E-consults: an effective way to decrease clinic wait times in rheumatology
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Patel et al. BMC Rheumatology (2020) 4:54 https://doi.org/10.1186/s41927-020-00152-5
RESEARCH ARTICLE
Open Access
E-consults: an effective way to decrease clinic wait times in rheumatology Veena Patel1* , Diana Stewart2
and Molly J. Horstman3,4,5
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 inperson 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. Keywords: Quality improvement, Telemedicine, Referral and consultation, Rheumatology
Background The term telehealth refers to multiple modalities to provide care remotely using some form of technology. Due to the COVID-19 pandemic, there has been a rapid increase in telehealth usage in 2020 [1]. One type of telehealth format, the electronic consult (E-consult), has been utilized by healthcare systems in the United States and internationally for many years [2, 3] as a way to help patients gain access to specialty care. E-consults are an * Correspondence: [email protected] 1 Division of Rheumatology, Department of Medicine, University of Texas at Austin, Dell Medical School, 1601 Trinity St., Bldg B, Stop Z0900, Austin, TX 78712, USA Full list of author information is available at the end of the article
asynchronous form of communication between referring provider and specialist through a shared EHR (electronic health record) or web-based platform that entails the specialist reviewing chart data and replying with recommendations electronically [1, 3]. E-consults have facilitated a decrease in face-to-face visits, increased access to care, and imp
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