Adaptation of a Structured Digital 5C Consultation Model and Its Effect on Patient Management Intervals In The Emergency Department

INTRODUCTION: Consultation-related delays contribute to emergency department (ED) crowding, especially for internal medicine referrals. The 5C consultation model provides a structured communication framework that may improve consultation efficiency when embedded in digital systems.
METHODS: This single-center quasi-experimental pre-post study was conducted in the ED of a tertiary-care hospital with approximately 450,000 annual visits. Internal medicine consultations requested from yellow-zone observation units were compared before (July 1-10, 2023) and after (July 20-30, 2023) implementation of a structured digital consultation form based on four 5C elements (Contact, Communicate, Core Question, Closing the Loop) following a 40-minute resident training session. The primary outcome was consultation-to-decision time..
RESULTS: Fifty-four emergency medicine residents generated 194 pre-intervention and 141 post-intervention consultations. Median consultation-to-decision time decreased from 65 minutes (IQR 40-112) to 44 minutes (IQR 28-69; p<0.001). Consultation response time and final decision time also decreased significantly (both p<0.001). Total ED LOS remained unchanged (median, 15 hours in both periods; p=0.772). Repeat consultations were less frequent after the combined intervention (p=0.035).
DISCUSSION AND CONCLUSION: The four-component 5C-derived model digital consultation form combined with targeted resident training was associated with shorter consultation-related decision intervals and fewer repeat internal medicine consultations without changing overall ED LOS. These preliminary findings suggest that digitizing structured communication may improve workflow efficiency, though multicenter randomized trials are required to confirm these effects..

Keywords: Emergency department, referral and consultation, communication, electronic health records, patient care management.