Implementing a hospital-wide program for documenting informal clinician consultations improved patient safety through better communication and multi-disciplinary care in a pediatric healthcare system, according to a recent study published in JAMA Pediatrics.
Curbside consultations, in which a physician informally asks their colleagues for medical advice, are an integral part of the U.S. healthcare system. While beneficial, these interactions can also increase the risk of miscommunication through poor exchange of information and a lack of compensation for time spent during the exchange.
In 2019, the American Medical Association established new Current Procedural Terminology (CPT) codes allowing for the reimbursement of patient care advice given by healthcare professionals who do not see the patient face-to-face. Successful implementation of these codes and the billing of insurers at a single healthcare system, however, had not yet been fully demonstrated until now.
“We realized that these billing codes that have existed for years but are underutilized. We aimed to develop a process to stand up use of those billing codes to improve communication by motivating providers to document recommendations given via curbside consultations” said lead author Caitlin Li, MD, assistant professor of Pediatrics in the Division of Infectious Diseases.
In the study, Li and colleagues implemented a hospital-wide program to document and bill for interprofessional consultations using the established CPT codes. Their interventions took place between March and July 2025 across Ann and Robert H. Lurie Children’s Hospital of Chicago.
They completed five rounds of interventions:
- The infectious diseases service had previously completed a successful pilot of interprofessional consultations. They established an expectation that infectious diseases providers would no longer perform undocumented curbside consultations for questions eligible for interprofessional consultations.
- Releasing a template accessible by all providers and providing education to clinical practice directors and advanced practice clinician leadership.
- Holding workshops for divisions to customize interprofessional consultation templates that maximize documentation efficiency.
- Providing education and coaching at faculty meetings, creating division-specific interprofessional consultation templates as additional divisions opted in, and sharing tip sheets.
- Releasing an interprofessional consultation-specific attestation phrase that supported inclusion of trainees in the interprofessional consult process, along with education at division head meetings.
At baseline, an average of 0.9 interprofessional consultations per week were performed, and following all interventions the hospital ultimately sustained over 40 interprofessional consultations per week.
This included the transition to a new academic year, and the authors noted that interprofessional consult rates actually increased as the new trainees started, suggesting that the program was well-received by residents and fellows. There was no decrease in overall face-to-face consultations during the entire study period.
Locations for the first 1,000 postintervention interprofessional consultations included acute care (42.2 percent), emergency department (22.1 percent), pediatric intensive care unit (11.1 percent), outpatient settings (9.6 percent), acuity-adaptable cardiac care unit (6.3 percent), neonatal intensive care unit (5.6 percent), and other or unknown settings (3.1 percent).
Top interprofessional consultation users by specialty were infectious diseases (26.3 percent), pulmonology (18 percent), wound care (13.1 percent) and endocrinology (10.4 percent).
Li said that leveraging existing CPT codes to convert curbside consultations to documented encounters is expected to improve safety of patient care, and this program can likely be implemented across different healthcare systems.
“With that documentation, you’re not relying on a game of telephone,” Li said. “Curbside consultations as a concept in medicine aren’t going away anytime soon. This is a much safer way to approach situations when a provider needs to ask a specialist but a face-to-face visit isn’t practical or possible.”
Ravi Jhaveri, MD, the Virginia H. Rogers Professor of Infectious Disease and chief of Infectious Diseases in the Department of Pediatrics, was senior author of the study.
Co-author of the study include Marcelo Malakooti, MD, MBA, ‘11 GME, the Crown Family Professor of Pediatrics; Jill Samis, MD, ‘09 GME, associate professor of Pediatrics in the Division of Endocrinology; Robert Greenberg, MD, ‘05, ‘07 GME, assistant professor of Pediatrics in the Division of Hospital-Based Medicine; Maria Dowell, MD, associate professor of Pediatrics in the Division of Pulmonary and Sleep Medicine; Dana Schinasi, MD, ‘23 MSHI, associate professor of Pediatrics in the Division of Emergency Medicine.
