576 Comparing Electronic Consults versus Outpatient Referrals to Gastroenterology: Impact on Timespan to and Completion Rates of Recommended Procedures

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INTRODUCTION: Electronic consults (econsults) are a valuable tool embedded in the electronic medical record. There have been a number of studies regarding econsults, however most are descriptive studies. There are currently few studies describing the impact of econsults on clinical practice. In this retrospective study we examined how econsults to gastroenterology compared to “standard consults” submitted via primary care practitioners (PCP) impacted 1) time to recommended procedure and 2) completion rate of recommended procedures. METHODS: A retrospective chart review of econsults and outpatient referrals made to the gastroenterology department at the Veteran's Affairs Medical Center in Vermont was performed from 2012 to 2014. Charts were analyzed and patient demographic information including age, gender, comorbidities (hypertension, coronary artery disease, diabetes mellitus) was collected. With regards to econsults and standard consults, the following information was collected: date of econsult/referral, referring PCP credentials, nature of question (clinical versus administrative), disease process in question, completion of econsult or referral, timespan to answer econsult, timespan to initial clinic visit for referrals, whether or not a procedure (EGD or colonoscopy) was recommended, whether or not recommended procedure was completed and time to completed procedure. Data collection and analyses were done in accordance with local IRB. Chi square and t-test were performed, and logistic regression model used to predict factors associated with time to procedure. RESULTS: Overall 253 econsults and 171 outpatient referrals were included in our study with 253 (100%) and 98 (57.3%) completed respectively. Sixty-four procedures were recommended via econsults and 53 procedures were recommended via referrals with 36 (56.2%) and 30 (56.6%) (P = 0.89) completed respectively. Of the completed consults, 25.3% of econsults versus 54.1% (P < 0.0001) of standard consults had a recommended procedure. The mean timespan to procedures was 82 days for econsults and 87.3 days (P = 0.21) for referrals. CONCLUSION: Gastroenterologists were more likely to recommend a procedure after a face to face encounter with patients compared to econsults. There was no difference found between rates of completed procedures or the timespan to completion for econsults versus standard outpatient referrals.