E-consults: an effective way to decrease clinic wait times in rheumatology

Abstract

Background To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology. Methods We conducted a pre-post study of E-consult implementation for positive ANA referrals. We retrospectively reviewed “positive ANA” referrals from 1/2015–3/2017. A statistical process control chart was created to display monthly average wait times for in-person clinic visits and to identify special cause variation. Final diagnoses, wait times and resource utilization were recorded and compared between E-consults and in-person referrals. Results There were 139 referrals for positive ANA with 126 occurring after E-consult implementation in August 2015. Forty-four percent (55/126) of referrals were E-consults; 76% did not have an in-person visit after initial electronic rheumatology recommendation. A control chart demonstrated special cause variation in the form of a shift from June 2016 – January 2017, suggesting a temporal association between decreased wait times and the implementation of E-consults. Eleven patients were diagnosed with ANA-associated rheumatic disease; the majority of patients (73%, 86/139) did not have a rheumatologic diagnosis. Overall E-consults utilized more labs than in-person visits, but this was not statistically significant. In-person visits utilized more imaging studies, which was statistically significant. Conclusion E-consults are an effective way to address positive ANA consults without significant increase in resource utilization and were temporally associated with decreased wait times for in-person visits.

Public interest in musculoskeletal symptoms and disorders during the COVID-19 pandemic

“…Considering the trends observed in this study (an upward trend in symptoms and some colloquial terms/well-known conditions coupled with a downward trend in general musculoskeletal disorder terms and certain specific diagnoses) and still on-going pandemic, rheumatologists should address the increased informational demand for musculoskeletal symptoms and develop effective strategies in delivering clinical care to minimize the potential detrimental impact of the pandemic on outcomes of patients with musculoskeletal disorders. Among these strategies, telerheumatology is gaining specific interest and being rapidly implemented in clinical practice during the pandemic [32][33][34][35][36][37].…”

APLAR recommendations on the practice of telemedicine in rheumatology

“…This reduced diagnostic accuracy of telemedicine was also found in prospective cohort studies of new patients from rheumatology clinics in the UK and US 23,24 . Another study showed that telemedicine shortened the wait time for an in‐person visit among patients referred for assessment of positive antinuclear antibody 25 . While noting the relatively low quality of this evidence, it does suggest that while telemedicine may not be as effective as conventional consultation in the diagnosis of new patients, it can provide benefit in terms of earlier access to a rheumatologist.…”

Understanding the factors that affect the appropriateness of rheumatology referrals

“…Back and forth, communication can then occur between the PCP and specialist until either the issue is resolved or there is a decision to have an in-person visit. Over time, possible benefits include increased PCP knowledge, reduced wait times [ 29 ], and reduction in inappropriate in-person visits. Symptom checkers (SCs) are another potential option to accelerate diagnosis, reduce misdiagnoses, and guide patients more effectively through the health care system [ 30 ].…”