Electronic Preconsultation as a Method of Quality Improvement for Urological Referrals

Abstract

Introduction: Preconsultation exchange is a method to promote expedited care among health care providers through communication between primary care providers and specialists before a clinic visit. We evaluated the efficacy of a preconsultation exchange in streamlining patient visits to the urology clinic with an emphasis on resource efficiency in a safety net hospital. Methods: Between April 1, 2011 and March 31, 2012 there were 1,705 electronic referrals to our urology department. A random sample of 500 referrals was selected for evaluation, of whom 487 patients met study inclusion criteria. Scheduling outcome and preconsultation exchange were evaluated for each chief complaint. Results: Patients with operative or procedural chief complaints, or potential oncologic diagnoses were most likely to be scheduled directly to the urology clinic. Of the 487 patients 36 (7.4%) were treated for benign urological conditions by primary care providers and did not need to be seen in the urology clinic. For 13.5% of patients recommended laboratory and radiological tests were obtained before the initial urology clinic visit as a result of preconsultation exchange. Conclusions: Electronic preconsultation exchange served as a method of quality improvement by promoting urology clinic efficiency. Unnecessary appointments were limited and the completeness of appropriate laboratory and imaging studies at the initial visit was increased. Health care was streamlined by increased access to urological care and by management of benign urological conditions without a formal clinic visit in appropriate cases.

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

“…✗“The shortcomings of referral systems with exchanges between PCPs and consultants include… loss of patients to follow up”77 (p. 174).…”

“…✗“A key barrier to widespread adoption of preconsultation exchange is the development of reimbursement models”77 (p. 174).…”

The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future

“…On-going use of this approach would allow involvement of clinicians in geographically remote locations, thus facilitating community providers (who know their patients best of all) who cannot interrupt their practice to physically a university board. Electronic consults (e-consults) allow for asynchronous interactions between two physicians (consulter and consultee) and improve access to specialty expertise without the need for face-to-face visits [61] , [62] , [63] . This approach allows timely access to expertise, is well received by primary care providers [64] , and can overcome physical space limitations, while allowing flexible scheduling of outpatient care (not restricted by clinic space availability, outside traditional hours, and interspersed during operating day downtimes).…”

Understanding the Potential for Patient Engagement in Electronic Consultation and Referral Systems: Lessons From One Safety Net System

“…; McGeady et al. ; Tuot et al. ), and enhanced provider satisfaction with the referral process, while reducing costs (Tuot et al.…”

“…eCR systems have been implemented across the United States and internationally (Esquivel et al 2012;Palen et al 2012;Scherpbier-de Haan et al 2013;Liddy et al 2015;Tuot et al 2015a) and have successfully created a paradigm shift from a focus on "access to specialty visits to access to specialty expertise" (Chen, Murphy, and Yee 2013). Consistent with the Quadruple Aim (Bodenheimer and Sinsky 2014) of specialty care delivery, eCR systems have improved population health (increased access to subspecialty care, reduced wait times for in-person specialty appointments, optimized efficiency in specialty care delivery, improved PCC capacity for complex decision making, and enhanced dialogue between PCCs and subspecialist providers) (Kim et al 2009;Kim-Hwang et al 2010;Straus et al 2011;Chen, Murphy, and Yee 2013;Sewell et al 2013;McGeady et al 2014;Tuot et al 2015b), and enhanced provider satisfaction with the referral process, while reducing costs (Tuot et al 2015b;Liddy, Drosinis, and Keely 2016;Olayiwola et al 2016).…”