Beyond the Outpatient Clinic: The Integral Role of In-Patient Rheumatology Consultation

Objectives Rheumatology is considered to be largely an outpatient specialty, however, inpatient consults play a vital role in managing acute patient presentations. This review aims to describe the nature of the inpatient rheumatology consultations that were completed at an academic hospital, Sunnybrook Health Sciences Centre, and demonstrate the impact these consults have toward shaping patient outcomes.

Methods All inpatient consultations done from March 1, 2024, to February 28, 2025, were summarized. The various categories of data collected included demographic information, consulting services, reason for referral, clinical impact of rheumatology consult, use of joint aspirations/steroid injections, POCUS utilization, urgency of referral, and time followed under the rheumatology service. Findings were also compared to previous 12-month period from June 2011- July 2012 looking at similar data to show changes in the patient population and rheumatology consults over time, significant differences are summarized (Table 1).

Results A total of 268 consults were completed during the study period, representing a 13% increase since 2012 (n=238). Due to some missing data, the reported figures underestimate the true number of patients and diagnosis seen. Female patients accounted for 58% of all consults compared to 50% in 2012. Referrals were most commonly from general internal medicine (n, 39.6%), cardiology (n, 7.5%), and neurology (n, 8.2%). Patients had a wide variety of rheumatic diseases, but the most common conditions seen were gout (n, 9.7%), osteoarthritis (n, 8.6 %), and systemic lupus erythematous (SLE) (n, 6.3%). Interestingly, the number of consults for SLE and osteoarthritis have increased dramatically compared to 2012 (n, 2.9% and n, 5.9% respectively). Patients were admitted in hospital for an average of 17 days, followed under rheumatology for an average of 5 days, and 54% of all cases were emergent/urgent. Joint aspirations and/or steroid injections were performed in 57 cases, and point-of-care ultrasound was used in 37 cases. Across 268 consultations, rheumatologists helped make the diagnosis in 202 cases (n, 75%) and confirmed diagnosis in 37 (n, 14%) cases (Table 1). Consults also commonly involved suggesting medications (n, 83%) and ordering investigations (n, 79%).

Conclusion Rheumatology consultations are predominantly urgent/emergent and complex, and rheumatologists play a large role impacting diagnosis, patient management and improving outcomes. As the number of in-patient rheumatology consults increases, access to rheumatology care is vital to treat patients in a timely manner and improve patient’s quality of life.