2024/08/28 by Isaac KS Ng, Isaac K S Ng, Shir Lynn Lim +6 · 6 citations
Business, Management and Accounting · Economics, Econometrics and Finance · Health Professions · Medicine · Nursing · #Audit #Context (archaeology) #Family medicine #Health care #Healthcare Policy and Management #Healthcare Systems and Technology #MEDLINE #Medicine #Nursing #Patient-Provider Communication in Healthcare #Referral #Specialty #Subspecialty
paper · doi:10.1093/postmj/qgae106
published in Postgraduate Medical Journal 101(1191), 76-83 (Oxford University Press)
openalex publication_date 2024/08/28 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
Subspecialty consultations are becoming highly prevalent in hospital medicine, due to an ageing population with multimorbid conditions and increasingly complex care needs, as well as medicolegal fears that lead to widespread defensive medical practices. Although timely subspecialty consultations in the appropriate clinical context have been found to improve clinical outcomes, there remains a significant proportion of specialty referrals in hospital medicine which are inappropriate, excessive, or do not add value to patient care. In this article, we sought to provide an overview of the common problems pertaining to excessive quantity and suboptimal quality of inpatient subspecialty consultations made in real-world practice and highlight their implications for healthcare financing and patient care. In addition, we discuss the underlying contributing factors that predispose to inappropriate use of the specialist referral system. Finally, we offer a practical, multitiered approach to help rationalize subspecialty consultations, through (i) a systematic model ('WISE' template) for individual referral-making, (ii) development of standardized healthcare institutional referral guidelines with routine clinical audits for quality control, (iii) adopting an integrated generalist care model, and (iv) incorporating training on effective referral-making in medical education.