Tips for Better Specialist-Generalist Communication in Treatment of Pediatric Patients

In the Agency for Healthcare Quality and Research (AHQR) 0024 guidelines on the management of otitis media there is a section on generalist-specialist communication, Dr. Grundfast said. The guidelines outline what the generalist needs to give the otolaryngologist, as well as what sort of information the generalist needs back.

Tips for Improving Communication Between a Child’s Primary Care Provider and Specialist

This summary of key points is provided by Christopher Stille, MD, Associate Professor of Pediatrics at the University of Massachusetts Medical School, who has co-authored several studies on generalist-specialist communication.

From the generalist to the otolaryngologist:

1. Information about the patient needs to arrive to the otolaryngologist before the patient does.
2. Even a little information is better than none at all!

Information provided by the generalist should include:

• The generalist’s specific question
• A brief history of the illness or condition
• What has been tried so far
• Current medications, allergies
• Any special concerns from the parents’ perspective.

From the otolaryngologist back to the generalist/primary care provider:

Information should arrive within two weeks after the otolaryngology consult (if possible), so the pediatrician does not have to rely solely on the parents for information about the visit.

Information provided by the otolaryngologist should include:

• Answers to the primary care provider’s specific question
• Impressions, plan and the reasons behind them (a tiny bit of education goes a long way)
• What to expect and when to call the otolaryngologist
• Specific roles (if any): the otolaryngologist will do X and Y; and the primary care provider should do Z.
• Follow-up plans, or discharge back to primary care provider’s care.

Laryngoscope Highlights

Meta-Analysis of Open Versus Percutaneous Tracheostomy

Numerous studies have been undertaken to characterize differences in complications and cost-effectiveness between open and percutaneous tracheostomy. Kevin M. Higgins, MD, and Xerxes Punthakee, MD, performed a meta-analysis of 15 prospective, randomized, controlled trials to compare complication rates, cost-effectiveness, and procedure length between the two techniques.

The 15 studies in the meta-analysis included 973 patients, almost equally divided between those who had open and percutaneous tracheostomies. Pooled ORs showed statistically significant results against percutaneous tracheostomy for complications of decannulation/obstruction, but there were significantly fewer complications in the percutaneous group with respect to wound infection and unfavorable scarring. Overall complications also tended to favor the percutaneous technique, but results were not statistically significant. There was no significant difference between the two groups in the incidence of death.