Pharmacokinetic and Pharmacodynamic Effects of Intranasal Epinephrine Versus Intramuscular Epinephrine in Adults

Abstract

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.