Electronic Consultations to Hepatologists Reduce Wait Time for Visits, Improve Communication, and Result in Cost Savings

Bhavsar, Indira; Wang, Jennifer; Burke, Sean; Dowdell, Kimberly; Hays, Rachel; Intagliata, Nicolas M.

doi:10.1002/hep4.1402

Cited by 3 publications

(19 citation statements)

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“…1 Advantages of econsults include improved patient access to specialist care, potential cost savings, 2 and convenience for both health care providers and patients. 1 The utility and feasibility of e-consults has been demonstrated across multiple specialties, including cardiology, 3,4 gastroenterology, 5 endocrinology, 6 infectious disease, 7 nephrology, 8 and dermatology. 9 Although the only data currently available addressing allergy/ immunology (A/I) e-consults come from the outpatient setting, 10 the inpatient setting is prime to incorporate asynchronous evaluations.…”

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confidence: 99%

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Mustafa

Staicu

Yang

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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What is already known about this topic? There are outpatient data for electronic consultations (e-consults) in allergy/ immunology (A/I) but no data for inpatient A/I consultations. What does this article add to our knowledge? We demonstrate that A/I inpatient e-consults are feasible, potentially less costly, and maintain requesting provider satisfaction for certain conditions. How does this study impact current management guidelines? E-consults are a strategy to improve A/I access in inpatient settings and are particularly relevant during the novel coronavirus infection pandemic. BACKGROUND: Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges within the electronic health record (EHR). OBJECTIVE: We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations. METHODS: Inpatients ‡18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An econsult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data were collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate. RESULTS: Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult and 31 (28.4%) were completed by an in-person consult. The most common indication for an inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes, interquartile range [IQR]: 10-15 vs 60 minutes, IQR: 45-60, P < .001) and had a shorter turnaround time (1 hour, IQR: 0.5-2 vs 7 hours, IQR: 3-19, P < .001). Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults vs 96% of in-person consults, P [ .162). A total of 97% of requesting providers reported an "excellent" or "good" impression of e-consults. E-consults were less costly than in-person consults. CONCLUSIONS: E-consults have utility in providing inpatient A/I consultation and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction.

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confidence: 99%

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Mustafa

Staicu

Yang

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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“…In this edition of Hepatology Communications , Bhavsar et al report their results from the successful implementation of eConsults within a single tertiary center. They showed in a retrospective study of 187 eConsults that the majority (76%) were resolved without the need for an in‐person visit.…”

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confidence: 99%

“…Recognition of the burden shift to primary care provider cannot be underestimated as it can lead to more burnout in health care systems that are already strained by the lack of front‐time providers . In this study, primary care providers were given a credit of 0.5 relative value units for placing the eConsult, which was paid by grant funding . This type of reimbursement model is not widely available but should be seriously considered as it increases the incentive for primary providers to support a system that benefits all.…”

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confidence: 99%

“…Both the patients who did not have to needlessly travel to the specialists and those patients who subsequently had face to face visits benefited. The authors report that of 44 (23%) patients who had to travel to the specialist, 87% had already received the completed workup that was recommended in the e‐Consult, making for a higher quality visit …”

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confidence: 99%

“…In a field such as Hepatology where a significant portion of care delivery involves thinking rather than procedures, electronic modalities, like eConsults and the ECHO programs, make sense. The majority of questions for hepatologists, such as the management of liver enzymes, abnormal imaging, and viral hepatitis, lend themselves well to a telemedicine modality . Not only can potentially unnecessary visits be avoided but there is also transfer of knowledge to the primary care providers by providing an interaction between the primary provider and specialist .…”

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confidence: 99%

See 2 more Smart Citations

Electronic Consultations: Delivering Specialty Care Anywhere

2019

Hepatol Commun

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Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

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Electronic Consultations to Hepatologists Reduce Wait Time for Visits, Improve Communication, and Result in Cost Savings

Cited by 3 publications

References 24 publications

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Electronic Consultations: Delivering Specialty Care Anywhere

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

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