The common practice of “curbside consultation”

Integrating trauma-informed services in out-of-school time programs to mitigate the impact of community gun violence on youth mental health

Community gun violence disproportionately impacts youth in low-income urban neighborhoods. Integrating trauma-informed mental health care in community-based out-of-school time (OST) programs is an innovative method of service delivery for these youth. This article provides justification for integrating evidence-based, trauma-informed services in OST programs within communities characterized by high rates of violent crime to minimize the impact of violence exposure on youth mental health. We describe the initial feasibility of a model program, the Violence Intervention and Prevention (VIP) Initiative, implemented in a small city in southeastern Pennsylvania. Within the first six months of the VIP Initiative, 95 community residents (90% under age 18; 51% Hispanic) received intervention services, primarily through single-session and short-term weekly group intervention in OST programs, and 80% of OST youth development staff participated in at least one trauma-informed professional development training. Recommendations to enhance and expand the delivery of trauma-informed services in the novel setting of OST programs are provided.

Development and Implementation of a Peer Curbside Consult Service for Pediatric Hospitalists

OBJECTIVE

To describe the development and implementation of a Peer Curbside Consult Service (PCCS) for a pediatric hospital medicine (PHM) division.

METHODS

We developed a pilot intervention with hospitalists at a freestanding children's hospital to provide peer consultation services for challenging clinical cases. Postconsultation surveys collected from both the requesting and consulting hospitalists provided feedback about the program. The 12-point Template for Intervention Description and Replication (TIDieR) checklist is used to describe the process for program creation and implementation.

RESULTS

The PCCS has provided 60 consultations in the first 2 years since implementation in April 2020 and supports a large PHM division with >75 members who practice at a tertiary care, freestanding children's hospital and 7 affiliate sites. Hospitalists request peer consultation for challenging clinical cases. The consultations were typically conducted in person or via telephone. Currently, 11 PHM faculty members within the division volunteer as consultants, with 2 assigned per week. Electronic postconsultation experience surveys were received from 70% of requesting and 89% of consultant hospitalists. We also provide preliminary data from this pilot intervention in the Supplemental Information.

CONCLUSIONS

We successfully established a peer consult service that provided just-in-time clinical decision support across the various practice sites. Through transparent reporting using the TIDieR checklist, other divisions may be able to replicate and adapt their own peer consult program.

Curbside Consultation for the Nurse Practitioner: Qualitative Inquiry for Education, Policy, and Practice

BACKGROUND AND PURPOSE

Curbside consultation (CC), defined as pursuing information or recommendation regarding patient care, without request for formal consultation is a favored information source for nurse practitioners (NPs) when making clinical decisions in practice settings. Research and education concerning CC among NPs is lacking. The purpose of this study was to obtain an understanding of NP perceptions of interpersonal aspects of the CC process to inform NP clinical practice and education.

METHODS

Qualitative descriptive design and inductive content analysis was used. Twenty primary care and specialty care NP were recruited using purposive sampling for conduct of individual interviews.

RESULTS

Content analysis identified themes describing interpersonal components of the CC process. NP practiced in collaboration with physicians in variable roles within primary care and specialty care settings. These collaborations varied dependent upon supervisory relationships with physicians. Additional themes concerned NP professional experience and characteristics of experts desired for CC. These characteristics included NP perceptions of colleague experience and expertise, trust, and interpersonal relationship dynamics.

IMPLICATIONS FOR PRACTICE

CC processes for NPs are multidimensional, including interpersonal themes as components of this communication exchange. Given CC is a highly utilized resource for NPs, further inquiry is critical for understanding of its implications for NP practice, policy, and education internationally.

Curbside consultation: A means to promote quality patient care

The objective of this descriptive, cross-sectional study was to describe curbside consultation, a bidirectional informal discussion with a colleague "expert" concerning patient care, among nurse practitioners. Curbside consultations are valuable, yet little is known about this process use for nurse practitioners. A national convenience sample was recruited using online social media platforms and email. Data were collected in June 2019 via Qualtrics survey software. Web-based survey included 80 questions concerning use and definition of curbside consultation, and followed STROBE guidelines for reporting. Questions also concerned work environment, personal and interpersonal qualities, communication modality and patient engagement. Descriptive and survey item analyses including frequency, percentage, means and standard deviation, Chi-square and Fisher's Exact Test, Pearson's correlation analysis, and one-way independent t-tests. Participants included nurse practitioners (N = 402) in primary (51.2%, N = 206) and specialty care (46%, N = 185). Nurse practitioners reported positive experiences with curbside consultations (96.8%, N = 384) and that reliable access to colleagues was correlated with multiple variables, including practice culture (r = 0.494, p = .001). Most reported (99%, N = 387) patients receive better care with successful curbside consultation. Curbside consultations provide nurse practitioners information access at point-of-care for implementation of evidence-based practice to promote quality patient care. Addition of curbside consultation education is a compelling consideration of nurse practitioner curriculum.

Exploring the use of curbside consultations for interprofessional collaboration and clinical decision-making

Nurse practitioners utilize curbside consultation, an interprofessional collaboration communication process in which one clinician seeks advice from another, in clinical decision-making practices. Nevertheless, this process is not well-understood. A qualitative design with individual open-ended interviews was used to explore the phenomenon of curbside consultation among nurse practitioners for clinical decision-making. Twenty primary care and specialty nurse practitioners participated. Participants were recruited via purposive sampling from in-patient and out-patient settings in order to reach saturation of themes. Using inductive content analyses, the findings revealed that nurse practitioners made multiple decisions in the course of information-seeking and its application during the curbside consultation process. Motivated by the patient's best interest, nurse practitioners provided advice in the curbside consultation exchange and sought answers to questions encountered in clinical decision-making. Multiple resources were often utilized with curbside consultation frequently evolving into formal consultation. Dynamics of curbside consultation included (a)synchronous approaches including text, e-mail, telephone, or face-to-face processes. Once information was received, nurse practitioners decided whether they (dis)agreed with advice and if validation was necessary. Nurse practitioners utilized curbside consultation for clinical decision-making and means for interprofessional collaboration, thereby increasing clinical competency and promoting quality patient outcomes. Implications of curbside consultation for education and practice require further exploration to enhance outcomes of curbside consultation processes.

What is curbside consultation for the nurse practitioner?

BACKGROUND

Curbside or informal consultations between clinicians regarding patient care occur frequently in clinical practice. Evaluation of curbside consultation (CC) among nurse practitioners (NPs) is limited.

PURPOSE

To develop an understanding of NP perceptions of the CC process.

METHODOLOGICAL ORIENTATION

A qualitative descriptive design was used to assess the context of CCs among NPs. Inductive content analysis was conducted, and Atlas.ti was used to organize the data.

SAMPLE

Purposive sampling was used to recruit 20 NPs within primary care and specialty settings.

CONCLUSIONS

Themes describing CC included the description of the CC process, advantages and disadvantages, documentation, legal liability, unspoken rules, and patient-centered engagement. There was a lack of consensus on the boundaries of the CC definition including difficulty in distinguishing a CC from a formal consultation. Generally, the NP acknowledges limitations and views the CC favorably as a helpful tool for receiving practical feedback and expanding learning, collegiality, and collaboration.

IMPLICATIONS FOR PRACTICE

Findings provide insight regarding the common practice of CC in management of patients at the point of care, what it means to the NP, and a description of the breadth of the CC use. Given its potentially substantial impact on patient care, further assessment of the context of CC among NPs is obligatory.

DETELPROG Study. Effectiveness of a New Model of Scheduled Telephone Referral from Primary Care to Internal Medicine. A Randomised Controlled Study

In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. A randomized controlled clinical trial has been carried out to assess the effectiveness of DELTELPROG. In a sample of 255 patients, the experimental group was referred via a scheduled telephone call, and those in the control group, by face-to-face hospital consultation area. The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20–33) regarding specialised consultation, 47 days (95% CI: 17–74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.