Discrepancies Between Perceived and True Urgencies of Vascular Surgery Consults

Abstract

Background: Appropriate allocation of consult service resources is essential to reduce burnout. This study analyzed vascular surgery consults to compare referring services' perceived urgency with actual need for urgent therapy.

Methods: A randomized sample of 1,279 consults for patients of >18 years from 2019 to 2023 was retrospectively reviewed. Consults were evaluated for indication and whether surgery occurred inpatient or outpatient. Perceived urgency was designated as STAT or routine by the referring team placing the consult. "True" urgency was defined by whether a vascular procedure occurred during the same hospitalization. Agreement was defined as matched perceived and true urgency. Logistic regression identified predictors of agreement by vascular pathology, consulting service, and time of day, adjusting for race, sex, and age.

Results: Overall, 67.0% of consults demonstrated agreement between perceived and true urgency. Routine consults were accurate in 77.6% of cases versus 22.1% of STAT consults, resulting in inpatient intervention (P < 0.001). Agreement was lowest for peripheral arterial disease (PAD), acute limb ischemia (ALI), and compartment syndrome (P < 0.05) and higher for aneurysmal, mesenteric ischemia, cerebrovascular, and venous diseases (P < 0.05). Intensive care unit (ICU) consults had lower agreement (adjusted odds ratio [aOR] 0.53, P < 0.001), while medicine consults had higher agreement (aOR 1.41, P < 0.05) compared to the emergency department (ED). Agreement was lowest for consults placed between 00:00-02:59 and 15:00-17:59.

Conclusion: Discrepancies exist between perceived and true urgency of vascular consults, particularly from the ICU and for PAD, ALI, and compartment syndrome, highlighting an opportunity for targeted education to improve inpatient workflow.