Abstract
BackgroundElectronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).MethodsRetrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.ResultsIn 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.ConclusionEconsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.
Highlights
IntroductionElectronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction
Electronic consultation systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction
To assess for potential harms in patient care that could occur with overzealous patient triage to maximize high surgical yield, we reviewed unanticipated health care utilization through December 31 2015 for patients who were not scheduled for an ambulatory general surgery visit based on information contained in the electronic consultation request, or for those patients who were scheduled but required more urgent admission and inpatient surgery while awaiting their general surgery clinic visit
Summary
Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. There is limited literature on the impact of eConsult systems upon the efficiency of specialty care delivery One measure of such efficiency among surgical services is surgical yield, defined as the percentage of ambulatory surgical consultations leading to scheduling of an operative intervention [11]. Measuring the impact of eConsult systems on surgical yield, along with its determinants, may provide additional data to encourage their adoption by public healthcare delivery systems that traditionally have had poor surgical access [3, 12, 13], suboptimal interprovider communication and care coordination, inappropriate referrals [14, 15], and high wait times for ambulatory clinic visits [16, 17]. The consequences of poor access to ambulatory specialty services within public health care systems, in particular surgical, include increased risk of requiring urgent or emergent surgery, longer lengths of hospitalizations, and decreased likelihood of receiving follow-up care [18,19,20]
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