Consultations from the Emergency Department

Authors: Jared Baylis, MD, FRCPC, Chad Singh, MD, Teresa M. Chan, MD, FRCPC, MHPE, DRCPSC
Updated: 1/22/2020

Consultations from the Emergency Department

The referral-consultation process is of utmost importance in the emergency department (ED). Here are three easy, evidence-based mnemonics to hep you navigate these situations: 5Cs, PIQUED, and CONSULT [1-3].

5Cs model [1, 4, 5]:

5Cs Model





These models are similar in content but have important differences.

  • 5Cs model has the largest evidence basis behind improving quality of consultation requests and communication [1,4,5]. Most studies involve medical students.
    • PIQUED was derived using residents from various specialties [2]. Includes educational modifications and debriefing to allow learning from each interaction.
    • CONSULT is the newest model. Also studied with residents and found to be beneficial after just one hour educational session [3].

For more information on this topic: Conquering Consultations: A Guide to Advances in the Science of Referral-Consultation Interactions for Residency Education


  1. Kessler CS, Afshar Y, Sardar G, et al. A prospective, randomized, controlled study demonstrating a novel, effective model of transfer of care between physicians: the 5 Cs of consultation. Acad Emerg Med. 2012;1998):968-974 [PubMed]
  2. Chan T, Orlich D, Kulasegaram K, Sherbino J. Understanding communication between emergency and consulting physicians: a qualitative study that describes and defines the essential elements of the emergency department consultation-referral process for the junior learner. CJEM. 2013;15(1):42-51. [PubMed]
  3. Podolsky A, Stern DT, Peccoralo L. The Courteous Consult: A CONSULT Card and Training to Improve Resident Consults. j Grad Med Educ. 2015;7(10:113-117. [PubMed]
  4. Kessler CS, Kalapurayil PS, Yudkowsky R, Schwartz A. Validity evidence for a new checklist evaluating consultations, the 5Cs model. Acad Med. 2012;87(10):1408-1412. [PubMed]
  5. Kessler CS, Tadisina KK, Saks M, et al. The 5Cs of Consultation: Training Medical Students to Communicate Effectively in the Emergency Department. J Emerg Med. 2015;49(5):713-721. [PubMed]
  6. Baylis J, Miloslavsky EM, Woods R, Chan TM. Conquering Consultations. A Guide to Advances in the Science of Referral Consultation Interactions for Residency Education. Ann Emerg Med. 2019;74(1):119-125. [PubMed]