Mass General Hospital. RATIONALE: Despite rising inpatient Allergy/Immunology (A/I) consultation need, allergist access is limited; even hospitals with on-site allergists have insufficient resources to address all inpatient allergy questions. Allergists are reticent to be pulled from ambulatory duties, particularly for consults that prioritize documentation or medicolegal protection over need for in-person allergist evaluation. Electronic consultations (e-consults) offer an electronic health record-based solution that has improved access while maintaining quality in ambulatory A/I but has not been studied in inpatient A/I. METHODS: E-consults provide formally-documented specialist guidance by addressing inpatient consult questions without patient interaction. We implemented inpatient A/I e-consults for pre-screened indications through an internally-funded pilot at Massachusetts General Hospital. We reviewed inpatient A/I e-consults from April through October 2019 for indication, recommendations, and completion/turnaround time; a random subset of in-person A/I consults were reviewed for completion time. RESULTS: Inpatient A/I e-consults were most frequently for adverse drug reactions (81%) followed by immunology evaluation (7%). Of 60 completed e-consults, 64% provided diagnostic and/or management guidance; 15% recommended subsequent in-person A/I consult. Allergists required a median of 25 minutes [IQR 19, 33 min] to complete inpatient e-consults; chart-documented guidance was available a median of 53 minutes [36, 90 min] after being requested. A median of 1554 minutes elapsed between time of in-person A/I consult request and finalized chart documentation. CONCLUSIONS: Inpatient e-consults efficiently and rapidly deliver formally-documented allergist guidance for hospitalized patients and may be a useful form of inpatient telemedicine for drug allergy and immunodeficiency. Inpatient e-consults maintain quality of care while minimally disrupting ambulatory allergy practice.
The resolution of food protein induced enterocolitis syndrome (FPIES) is confirmed by an oral challenge (OC). The COVID-19 pandemic has delayed scheduling of OC, due to lockdown barriers to inperson care. Assessing parental attitudes on the possibility of supervised remote at-home OCs may lay the groundwork of selected low risk home OCs in facilitating early reintroduction of FPIES allergenic foods METHODS: A 12 point questionnaire was collected from FPIES parents between the ages of 2-4 years to assess attitudes towards their toddlers' FPIES status. Questions addressed FPIES re-assessment during the pandemic, parental consideration for an home oral challenge from start to finish or the option of a hybrid in-office/ home model. RESULTS: Thirty-six parents (n536) of toddlers with FPIES replied. In five children, FPIES resolved from initial diagnosis. Forty-eight percent (15/31) of parents stated that they would proceed with an FPIES OC during a pandemic, with 52% (16/31) choosing to delay. Eleven of these 16 (69%) parents agreed to proceed with a supervised at-home OC, with 2 preferring a hybrid in-office-home model. Thirteen of 15 (87%) parents agreeing to proceed with an FPIES OC ASAP would also agree for home challenge. CONCLUSIONS: The majority of FPIES families preferred the choice of an in-home OC, 77% (24/31) due to the current pandemic, with a hybrid model being less desired. Resolution of FPIES occurred in 14%. With significant familial interest in home OC for diagnosis of continued FPIES, further research into appropriate selection and monitoring, for home FPIES OC is needed.
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