciplinary Consultation in General Hospitals

With the acceleration of population aging in China and the increasing complexity of medical service demands, the conditions of hospitalized patients often involve multiple systems and organs. Consequently, the traditional single-discipline diagnostic and treatment model can no longer meet the holistic medical needs of patients. Interdisciplinary consultation, as a collaborative medical service model involving multiple specialties, plays an increasingly vital role in improving the quality of diagnosis and treatment and integrating medical resources. However, systematic research on the current status of interdisciplinary consultation in domestic general hospitals is relatively scarce. The actual operation, existing problems, and potential improvement paths of these consultations have not yet been fully revealed.

1. Objectives

This study aims to investigate the current status of interdisciplinary consultation in general hospitals and analyze clinicians' perceptions and evaluations of the process. The findings are intended to provide reference opinions for the continuing education and training of clinicians and for medical departments to optimize clinical consultation workflows.

2. Methods

From August 14 to September 14, 2023, clinicians from general hospitals who voluntarily participated in an online questionnaire survey were selected as the study subjects. A preliminary questionnaire was designed based on a literature analysis and subsequently refined through consultation with two senior clinical experts. After six rounds of a "consultation-feedback-modification" cycle, the final "Survey on the Current Status of Interdisciplinary Consultation in General Hospitals" was developed. The questionnaire content included basic demographic information of respondents, the current status of interdisciplinary consultations, perceptions and evaluations of the process, and expectations for improvement. The questionnaire was imported into the "Wenjuanxing" platform, and after repeated testing, a link was generated and distributed to several national clinician WeChat groups.

3. Results

A total of 281 questionnaires were recovered, with 216 confirmed as valid (recovery rate of 76.87%). The average age of the 216 clinicians was $38.14 \pm 7.79$ years. The majority of respondents, 90.28% (195/216), were from tertiary hospitals, and the most common professional title was attending physician, accounting for 39.35% (85/216).

Routine and emergency consultations were primarily handled by attending physicians, accounting for 71.30% (154/216) and 62.04% (134/216), respectively; however, in some hospitals, resident physicians were found to be performing consultation duties. Regarding timeliness, 94.44% (204/216) of routine consultations were completed within 24 hours, while only 79.17% (171/216) of emergency consultations were completed within the required 10 minutes.

The 216 clinicians identified the primary advantages of interdisciplinary consultation as: assisting in the formulation of treatment plans (90.28%, 195/216), providing opportunities for professional knowledge and opinion exchange (89.35%, 193/216), and assisting in definitive diagnosis (86.11%, 186/216). Conversely, the main disadvantages cited were increased treatment and waiting times (63.89%, 138/216) and untimely or inaccurate information transmission (61.11%, 132/216). In terms of evaluation, the primary reasons for dissatisfaction with consultation results were "failure to provide specific treatment suggestions" (76.39%, 165/216) and "failure to provide valuable diagnostic information" (73.15%, 158/216).

4. Conclusion and Recommendations

The surveyed clinicians generally expect optimizations and improvements in consultation workflows, quality and safety, incentive mechanisms, and the enhancement of hospital information technology systems. Based on these findings, the following recommendations are proposed:
- Strengthen continuing education and training for clinicians to enhance their comprehensive diagnostic and treatment capabilities.
- Increase training in humanities and communication to improve consultation satisfaction.
- Implement strict management of consulting physician qualifications to ensure the quality of consultations.
- Introduce artificial intelligence to strengthen management and ensure the timeliness of consultations.
- Optimize consultation workflows to improve overall clinical efficiency.

Keywords: General Hospital; Interdisciplinary Consultation; Questionnaire Survey; Consultation Status

SUN J S，YUAN F Z，LIU Y，et al. Study on the status of inter-division consultations in general hospitals［J］. Chinese General Practice，2025. ［Epub ahead of print］ Editorial Office of Chinese General Practice. This is an open access article under the CC BY-NC-ND 4.0 license.

Chinese General Practice https

Background

With the acceleration of population aging and the increasing complexity of healthcare service demands in China，hospitalized patients often suffer from diseases affecting multiple systems and organs. The traditional single-discipline treatment model can no longer meet patients comprehensive healthcare needs. Interdisciplinary consultation， as a cross-disciplinary and multi-professional collaborative healthcare service model，plays an increasingly important role in improving the quality of diagnosis and treatment and integrating medical resources. However，systematic research on the current status of interdisciplinary consultation in general hospitals remains relatively scarce in China，and the actual operational conditions，existing problems，and improvement pathways of interdisciplinary consultation have not been comprehensively revealed.

Objective To investigate the current status of interdisciplinary consultation in general hospitals and analyze clinical physicians perspectives and evaluations of consultation services，thereby providing reference recommendations for continuing education training of clinical physicians and optimization of clinical consultation work by medical administration departments.

Methods

Clinical physicians from general hospitals who voluntarily participated in an online questionnaire survey were selected as subjects from August 14 to September 14，2023. Based on literature analysis，a preliminary questionnaire was designed and then consulted with two senior clinical experts. Through six rounds of consultation-feedback-modification-consultation cycles， the “Survey on Current Status of Interdisciplinary Consultation in General Hospitals” questionnaire was finalized，including basic information of respondents，current status of interdisciplinary consultation，perspectives and evaluations of interdisciplinary consultation，and expectations for consultation improvement. The questionnaire word document was imported into “Questionnaire Star” platform，and after repeated testing，a link was generated and distributed to multiple national clinical physician WeChat communication groups.

Results

A total of 281 questionnaires were collected，with 216 valid questionnaires confirmed（response rate 76.87%）. The 216 clinical physicians had a mean age of（38.14 ± 7.79）years，with 90.28%（195/216）from tertiary hospitals. Attending physicians constituted the majority by professional title，accounting for 39.35%（85/216）. Regular consultations and urgent consultations were primarily undertaken by attending physicians，accounting for 71.30%（154/216）and 62.04%（134/216），respectively，though some hospitals had residents undertaking consultation work. Regular consultations completed within 24 hours accounted for 94.44%（204/216），while urgent consultations completed within 10 minutes were only 79.17%（171/216）. The 216 clinical physicians identified the main advantages of interdisciplinary consultation as：assisting in treatment plan formulation（90.28%，195/216），providing opportunities for professional knowledge and opinion exchange（89.35%， 193/216），and assisting in diagnostic determination（86.11%，186/216）. The main disadvantages were concentrated in increasing treatment and waiting time（63.89%，138/216）and untimely and inaccurate information transmission（61.11%， 132/216）. Regarding evaluation of interdisciplinary consultation，the main reasons for dissatisfaction with consultation results were “failure to provide specific treatment recommendations（76.39%，165/216）” and “failure to provide valuable diagnostic information（73.15%，158/216）”. The 216 clinical physicians generally expected consultation optimization and improvement in consultation processes，consultation quality and safety，consultation incentives，and strengthening hospital informatization construction.

Conclusion

Continuing education training for clinical physicians should be strengthened to enhance comprehensive diagnostic and treatment capabilities；humanities course training should be reinforced to improve consultation satisfaction；strict management of consultant physician qualifications should be implemented to ensure consultation quality； artificial intelligence should be introduced to strengthen management and ensure consultation timeliness；consultation processes should be optimized to enhance consultation efficiency..

In large general hospitals, the complexity of patient conditions and the high prevalence of comorbidities place significant demands on the continuity and integrity of medical services. Interdepartmental consultation serves as a critical link in internal hospital collaboration, playing a vital role in ensuring the quality of patient diagnosis and treatment while facilitating technical exchange between departments \cite{1-2}. Interdepartmental consultation refers to the process where physicians from different specialties engage in multidisciplinary discussion and collaboration to jointly develop a diagnosis and treatment plan for a patient. As the aging process accelerates in our country, the diseases of hospitalized patients often involve multiple systems and organs; consequently, the importance of interdepartmental consultation cannot be overlooked. It not only integrates multidisciplinary diagnostic and therapeutic resources—improving the accuracy of clinical diagnosis and the synergy of treatment—but also strengthens technical cooperation between departments, thereby promoting the improvement of the hospital's overall medical standards. Despite the significant position of interdepartmental consultation within the healthcare system, current research on its status in general hospitals remains relatively scarce. This study utilizes a questionnaire survey to understand the current state of interdepartmental consultation in general hospitals and analyze potential issues, aiming to provide reference points for the continuing education and training of clinicians and the optimization of clinical consultation management by medical departments.

the improvement of the hospital's overall medical standards.

1.1 研究对象

From August 14 to September 14, 2023, clinicians from general hospitals who voluntarily participated in an online questionnaire survey were selected as the study subjects. Key words: General hospital; Interdisciplinary consultation; Questionnaires; Status of consultation.

The study subjects were clinicians recruited via an online questionnaire survey. The inclusion criteria were as follows: (1) currently engaged in clinical medical work within a general hospital; (2) possessing the capacity to conduct clinical diagnosis and treatment independently; (3) having experience with interdisciplinary consultations within the past year; and (4) voluntarily participating in the survey and signing the informed consent form. The exclusion criteria were: (1) medical personnel not working on the clinical frontline; (2) subjects who provided incomplete questionnaires or completed the survey in less than 60 seconds; and (3) medical personnel who refused to sign the informed consent form. This study was reviewed and approved by the Medical Ethics Committee of Shenzhen Longgang Central Hospital (Ethics Approval No.: 2023ECYJ064), and all participants provided signed informed consent.

1.2.1 问卷设计：研究者（主任医师）检索中国知网、

Methodology

Survey Instrument Design

The research team developed the initial draft of the "Survey on the Current Status of Inter-departmental Consultations in General Hospitals" by reviewing relevant literature from databases such as Wanfang Data and PubMed, combined with clinical experience and specific research objectives. To ensure the instrument's rigor, two senior clinical experts were consulted. Following six iterative cycles of consultation, feedback, and revision, the final questionnaire was established. The survey comprises four primary sections: basic demographic information of respondents, the current status of inter-departmental consultations, perceptions and evaluations of these consultations, and respondents' expectations for system improvements.

Measurement and Definitions

The section regarding the current status of inter-departmental consultations utilized a ranking format. Respondents were asked to rank relevant departments based on the frequency of consultation requests. A weighted scoring method was employed for quantitative analysis: 1st place received 5 points, 2nd place 4 points, 3rd place 3 points, 4th place 2 points, 5th place 1 point, and 6th place or lower received 0 points. The comprehensive score was calculated using the following formula:

$$ \text{Comprehensive Score} = \frac{\sum (\text{Frequency of rank position} \times \text{Corresponding rank score})}{\text{Total frequency of the department being ranked in the top five}} $$

A higher score indicates that a department is prioritized more highly in the clinical perception of consultation needs. For the purposes of this study, consultations were categorized into two types:
- Routine Consultations: Defined as cases where the patient's condition is stable with no immediate life-threatening risks (e.g., difficult diagnoses or management of chronic complications). These are requested via written or electronic applications by the primary department to optimize diagnosis and treatment. The invited department is required to arrange for a physician at the attending level or above to complete the consultation within 24 hours.
- Emergency Consultations: Defined as critical, potentially life-threatening situations (e.g., shock or massive hemorrhage) where resuscitation is the priority. These can be initiated verbally; the invited department must ensure a senior physician arrives on-site within 10 minutes, with documentation completed subsequently.

Reliability and Validity

The section evaluating perceptions and evaluations of inter-departmental consultations utilized a 5-point Likert scale [TABLE:5]. Responses ranged from "Strongly Agree" (5 points) to "Strongly Disagree" (1 point). Data analysis yielded a Cronbach’s alpha coefficient of 0.80 and a Kaiser-Meyer-Olkin (KMO) value of 0.838 ($p < 0.001$), indicating that this portion of the questionnaire possesses high internal consistency and structural validity.

Expectations for Improvement

The final section of the survey addressed respondents' expectations for improving the consultation process. This section employed closed-ended multiple-choice and single-choice questions to investigate the implementation of existing consultation protocols, incentive mechanisms, and suggestions for systemic improvements within the hospital.

1.2.2 问卷发放：本研究采用问卷调查方法，采用

The Word document was imported into the "Wenjuanxing" (SurveyStar) platform. After iterative testing and refinement, a finalized link was generated and distributed to multiple national-level clinical physician WeChat exchange groups. In the introductory section of the questionnaire, the purpose and significance of the study were clearly explained to the participants to obtain their informed consent. It was explicitly stated that all raw information collected in this study would remain strictly confidential, and standardized language was used to explain the requirements for completing the survey.

1.2.3 问卷收集及质量控制：到调查截止日期后，研究

The researchers then closed the data collection system. The collected questionnaires were exported to Excel spreadsheets and independently reviewed by two researchers. The review primarily focused on identifying missing items, assessing the logical consistency between responses, and ensuring the completeness of key information fields (such as professional title and years of experience). Furthermore, the rationality of the responses was verified against the participants' professional backgrounds. According to the established quality standards, the questionnaires were categorized as fully valid (all questions completed accurately), partially valid (key information complete with a few minor questions left blank), or invalid (informed consent not signed, completion time under 60 seconds, more than 30% of questions unanswered, or evidence of arbitrary responses). Following a consensus discussion, partially valid questionnaires were retained for their key information, while invalid questionnaires were excluded to ensure the accuracy and reliability of the subsequent data analysis.

Statistical Analysis

Statistical analysis was performed using SPSS 25.0 software. Descriptive statistical methods were employed for data analysis. Quantitative data following a normal distribution are expressed as mean ± standard deviation ($\bar{x} \pm s$), with intergroup comparisons conducted using the independent samples $t$-test. Categorical data are presented as relative numbers (frequencies and percentages), and intergroup comparisons were performed using the $\chi^2$ test.

2 检验或fisher

The exact probability method was employed; for ranking questions, the case-ranking method was used to determine the sequence. A p-value of less than 0.05 was considered to indicate a statistically significant difference.

2.1 问卷回收情况

A total of 283 electronic questionnaires were recovered. Among these, 281 respondents (281/283, 99.29%) completed the survey after signing the informed consent form, resulting in a recovery rate of 99.29% (281/283). Of the 281 questionnaires, 233 (233/281, 82.92%) were from general hospitals, and 48 (48/281, 17.08%) were from primary healthcare institutions. Among the 233 questionnaires completed by clinicians in general hospitals, 220 (220/233, 94.42%) indicated that they had carried out inpatient clinical work. Of these, 216 (216/220, 98.18%) questionnaires indicated that the respondents

had actually performed interdepartmental consultations, and all 216 questionnaires had a completion time of $>60$ seconds. Finally, after review and verification by two researchers, these 216 valid questionnaires were included in this study, yielding an effective recovery rate of 76.33% (216/283).

2.2 General Information

The 216 respondents were clinicians from general hospitals across 21 provinces, municipalities, and autonomous regions, including Guangdong, Jiangxi, Zhejiang, Guangxi Zhuang Autonomous Region, and Shaanxi. Their demographic characteristics are summarized in [TABLE:1]. The average age of the 216 clinicians surveyed was $(38.14 \pm 7.79)$ years. Respondents from tertiary hospitals accounted for 90.28% of the sample. There were 93 general practitioners (43.06%) and 123 non-general practitioners (56.94%). Clinicians with more than 10 years of clinical experience accounted for 51.39% of the total, and the majority held the professional title of attending physician (39.35%).

2.3 Current Status of Interdepartmental Consultations

This study analyzed the distribution of routine and emergency consultations performed by physicians with different professional titles [TABLE:2]. For resident physicians, the proportion of emergency consultations was higher than that of routine consultations, and this difference was statistically significant ($P < 0.05$). Attending physicians...

Chinese General Practice https General information of 216 clinical physicians

< 30 years old: 29 (13.43%)

40 years old: 79 (36.57%)

Years of clinical experience

< 5 years: 43 (19.91%)

10 years: 111 (51.39%)

When comparing the proportions of routine and emergency consultations performed by residents, attending physicians, associate chief physicians, and chief physicians, no statistically significant differences were observed ($P > 0.05$). However, there was a statistically significant difference in the distribution of physicians across different professional titles for both routine and emergency consultations ($P < 0.001$). Attending physicians played a dominant role, followed by associate chief physicians, while residents and chief physicians were the least represented. Regarding completion times, 94.44% (204/216) of routine consultations were completed by midnight of the same day or within 24 hours, with only 5.56% (12/216) requiring up to 48 hours. For emergency consultations, 79.17% (171/216) were completed within 10 minutes, and 98.05% (212/216) were completed within 30 minutes; only 1.85% (4/216) took up to 60 minutes to complete.

When asked, "In your clinical practice, what proportion of patients require interdepartmental consultation?", 43.52% (94/216) of respondents selected < 20%, 23.15% (50/216) indicated that 41%–80% of patients required consultation, and only 2.78% (6/216) selected 81%–100%. Physicians primarily completed consultations by visiting wards to examine patients and providing written recommendations, accounting for 85.19% (184/216) of routine consultations and 83.33% (180/216) of emergency consultations. Telephone consultations accounted for 2.78% (6/216) of routine and 11.11% (24/216) of emergency cases. Modern network-based consultation methods (such as WeChat, DingTalk, or Hospital Information Systems) were utilized in 12.04% (26/216) of routine and 5.56% (12/216) of emergency consultations.

Clinicians generally believed that the issues raised could be effectively resolved through a single consultation. The number of patients requiring interdepartmental consultation in general practice departments ($36.80 \pm 21.54$) was significantly higher than in non-general practice departments ($24.91 \pm 17.27$), a difference that was statistically significant ($t = 4.370, P < 0.001$). Based on the clinicians' retrospective assessment of consultation frequency and comprehensive scores over the preceding three months, the top five departments requested for consultations were Internal Medicine (6.67 points), Surgery (5.81 points), Rehabilitation and Physiotherapy (3.48 points), ENT (3.34 points), and Traditional Chinese Medicine (3.27 points). For patients with comorbid non-surgical diseases, the top five departments by consultation frequency and score were Cardiology (8.81 points), Neurology (6.63 points), Respiratory Medicine (6.62 points), Endocrinology (5.75 points), and Gastroenterology (5.39 points). For patients with comorbid surgical diseases, the top five departments were General Surgery (7.71 points), Orthopedics (5.08 points), Vascular Surgery (4.87 points), Thoracic Surgery (4.42 points), and Neurosurgery (3.75 points).

Distribution of general consultation and emergency consultation by physician title

2 值

P-value <0.001 <0.001

Note: — indicates the use of Fisher's exact test.

2.4 临床医师对科间会诊的看法及评价

In an analysis of clinicians' perceptions of interdepartmental consultations, the 216 participating clinicians showed high levels of agreement with the statements that "interdepartmental consultation can improve the quality of medical care" and "interdepartmental consultation can assist in clarifying diagnoses." The vast majority of clinicians considered interdepartmental consultation necessary for patients who "experience poor initial treatment effects and may require transfer to another department." Furthermore, most clinicians expressed high levels of support for interdepartmental consultation when managing patients with "undifferentiated diseases, comorbidities, or complex conditions," as detailed in [TABLE:3]. The results of this survey indicate that clinicians perceive the primary advantages of interdepartmental consultation to be: assisting in the formulation of optimal treatment plans (90.28%, 195/216), providing opportunities for the exchange of professional knowledge and opinions (89.35%, 193/216), and assisting in establishing correct diagnoses (86.11%, 186/216). Conversely, the perceived disadvantages were primarily concentrated on increased treatment and waiting times (63.89%, 138/216) and the untimely or inaccurate transmission of information (61.11%, 132/216). Regarding personal clinical experience, respondents reported that interdepartmental consultations "frequently" resolved patient issues in 68.06% of cases (147/216) and "sometimes" resolved them in 30.09% of cases (65/216).

The analysis of clinicians' evaluations regarding interdepartmental consultations revealed significant findings.

Clinicians expressed a high level of approval regarding the quality of consultations provided by associate chief physicians and chief physicians, with satisfaction rates of 97.68% (211/216) and 96.76% (209/216), respectively. In contrast, the satisfaction rate for the quality of consultations provided by attending physicians was notably lower at 81.02% (175/216).

Further investigation into the reasons for clinician dissatisfaction with consultation results showed that issues were primarily concentrated on the "failure to provide specific treatment recommendations" (76.39%, 165/216) and the "failure to provide valuable diagnostic information" (73.15%, 158/216).

Personal factors attributed to the consulting physicians included a lack of communication and collaboration (53.70%, 116/216), time management issues (39.35%, 85/216), insufficient professional competence (32.87%, 71/216), and a lack of care and empathy (25%, 54/216), as shown in [FIGURE:1]. When faced with a lack of communication and collaboration from a consulting physician, the survey indicated that requesting clinicians would often seek a second opinion (75.86%, 88/116) or provide more explicit patient-specific information (64.66%, 75/116), while rarely filing a complaint with hospital management (7.76%, 9/116). For consulting physicians with time management issues, applicants typically took the initiative to negotiate consultation times (74.12%, 63/85), utilize consultation time more efficiently (56.47%, 48/85), or provide necessary information in advance (54.12%, 46/85). When encountering low professional competence in a consulting physician, applicants were likely to seek a second opinion (81.69%, 58/71) or raise questions and concerns (80.28%, 57/71), with few providing feedback to hospital management (18.31%, 13/71). Over the past year, respondents performed an average of $25.54 \pm 30.96$ interdepartmental consultations; however, only 63.9% (138/216) believed their consultations successfully resolved the requesting clinician's problems. This survey suggests that factors hindering the motivation of consulting physicians include high work pressure (65.2%, 141/216), poor time management (62.96%, 136/216), a lack of recognition and rewards (60.19%, 130/216), and a lack of teamwork awareness (40.74%, 88/216).

Regarding clinicians' expectations for interdepartmental consultations, 176 out of 216 clinicians (81.48%) reported that their hospitals have established consultation systems and provide relevant training. Additionally, 77.78% (168/216) noted that their hospital's medical management department conducts regular quality inspections of consultations. Incentive mechanisms for consultations were established in 62.5% (135/216) of the respondents' hospitals; among these, material incentives accounted for 37.5% (81/216), spiritual incentives for 8.8% (19/216), and a combination of both for 26.39% (57/216), while 27.31% (59/216) reported no incentive mechanism. In this study, the 216 clinicians expressed expectations at the hospital level regarding the reasons for dissatisfaction with consulting physicians and corresponding countermeasures for applicants.

Chinese General Practice https

($\bar{x} \pm s$, points) Clinical physicians' perceptions of interdisciplinary consultations

Regarding consultation management, optimizations and improvements can be implemented in several key areas: "consultation workflow" (75.00%, 162/216), "consultation quality and safety" (75.00%, 162/216), "consultation incentives" (74.54%, 161/216), and "strengthening hospital information technology infrastructure" (64.81%, 140/216). Furthermore, a vast majority of clinical physicians expressed a willingness to undergo training to enhance their knowledge and skills related to interdisciplinary consultations (92.13%, 199/216).

3 讨论

Consultation is a common medical activity in general hospitals and serves as a fundamental medical system. Types of consultations include intra-departmental, inter-departmental, and multidisciplinary team (MDT) consultations. Among these, inter-departmental consultation is the most common modality. Currently, as clinical disciplines become increasingly specialized, the capacity for treating specific diseases has become more prominent; however, the comprehensive diagnostic and therapeutic abilities of some clinicians have weakened. This shift has made it difficult to meet the needs of patient-centered integrated care, leading to a continuous increase in the demand for inter-departmental consultations. This study utilizes a questionnaire survey to understand the current status of inter-departmental consultations in general hospitals and analyze potential issues. Based on these findings, we propose the following strategies to provide a reference for the continuing education and training of clinicians and the management of consultation work by medical departments.

Strengthening continuing education and training for clinicians is essential to enhance their comprehensive diagnostic and therapeutic capabilities. The results of this survey show that in clinical practice, 30.03% of patients require inter-departmental consultations during a single hospitalization to assist in managing related diseases, health issues, or collaborative treatment. This indicates that disease complexity and clinical collaboration account for a significant proportion of overall medical care, which is related to the fact that tertiary hospitals primarily admit critically ill and complex cases. Furthermore, this trend is linked to the acceleration of population aging and the increase in patients with comorbidities as life expectancy extends. Further analysis revealed that, compared to non-general practice departments, patients managed by general practitioners required a higher proportion of inter-departmental consultations ($P < 0.05$). This may be because general practice departments primarily admit patients with undifferentiated diseases and comorbidities. Undifferentiated diseases refer to a category of conditions where a definitive diagnosis cannot yet be made based on clinical manifestations and examination results at any given stage \cite{6-7}; these cases require inter-departmental consultations or even hospital-wide MDT collaboration to complete diagnosis and treatment. Patients with comorbidities involve multiple systems and diseases, requiring high technical standards for diagnosis and treatment. Moreover, research on the management of comorbidities is relatively weak and lacks systematic clinical guidelines, necessitating inter-departmental consultations to ensure the quality of care. Regarding the frequency of consultations within a cycle for patients managed by clinicians, the results showed a descending order of internal medicine, surgery, and rehabilitation/physiotherapy. Further analysis of non-surgical departments showed that the top three departments for consultation frequency were cardiovascular medicine, neurology, and respiratory medicine; for surgical departments, the top three were general surgery, orthopedics, and vascular surgery. This suggests that hospital continuing education departments should strengthen post-graduate and lifelong learning education for clinicians, focusing on training and assessment for cardiovascular, cerebrovascular, and respiratory diseases, as well as orthopedics and vascular surgery. By organizing specialized lectures and training sessions led by experts from departments with high invitation frequencies, hospitals can address the weaknesses of clinicians and improve their overall ability to analyze and manage cases. Additionally, during the inter-departmental consultation process, active communication between the requesting physician and the invited consultant should be encouraged to strengthen the understanding of professional knowledge, ensuring that clinicians genuinely acquire knowledge from consultations to enhance their professional skills and diagnostic levels.

3.2 加强人文课程培训，提升会诊满意度

A 2021 study on the prevalence of incivility among clinicians during interdepartmental consultations revealed that consultants in ophthalmology and emergency departments frequently exhibit uncivil behaviors during routine consultations, such as arrogant attitudes, verbal reprimands, and inappropriate joking.

In the present study, the primary reasons for clinician dissatisfaction with consultants included "lack of communication and collaboration" and "time management issues." These findings suggest a deficiency in communication skills among clinicians, indicating that medical continuing education should incorporate humanistic curricula focused on communication skills training. Content should include effective communication techniques, active listening, and non-verbal communication to enable clinicians to demonstrate higher humanistic literacy when interacting with patients, colleagues, and other members of the healthcare team. Furthermore, medical administration departments are encouraged to implement diverse communication training programs, such as clinical skill competitions and debates. These activities not only help improve clinical proficiency but also enhance communication skills and teamwork in practical scenarios, as noted by MGBOJI et al. Regarding time management, medical departments should first provide training on standardized consultation protocols, covering application, preparation, the consultation process, and documentation. Secondly, medical administrators must continuously improve and optimize consultation workflows to eliminate unnecessary steps and time waste, while establishing efficiency evaluation mechanisms for real-time monitoring and assessment to identify and address issues promptly.

Strict management of consultant qualifications is essential to ensure the quality of consultations. Current regulations stipulate that invited consultants must hold the rank of attending physician or higher. However, this survey indicates that in some hospitals, residents are participating in routine or even emergency consultations. This reflects an insufficient reserve of attending physicians in certain institutions, necessitating that residents assume these responsibilities. Because junior physicians have limited experience, their consultation results may fail to meet the requirements of the requesting department or achieve the desired clinical effect, thereby diminishing overall quality. Consequently, clinical departments must strictly enforce qualification requirements: emergency consultations should be handled by the chief resident, while routine consultations should be conducted by senior attending physicians or those of higher rank. If a clinician encounters difficulties during a consultation, they should promptly request on-site guidance from a superior physician to ensure the quality of care.

Artificial intelligence (AI) should be introduced to strengthen management and ensure the timeliness of consultations. Consultation quality is a vital metric for quantifying hospital medical quality, and timeliness is a core indicator of medical quality control \cite{11-12}. Previous research has shown that patients requiring consultations from two or more departments often experience emergency department stays exceeding 4 hours [16.4% ($\ge 4$ h) vs. 0.6% ($< 4$ h)], suggesting that an increase in the number of required departments and delayed completions prolong patient hospitalization. In this survey, only 75.00% of the 216 clinicians believed that routine consultations could be completed within 24 hours, representing a 25.00% timeout rate. This indicates a lack of timeliness among some physicians, potentially due to a shortage of consultants and heavy workloads, or a lack of professional responsibility leading to delays. To address this, medical management departments should utilize AI to enhance quality control before, during, and after consultations. Pre-consultation, AI-driven reminder functions modeled after critical value management should be implemented. For instance, if a request remains unacknowledged for a certain period (e.g., 6 hours), a reminder can be sent via SMS or platforms like WeChat and DingTalk. If unaddressed after 24 hours, a notification should be sent to the head of the invited department; after 48 hours, the information should be escalated directly to the medical management department. During the consultation, the AI system can verify the consultant's qualifications upon their arrival. Simultaneously, the requester should provide real-time feedback to the system regarding the consultant's performance, such as whether they examined the patient before documenting the consultation. Post-consultation, the system should re-verify qualifications and require the submission of satisfaction and quality monitoring data. Additionally, consultants can use the AI system to report issues such as poorly justified consultation requests. Management can then exercise effective oversight based on this feedback, incorporating it into scoring mechanisms and reward/punishment systems. Establishing this bidirectional feedback mechanism allows for the scientific supervision and evaluation of the consultation process, strengthening interdisciplinary cooperation and improving quality. Administrators are also encouraged to engage directly with frontline clinical activities—such as morning handovers, night rounds, and irregular inspections—to gather direct feedback. Regularly distributing feedback forms and publicly addressing departments or individuals responsible for poor quality or delays will ensure the timeliness and effectiveness of consultation work \cite{15-16}. Optimizing consultation workflows is also critical for efficiency. According to this survey, the majority of clinicians (75.00%, 162/216) expect the hospital to optimize these processes. Currently, the routine workflow involves clinicians issuing requests via the "Consultation Application" module in the Haitai system, with invited physicians logging in periodically to check for requests. Problems in this process include insufficient descriptions of patient conditions, incomplete auxiliary examinations, perfunctory documentation, and the failure of the primary physician to brief the consultant, all of which hinder efficiency. Therefore, as the initiators of the process, clinicians should strictly adhere to consultation indications, clarify the urgent issues to be resolved, and issue requests only after approval from the medical group leader or chief resident. Upon the consultant's arrival, the primary physician or chief resident should present the case and provide medical records to facilitate the work. Furthermore, medical departments should strengthen the enforcement of these protocols and establish an adverse event reporting system. Issues such as unjustified requests or delays should be classified as medical adverse events; once reported and verified, the medical department should conduct formal interviews with the involved departments and physicians \cite{19-20}. In cases of persistent untimeliness, the medical department should notify the department head to arrange for a qualified physician to complete the consultation within the specified timeframe.

4 小结

This study summarizes and analyzes the current status of interdepartmental consultations in general hospitals, as well as the perceptions and evaluations of clinical physicians regarding these consultations. Although this study was conducted via an online questionnaire and is subject to certain limitations in sample size, a search of databases including CNKI, Wanfang Data, and PubMed revealed no similar published literature. Furthermore, the data in this study were screened based on strict exclusion criteria, resulting in 216 cases included for statistical analysis. Consequently, the data presented here possess a degree of representativeness that can help clinicians understand the characteristics and current state of interdepartmental consultations, providing a reference for optimizing clinical consultation practices. Additionally, due to practical constraints, this study performed only a preliminary analysis of the frequency of consultations within the inpatient cycles managed by clinicians and did not further categorize the specific disease composition of these consultations. Future research could expand the sample size and conduct a systematic analysis of the disease profiles involved in interdepartmental consultations. Such efforts are expected to yield conclusions with greater clinical guidance value, providing a more precise basis for optimizing consultation workflows and improving diagnostic and therapeutic efficiency.

Author Contributions: Sun Junsheng was responsible for questionnaire design, study design, data organization, statistical analysis, and the writing and revision of the manuscript; Yuan Fuzhen was responsible for data organization, statistical analysis, and manuscript writing; Liu Ying and Zhang Eryao were responsible for questionnaire design and guidance; Ren Jingjing was responsible for questionnaire design, study design, research guidance, and manuscript revision, and assumes overall responsibility for the article.

The authors declare no conflicts of interest.

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(Received: 2024-02-20; Revised: 2024-09-04)
(Editor: Wang Shiyue)