Assessing Referrals and Improving Information Availability for Consultations in an Academic Endocrinology Clinic

Hendrickson, Chase D.; Saini, Saumya; Pothuloori, Avin; Mecchella, John N.

doi:10.4158/ep161514.or

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…The specific clinical information that must be provided in a consultation request that would make it amenable for eConsult has not been identified but would be of interest. In a face to face consultation setting, Hendrickson et al [4] reported that specific lab test results pertaining to individual endocrinological diagnoses (e.g., diabetes mellitus, hypercalcemia) that were essential to an effective consultation visit were often omitted from the initial referral request; for an effective eConsult, essential data elements exceed laboratory results alone and likely include crucial historical features and physical examination findings, which have not been identified in our current study but would be a logical next step to delineate. In health care systems where referring providers and specialists share the same electronic medical record and thus have access to all documentation, there may be different needs for including clinical information.…”

Section: Discussionmentioning

confidence: 99%

“…One of the factors that impedes prompt access to specialist care is the structure of the referral-consultation system itself, which is fraught with inefficiencies and often relies on outdated technology such as fax machines [3] . Referrals often lack essential information or include incomplete patient workups, necessitating additional back-and-forth between clinics that delays treatment and risk referrals falling through the cracks [4] . New models of care delivery are needed to streamline the process.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the content of traditional faxed consultations to eConsults within an academic endocrinology clinic

Pun

Arnaout

Tran

et al. 2021

Journal of Clinical & Translational Endocrinology

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Objective To compare the content of traditional faxed referrals and electronic consultations (eConsults) and determine how many questions sent by traditional referral could be successfully addressed using eConsult. Methods We conducted a cross-sectional, qualitative study of eConsults and faxed referrals sent to a tertiary diabetes and endocrinology clinic in Ottawa, Ontario. A convenience sample of 300 faxed referrals sent between March and July 2017 and 300 eConsults submitted between January and December 2017 were selected and coded using an established taxonomy to determine question type. Two endocrinologists reviewed the faxed referrals to assess whether they could have been addressed using eConsult. Responses to a mandatory closeout survey were reviewed for all eConsults, assessing the case’s outcome, impact on decision to refer, and educational value. Results Most faxed consultations were requests for shared care in diabetes mellitus, whereas most eConsults requested help in diagnostic test interpretation. 25–27% of faxed consults were felt to be potentially amenable to eConsult. Referring provider behaviour was changed in 45.3% of eConsult cases through avoidance of face-to-face consultation. Conclusion eConsult is a promising tool for PCPs to improve access to specialist opinion without necessitating a face-to-face visit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing the content of traditional faxed consultations to eConsults within an academic endocrinology clinic

Pun

Arnaout

Tran

et al. 2021

Journal of Clinical & Translational Endocrinology

View full text Add to dashboard Cite

show abstract

“…Hendrickson et al 8 reported the impact of a systemsapproach to laboratory testing when combined with an outpatient endocrinology clinic visit. The authors reported a stepwise quality improvement initiative, identifying that having the laboratory testing performed immediately before the first clinic visit, with results available at the visit, improved care in many ways.…”

Section: Cost Analysis For System To Support Testing At Commercial Rementioning

confidence: 99%

The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System

Rogers

Adams

Carter

et al. 2018

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm.Objective.-To identify differences when outpatient tests are performed at the Children's Healthcare of Atlanta (Children's) Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing.Design.-Outpatient testing was sent to 3 different laboratories specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual.Results.-The median time from phlebotomy to result was 0.7 hours for testing at the Children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and reporting for testing performed at commercial labs was approximately $640,000 per year.Conclusions.-Tangible monetary costs, plus intangible costs related to delayed results, occur when the laboratory testing system is disrupted.

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Use of Structured Templates to Improve Completeness of Endocrinology Referrals

Arao¹,

Wong²,

Wormwood³

et al. 2023

Endocrine Practice

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Assessing Referrals and Improving Information Availability for Consultations in an Academic Endocrinology Clinic

Cited by 6 publications

References 17 publications

Comparing the content of traditional faxed consultations to eConsults within an academic endocrinology clinic

Comparing the content of traditional faxed consultations to eConsults within an academic endocrinology clinic

The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System

Use of Structured Templates to Improve Completeness of Endocrinology Referrals

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